Friends and Family: How African-American Adolescents’ Perceptions of Dietary Beliefs and Behaviors of Others Relate to Diet Quality

Published:October 15, 2018DOI:



      Adolescents’ dietary intake often fails to meet national dietary guidelines, especially among low-income African-American youth. The dietary habits established in adolescence are likely to continue into adulthood, and a poor-quality diet increases the risk of developing obesity and chronic disease. Based on principles from ecological and social-cognitive behavior change health theories, perceptions of parental beliefs about healthy eating, perceptions of peer eating behaviors, and parental monitoring of what adolescents eat may positively influence adolescent diet quality.


      The purposes of this study were to determine whether perceived parental beliefs about nutrition, perceived peer eating behaviors, and reported parental monitoring of the adolescent diet were related to African-American adolescent diet quality and whether these relationships were moderated by adolescent age or sex.


      This secondary cross-sectional study used baseline data (2002 to 2004) from an urban community sample of low-income adolescents participating in a health promotion trial.


      Participants were 216 African-American adolescent-caregiver dyads in Baltimore, MD.

      Main outcome measures

      The 2010 Healthy Eating Index was used to estimate adolescent diet quality.

      Statistical analyses performed

      Analyses included correlations, t tests, age- and sex-by-perception regression interactions, and multivariate regressions adjusted for body mass index–for-age percentile, caregiver weight status, and caregiver depressive symptoms.


      Higher diet quality scores were related to higher levels of perceived parental and peer support for healthy eating behaviors among adolescents (β=.21; P<0.05; β=.15; P<0.05, respectively) and to caregiver reports of parental monitoring of adolescent dietary behavior (β=1.38, P<0.01). Findings were not moderated by age or sex.


