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ORIGINAL ARTICLE
Year : 2020  |  Volume : 64  |  Issue : 2  |  Page : 154-160  

The relationship between parental religiosity and school age children's dietary behavior in Ningxia Province, China: A cross-sectional study


1 Resident, Department of Epidemiology and Statistic; School of Public Health and Management, Ningxia Medical University, Yinchuan 750004, China
2 Professor, Department of Children and Maternal Health; School of Public Health and Management, Ningxia Medical University, Yinchuan 750004, China
3 Professor, Department of Epidemiology and Statistic, School of Public Health and Management, Ningxia Medical University, Yinchuan 750004, China
4 Director of the Center, Department of Epidemiology and Statistic, School of Public Health and Management, Ningxia Medical University, Yinchuan 750004, China, Direc or of the Center, Department of Psychiatry, Duke University Medical Center, Durham, NC 27710, USA, Director of the Center, Department of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
5 Professor, Department of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia

Date of Submission12-Apr-2019
Date of Decision20-Jul-2019
Date of Acceptance27-Apr-2020
Date of Web Publication16-Jun-2020

Correspondence Address:
Zhizhong Wang
Department of Epidemiology and Statistic, School of Public Health and Management, Ningxia Medical University, Yinchuan 750004
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_128_19

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   Abstract 


Background: Studies have shown parental religious involvement was associated with better health behaviors of their children. However, the relationship between parental religiosity and child dietary behaviors remains unclear. Objectives: This study aimed to examine the relationship between parental religious involvement and the dietary behaviors of school-aged children in mainland, China. Methods: Participants were selected from a northwest province of China using a multi-stage sampling process from July 2017 to October 2017. The frequency of parental religious activities and the importance of religion in life, along with the dietary behaviors of children, were collected using a questionnaire. Dietary pattern analysis coupled with multivariable linear regression was employed to test the association between parental religious involvement and children's dietary behavior. Results: The regression model indicated no significant relationship between parental religious behaviors and children's dietary behaviors in the overall sample. However, the frequency of mother's religious attendance was inversely related to children's consumption of vegetables (β = −0.40, P < 0.05) in the Hui subsample (vs. Han) when stratifying analyses by ethnicity. Conclusion: These findings suggest among those of Hui ethnicity, parental religious involvement may impact children's dietary behavior in a way that may affect their future health habits.

Keywords: Children, dietary behavior, mainland china, parents, religious attendance, religious importance


How to cite this article:
Wu Y, Ding W, Wang Z, Koenig HG, Al Shohaib S. The relationship between parental religiosity and school age children's dietary behavior in Ningxia Province, China: A cross-sectional study. Indian J Public Health 2020;64:154-60

How to cite this URL:
Wu Y, Ding W, Wang Z, Koenig HG, Al Shohaib S. The relationship between parental religiosity and school age children's dietary behavior in Ningxia Province, China: A cross-sectional study. Indian J Public Health [serial online] 2020 [cited 2020 Sep 30];64:154-60. Available from: http://www.ijph.in/text.asp?2020/64/2/154/286806




   Introduction Top


Good behavioral health practices can build up a child's sense of well-being that can positively contribute to their development and future health habits. In addition, good health leads to satisfying social relationships at home and with peers.[1] Sociological research has focused on the correlations between children's mental health and their family environment, particularly the quality of parent–child relationships.[2] Research has found that mothers who attend religious services at least once a week report greater overall life satisfaction, and more involved with their families, also employ better skills in solving health-related problems.[3]

More recent research indicates that parental religious involvement benefits child development more generally.[4] Religious attendance provides a broad social network of like-minded peers. Sermons often include topics on marital stability, parenting, and how to socialize children into religious habits such as attending religious services and prayer.[5] Parents who report higher levels of personal religiosity also exhibit stronger parenting skills[6] and report less parent–child conflict.[7] Religious involvement helps to promote more intimate relationships between spouses, and between parents and children. Religious commitment in the form of affiliation, regular attendance, devout religious beliefs, and subjective importance of religion have all been related to greater family cohesiveness and better physical and mental health.[8]

Thus, religious influences in the family could contribute to the current and future health of children. A systematic review of literally thousands of quantitative studies on religion and health conducted over the past 100 years found that religious beliefs and practices (in the United States and elsewhere) were positively associated with health and well-being, including studies in children, adolescents, and young adults.[9] This research has found that familial religious involvement often dissuades adolescents from detrimental behaviors such as violence, drugs and alcohol use, and early sexual activity.[10] For example, one study examined the effects of parent religiosity on adolescent behavior in light of social control and social learning theories, finding that parent religiosity was inversely related to substance abuse in children.[11] The findings of Caputo's study indicated that parent religiosity was positively associated with good health and better academic performance, and was inversely related to substance abuse, all independent of other predictors in this study.