      Consistent with ecological and social-cognitive theories, adolescents look to their friends and family in making healthy food choices. The relationships uncovered by this study describe some of the contextual, interpersonal influences associated with diet quality among low-income, urban African-American adolescents and warrant further exploration in future intervention studies.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Banfield E.C.
        • Liu Y.
        • Davis J.S.
        • Chang S.
        • Frazier-Wood A.C.
        Poor adherence to US Dietary Guidelines for children and adolescents in the NHANES population.
        J Acad Nutr Diet. 2016; 116: 21-27
        • Papanikolaou Y.
        • Brooks J.
        • Reider C.
        • Fulgoni V.L.
        Comparison of inadequate nutrient intakes in non-Hispanic Blacks vs. non-Hispanic Whites: An analysis of NHANES 2007-2010 in U.S. children and adults.
        J Health Care Poor Underserved. 2015; 26: 726-736
        • Freedman D.S.
        • Kettel L.
        • Serdula M.K.
        • Dietz W.H.
        • Srinivasan S.R.
        • Berenson G.S.
        The relation of childhood BMI to adult adiposity: The Bogalusa Heart Study.
        Pediatrics. 2005; 115: 22-27
        • Short K.R.
        • Blackett P.R.
        • Gardner A.W.
        • Copeland K.C.
        Vascular health in children and adolescents: Effects of obesity and diabetes.
        Vasc Health Risk Manag. 2009; 5: 973-990
        • Langevin D.D.
        • Kwiatkowski C.
        • McKay M.G.
        • et al.
        Evaluation of diet quality and weight status of children from a low socioeconomic urban environment supports “at risk” classification.
        J Am Diet Assoc. 2007; 107: 1973-1977
        • Kirkpatrick S.I.
        • Dodd K.W.
        • Reedy J.
        • Krebs-Smith S.M.
        Income and race/ethnicity are associated with adherence to food-based dietary guidance among US adults and children.
        J Acad Nutr Diet. 2012; 112: 624-635
        • Schefske S.D.
        • Bellows A.C.
        • Byrd-Bredbenner C.
        • et al.
        Nutrient analysis of varying socioeconomic status home food environments in New Jersey.
        Appetite. 2010; 54: 384-389
        • Kolahdooz F.
        • Butler J.L.
        • Christiansen K.
        • et al.
        Food and nutrient intake in African American children and adolescents aged five to 16 years in Baltimore City.
        J Am Coll Nutr. 2016; 35: 205-216
        • Ogden C.L.
        • Carroll M.D.
        • Lawman H.G.
        • et al.
        Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014.
        JAMA. 2016; 315: 2292-2299
        • Frederick C.B.
        • Snellman K.
        • Putnam R.D.
        Increasing socioeconomic disparities in adolescent obesity.
        Proc Natl Acad Sci U S A. 2014; 111: 1338-1342
        • Dewar D.
        • Lubans D.
        • Plotnikoff R.
        • Morgan P.
        Development and evaluation of social cognitive measures related to adolescent dietary behaviors.
        Int J Behav Nutr Phys Act. 2012; 9: 36
        • Story M.
        • Neumark-Sztainer D.
        • French S.
        Individual and environmental influences on adolescent eating behaviors.
        J Am Diet Assoc. 2002; 102: S40-S51
        • Anderson Steeves E.T.
        • Johnson K.A.
        • Pollard S.L.
        • et al.
        Social influences on eating and physical activity behaviours of urban, minority youths.
        Public Health Nutr. 2016; 19: 3406-3416
        • Scaglioni S.
        • Salvioni M.
        • Galimberti C.
        Influence of parental attitudes in the development of children eating behaviour.
        Br J Nutr. 2008; 99: S22-S25
        • Pedersen S.
        • Gronhoj A.
        • Thogersen J.
        Following family or friends. Social norms in adolescent healthy eating.
        Appetite. 2015; 86: 54-60
        • Van der Horst K.
        • Kremers S.
        • Ferreira I.
        • Singh A.
        • Oenema A.
        • Brug J.
        Perceived parenting style and practices and the consumption of sugar-sweetened beverages by adolescents.
        Health Educ Res. 2007; 22: 295-304
        • Gevers D.W.M.
        • van Assema P.
        • Sleddens E.F.C.
        • de Vries N.K.
        • Kremers S.P.J.
        Associations between general parenting, restrictive snacking rules, and adolescent’s snack intake. The roles of fathers and mothers and interparental congruence.
        Appetite. 2015; 87: 184-191
        • Towner E.K.
        • Reiter-Purtill J.
        • Boles R.E.
        • Zeller M.H.
        Predictors of caregiver feeding practices differentiating persistently obese from persistently non-overweight adolescents.
        Appetite. 2015; 84: 120-127
        • Loth K.A.
        • MacLehose R.F.
        • Fulkerson J.A.
        • Crow S.
        • Neumark-Sztainer D.
        Eat this, not that! Parental demographic correlates of food-related parenting practices.
        Appetite. 2013; 60: 140-147
        • Christiansen K.M.H.
        • Qureshi F.
        • Schaible A.
        • Park S.
        • Gittelsohn J.
        Environmental factors that impact the eating behaviors of low-income African American adolescents in Baltimore City.
        J Nutr Educ Behav. 2013; 45: 652-660
        • Molaison E.
        • Connell C.
        • Stuff J.
        • Yadrick M.
        • Bogle M.
        Influences on fruit and vegetable consumption by low-income Black American adolescents.
        J Nutr Educ Behav. 2005; 37: 246-251
        • Larson N.
        • Eisenberg M.E.
        • Berge J.M.
        • Arcan C.
        • Neumark-Sztainer D.
        Ethic/racial disparities in adolescents’ home food environments and linkages to dietary intake and weight status.
        Eat Behav. 2015; 16: 43-46
        • Reed M.
        • Dancy B.
        • Holm K.
        • Wilbur J.
        • Fogg L.
        Eating behaviors among early adolescent African American girls and their mothers.
        J Sch Nurs. 2013; 29: 452-463
        • Dodson J.L.
        • Hsiao Y.C.
        • Kasat-Shors M.
        • et al.
        Formative research for a healthy diet intervention among inner-city adolescents: The importance of family, school and neighborhood environment.
        Ecol Food Nutr. 2009; 48: 39-58
        • Bassett R.
        • Chapman G.E.
        • Beagan B.L.
        Autonomy and control: The co-construction of adolescent food choice.
        Appetite. 2008; 50: 325-332
        • Luszczynska A.
        • de Wit J.B.F.
        • de Vet E.
        • et al.
        At-home environment, out-of-home environment, snacks and sweetened beverages intake in preadolescence, early and mid-adolescence: The interplay between environment and self-regulation.
        J Youth Adolesc. 2013; 42: 1873-1883
        • Stok F.M.
        • de Vet E.
        • de Wit J.B.F.
        • Luszczynska A.
        • Safron M.
        • de Ridder D.T.D.
        The proof is in the eating: Subjective peer norms are associated with adolescents’ eating behavior.
        Public Health Nutr. 2015; 18: 1044-1051
        • Larson N.
        • Miller J.M.
        • Eisenberg M.E.
        • Watts A.W.
        • Story M.
        • Neumark-Sztainer D.
        Multicontextual correlates of energy-dense, nutrient-poor snack food consumption by adolescents.
        Appetite. 2017; 112: 23-34
        • Larson N.I.
        • Neumark-Sztainer D.R.
        • Story M.T.
        • Wall M.M.
        • Harnack L.J.
        • Eisenberg M.E.
        Fast food intake: Longitudinal trends during the transition to young adulthood and correlates of intake.
        J Adolesc Health. 2008; 43: 79-86
        • Ali M.M.
        • Amialchuk A.
        • Heiland F.W.
        Weight-related behavior among adolescents: The role of peer effects.
        PLoS One. 2011; 6e21179
        • Wouters E.J.
        • Larsen J.K.
        • Kremers S.P.
        • Dagnelie P.C.
        • Geenen R.
        Peer influence in snacking behavior in adolescence.
        Appetite. 2010; 55: 11-17
        • Sawka K.J.
        • McCormack G.R.
        • Nettel-Aguirre A.
        • Swanson K.
        Associations between aspects of friendship networks and dietary behavior in youth: Findings from a systematized review.
        Eat Behav. 2015; 18: 7-15
        • Fitzgerald A.
        • Heary C.
        • Kelly C.
        • Nixon E.
        • Shevlin M.
        Self-efficacy for healthy eating and peer support for unhealthy eating are associated with adolescents’ food intake patterns.
        Appetite. 2013; 63: 48-58
        • Salvy S.J.
        • Elmo A.
        • Nitecki L.A.
        • Kluczynski M.A.
        • Roemmich J.N.
        Influence of parents and friends on children's and adolescents' food intake and food selection.
        Am J Clin Nutr. 2011; 93: 87-92
        • Cutler G.J.
        • Flood A.
        • Hannan P.
        • Neumark-Sztainer D.
        Multiple sociodemographic characteristics are correlated with major patterns of dietary intake in adolescents.
        J Am Diet Assoc. 2011; 111: 230-240
        • Stephens L.D.A.
        • McNaughton S.A.
        • Crawford D.
        • MacFarlane A.
        • Ball K.
        Correlates of dietary resilience among socioeconomically disadvantaged adolescents.
        Eur J Clin Nutr. 2011; 65: 1219-1232
        • Salvy S.J.
        • de la Haye K.
        • Bowker J.C.
        • Hermans R.C.J.
        Influence of peers and friends on children’s and adolescents’ eating and activity behaviors.
        Physiol Behav. 2012; 106: 369-378
        • Bruening M.
        • Eisenberg M.
        • MacLehose R.
        • Nanney M.S.
        • Story M.
        • Neumark-Sztainer D.
        Relationship between adolescents’ and their friends’ eating behaviors: Breakfast, fruit, vegetable, whole-grain, and dairy intake.
        J Acad Nutr Diet. 2012; 112: 1608-1613
        • De la Haye K.
        • Robins G.
        • Mohr P.
        • Wilson C.
        Obesity-related behaviors in adolescent friendship networks.
        Soc Networks. 2010; 32: 161-167
        • Robson S.M.
        • Couch S.C.
        • Peugh J.L.
        • Glanz K.
        • Zhou C.
        • Sallis J.F.
        • Saelens B.E.
        Parent diet quality and energy intake are related to child diet quality and energy intake.
        J Acad Nutr Diet. 2016; 116: 984-990
        • St George S.M.
        • Wilson D.K.
        A qualitative study for understanding family and peer influences on obesity-related health behaviors in low-income African-American adolescents.
        Child Obes. 2012; 8: 466-476
        • Black M.M.
        • Hager E.R.
        • Le K.
        • et al.
        Challenge! Health promotion/obesity prevention mentorship model among urban, black adolescents.
        Pediatrics. 2010; 126: 280-288
      1. Office of the Assistant Secretary for Planning and Evaluation. (2008, December). The 2008 HHS Poverty Guidelines (Federal Register, Vol. 73, No. 15, January 23, 2008, pp. 3971-3972). U.S. Department of Health and Human Services via 2008 HHS Poverty Guidelines at Accessed April 16, 2018.

      2. Kuczmarski R, Ogden C, Guo S. 2000 CDC Growth Charts for the United States: Methods and development. National Center for Health Statistics. Accessed August 13, 2016.

        • Rockett H.R.H.
        • Breitenbach M.
        • Frazier A.L.
        • et al.
        Validation of a youth/adolescent food frequency questionnaire.
        Prev Med. 1997; 26: 808-816
        • Gilmer M.
        • Speck B.
        • Bradley C.
        • Harrell J.
        • Belyea M.
        The Youth Health Survey: Reliability and validity of an instrument for assessing cardiovascular health habits in adolescents.
        J Sch Health. 1996; 66: 106-111
        • Birch L.L.
        • Fisher J.O.
        • Grimm-Thomas K.
        • Markey C.N.
        • Sawyer R.
        • Johnson S.L.
        Confirmatory factor analysis of the Child Feeding Questionnaire: A measure of parental attitudes, beliefs and practices about child feeding and obesity proneness.
        Appetite. 2001; 36: 201-210
        • Kaur H.
        • Li C.
        • Nazir N.
        • et al.
        Confirmatory factor analysis of the child-feeding questionnaire among parents of adolescents.
        Appetite. 2006; 47: 36-45
        • Berger P.K.
        • Hohman E.E.
        • Marini M.E.
        • Savage J.S.
        • Birch L.L.
        Girls’ picky eating in childhood is associated with normal weight status from ages 5 to 15 y.
        Am J Clin Nutr. 2016; 104: 1577-1582
        • Allen H.A.
        • Chambers A.
        • Blissett J.
        • et al.
        Relationship between parental feeding practices and neural responses to food cues in adolescents.
        PLoS One. 2016; 11: e0157037
        • Beck A.
        • Ward C.
        • Mendelson M.
        • Mock J.
        • Erbaugh J.
        An inventory for measuring depression.
        Arch Gen Psychiatry. 1961; 4: 561-571
        • Beck A.
        • Steer R.
        Internal consistencies of the original and revised Beck Depression Inventory.
        J Clin Psychol. 1984; 40: 1365-1367
        • Pott W.
        • Albayrak A.
        • Hebebrand J.
        • Pauli-Pott U.
        Treating childhood obesity: Family background variables and the child's success in a weight-control intervention.
        Int J Eat Disord. 2009; 42: 284-289
        • Bickel G.
        • Nord M.
        • Price C.
        • Hamilton W.
        • Cook J.
        Guide to Measuring Household Food Security, Revised 2000.
        US Department of Agriculture, Food and Nutrition Service, Alexandria VAMarch 2000
        • Guenther P.M.
        • Casavale K.O.
        • Reedy J.
        • et al.
        Update of the Healthy Eating Index: HEI-2010.
        J Acad Nutr Diet. 2013; 113: 569-580
        • US Department of Agriculture and US Department of Health and Human Services
        Dietary Guidelines for Americans, 2010.
        7th ed. US Government Printing Office, Washington, DCDecember 2010 (Accessed August 22, 2017)
        • Willett W.C.
        Nutritional Epidemiology.
        2nd ed. Oxford University Press, New York, NY1998
      3. National Cancer Institute, Division of Cancer Control and Population Sciences, Epidemiology and Genomics Research Program. (n.d.). SAS Code. Accessed November 7, 2017.

        • Wrobleski M.M.
        • Parker E.A.
        • Hurley K.M.
        • Oberlander S.
        • Merry B.C.
        • Black M.M.
        Comparison of the HEI and HEI-2010 diet quality measures in association with chronic disease risk among low-income, African American urban youth in Baltimore, Maryland.
        J Am Coll Nutr. 2018; : 1-8
      4. SPSS Statistics for Windows [computer program]. Version 22.0.0. Armonk, NY: IBM Corp; 2013.

      5. SAS [computer program]. Version 9.4. Cary, NC: SAS Institute Inc; 2015.

        • Goodwin D.
        • Knol L.
        • Eddy J.
        • Fitzhugh E.
        • Kendrick O.
        • Donohue R.
        Sociodemographic correlates of overall quality of dietary intake of US adolescents.
        Nutr Res. 2006; 26: 105-110
        • Pearson N.
        • Biddle S.J.H.
        • Gorely T.
        Family correlates of fruit and vegetable consumption in children and adolescents: A systematic review.
        Public Health Nutr. 2008; 12: 267-283
        • Boutelle K.N.
        • Birkeland R.W.
        • Hannan P.J.
        • Story M.
        • Neumark-Sztainer D.
        Associations between maternal concern for healthful eating and maternal eating behaviors, home food availability, and adolescent eating behaviors.
        J Nutr Educ Behav. 2007; 39: 248-256
        • Pearson N.
        • Timperio A.
        • Salmon J.
        • Crawford D.
        • Biddle S.J.
        Family influences on children’s physical activity and fruit and vegetable consumption.
        Int J Behav Nutr Phys Act. 2009; 16: 34
        • Loth K.A.
        • MacLehose R.F.
        • Larson N.
        • Berge J.M.
        • Neumark-Sztainer D.
        Food availability, modeling, and restriction: How are these different aspects of the family eating environment related to adolescent dietary intake?.
        Appetite. 2016; 96: 80-86
        • Vagstrand K.
        Sex differences among Swedish adolescents in mother–child relationships in the intake of different food groups.
        Br J Nutr. 2010; 103: 1205-1211
        • Schunk D.
        • Meece J.
        Self-efficacy development in adolescence.
        in: Pajares F. Urdan T. Self-Efficacy Beliefs of Adolescents. IAP Information Age Publishing, Inc, Greenwich, CT2006: 81-83
        • Renna F.
        • Grafova I.B.
        • Thakur N.
        The effect of friends on adolescent body weight.
        Econ Hum Biol. 2008; 6: 377-387
        • De Bourdeaudhuij I.
        • Van Oost P.
        Family members’ influence on decision making about food: Differences in perception and relationship with healthy eating.
        Am J Health Promot. 1998; 13: 73-81
        • Kosti R.I.
        • Panagiotakos D.B.
        • Tountas Y.
        • et al.
        Parental body mass index in association with the prevalence of overweight/obesity among adolescents in Greece: Dietary and lifestyle habits in the context of the family environment: The Vyronas Study.
        Appetite. 2008; 51: 218-222
        • Bhattacharya J.
        • Currie J.
        • Haider S.
        Poverty, food insecurity, and nutritional outcomes in children and adults.
        Health Econ. 2004; 23: 839-862
        • Reicks M.
        • Banna J.
        • Cluskey M.
        • et al.
        Influence of parenting practices on eating behaviors of early adolescents during independent eating occasions: Implications for obesity prevention.
        Nutrients. 2015; 7: 8783-8801
        • Gu X.
        • Tucker K.L.
        Dietary quality of the US child and adolescent population: Trends from 1999 to 2012 and associations with the use of federal nutrition assistance programs.
        Am J Clin Nutr. 2017; 105: 194-202
        • Stewart S.D.
        • Menning C.L.
        Family structure, nonresident father involvement, and adolescent eating patterns.
        J Adolesc Health. 2009; 45: 193-201
        • Krebs-Smith S.M.
        • Reedy J.
        • Bosire C.
        Healthfulness of the US food supply: Little improvement despite decades of dietary guidance.
        Am J Prev Med. 2010; 38: 472-477
        • Franco M.
        • Diez Roux A.V.
        • Glass T.A.
        • Caballero B.
        • Brancati F.L.
        Neighborhood characteristics and availability if healthy foods in Baltimore.
        Am J Prev Med. 2008; 35: 561-567
        • Darmon N.
        • Drewnowski A.
        Does social class predict diet quality?.
        Am J Clin Nutr. 2008; 87: 1107-1117
        • Galvez M.P.
        • Morland K.
        • Raines C.
        • et al.
        Race and food store availability in an inner-city neighborhood.
        Public Health Nutr. 2008; 11: 624-631
        • Baker E.A.
        • Schootman M.
        • Barnidge E.
        • Kelly C.
        The role of race and poverty in access to foods that enable individuals to adhere to dietary guidelines.
        Prev Chronic Dis. 2006; 3: A76
        • Zenk S.N.
        • Schultz A.J.
        • Israel B.A.
        • Bao S.
        • Wilson M.L.
        Fruit and vegetable access differs by community racial composition and socioeconomic position in Detroit, Michigan.
        Ethn Dis. 2006; 16: 275-280
        • D’Angelo H.
        • Suratkar S.
        • Song H.J.
        • Stauffer E.
        • Gittelsohn J.
        Access to food source and food source use are associated with healthy and unhealthy food-purchasing behaviours among low-income African American adults in Baltimore City.
        Public Health Nutr. 2011; 14: 1632-1639
        • Kestens Y.
        • Daniel M.
        Social inequalities in food exposure around schools in an urban area.
        Am J Prev Med. 2010; 39: 33-40
        • Hager E.R.
        • Cockerham A.
        • O’Reilly N.
        • et al.
        Food swamps and food deserts in Baltimore City, MD, USA: Associations with dietary behaviours among urban adolescent girls.
        Public Health Nutr. 2017; 20: 2598-2607
      6. Ver Ploeg M, Breneman V, Dutko P, Williams R, Snyder S, Dicken C, Kaufman P. Access to affordable and nutritious food: Updated estimates of distance to supermarkets using 2010 data. 2012. ERR-143. United States Department of Agriculture, Economic Research Service, Washington, DC. Accessed June 15, 2017.

      7. Mulik K, Haynes-Maslow L. The affordability of MyPlate: An analysis of SNAP benefits and the actual cost of eating according to the Dietary Guidelines. J Nutr Educ Behav.

        • Cozby P.C.
        Asking people about themselves: Survey research.
        in: Methods in Behavioral Research. 7th ed. McGraw-Hill Higher Education, New York, NY2003: 105-106
        • Di Noia J.
        • Cullen K.W.
        • Monica D.
        Social desirability trait is associated with self-reported vegetable intake among women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children.
        J Acad Nutr Diet. 2016; 116: 1942-1950
        • Sproesser G.
        • Klusmann V.
        • Schupp H.T.
        • Renner B.
        Self-other differences in perceiving why people eat what they eat.
        Front Psychol. 2017; 8: 209


      M. M. Wrobleski is a research consultant dietitian, Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, Baltimore.


      E. Hager is an assistant professor, Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, Baltimore.


      B. C. Merry is a research associate, Department of Pediatrics, Growth and Nutrition Division, University of Maryland School of Medicine, Baltimore.


      E. A. Parker is an assistant professor, Department of Family and Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore.


      K. M. Hurley is an assistant professor, Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.


      S. Oberlander is a social science analyst, Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC.


      M. M. Black is a professor, Department of International Development, RTI International, Research Triangle Park, NC.