Religiosity is a construct involving beliefs and behaviors that may vary in their impact on children's well-being.[12] China has a large population with many different religious groups including Buddhists, Taoists, Muslims, Jews, Christians, and a variety of other Chinese religious.[12] In the past 10 years, there has been a rapid increase in the publications about religion and health in Chinese populations, which in general tend to be less religious than those in Western countries.[13],[14] It is an established fact that a healthy diet can maintain and promote physical and mental health.[15] However, to the best of our knowledge, there are no published studies focusing on the relationship between parental religiosity and child dietary behaviors from Mainland China.

To address this gap in the literature, the present study examined the association between parental religiosity and dietary behaviors of their children in a sample of school aged children and their parents in northwest China.


   Materials and Methods Top


Study participants, sampling and setting

The data for this study were collected from adolescents attending public schools in the city of Yinchuan, located in the northwest region of China. Participants were identified through a multistage sampling process now described. First, a convenience sample of eight schools was identified from a total number of 53 public schools depending on their interest to participate. From those eight schools, three schools (including one primary school, one middle school, and one high school) were selected based on their size and geographic location to maximize their representativeness of public schools in this region. Second, a stratified cluster sampling method was used to select participants. Students in the same classroom (ranged from 45 to 60 students) were defined as a cluster, and classrooms were stratified by grade in each school (grade 1st to 6th for primary school, grade 7th to 9th for middle school, and grade 10th to 12nd for high school) lead to 12 stratus in total. One classroom was selected in each grade at the primary school, four classrooms were selected in each grade at middle school, and four classrooms were selected in each grade at high school. In all, 30 classrooms were selected to represent the final sample that consisted of 1,690 students aged 6–18 years old. Of those, 1,342 students completed the survey. Among students completing the survey, parents were approached to complete a questionnaire. Of those, 960 completed the parental questionnaire and provided consent for the data collected from their children to be used in this study.

Procedure of data collection

Participants were instructed about how to complete the survey. Prior to the survey, a parental consent form and parental religious questionnaires were mailed to the student's home and responded by the parents. For students aged 6–8 years, the Food Frequency Questionnaire (FFQ) was mailed to their homes and completed by their parents after parental consent was obtained. Students aged 8 years or older completed the questionnaire themselves during class time after parental consent was obtained. The whole survey was completed from July 2017 to October 2017.

Ethics approval and consent to participate

The study was approved by the Institutional Review Board at Ningxia Medical University (reference number: 2015-150) at March 12, 2015. Written informed consent was obtained from all participants.

Measures for variables and categorization

A self-administered, semi-quantitative FFQ was used to collect information about dietary habits, including consumption of meat, fish, dairy products, beans and legumes, fruit, vegetables, fried food, snacks, and sugary soft drinks. The FFQ is a low-cost frequent measure of dietary habits used in large scale epidemiology and health promotion studies.[16] The FFQ assesses a finite list of foods and food groups from which participants quantitatively report how often each item is consumed over a specified period. Portion size is collected according to recommended guidelines.[17]

Dietary pattern analysis was conducted to examine the FFQ data.[18] Exploratory factor analysis was used to establish dietary pattern models by examining combinations of foods based on their intercorrelations. Factor loading coefficients larger than 0.25 indicate that dietary behaviors show strong intercorrelations and clustered as one of the identified dietary pattern models.[19] The number of common factors was determined based on eigenvalue, debris map, and professional knowledge. Summary scores for factors were calculated and be divided into three categories from low to high (T1, T2, T3). The difference in the proportion of children across different demographic characteristics was calculated using rank and test analysis. Four factors were extracted according to the factor analysis: balanced diet, vegetarian diet, high-fat/salt diet, and high sugar diet. The four summary factor scores were the dependent variables examined in the data analysis.

Parental religious involvement was determined by three questions abstracted from Duke University Religion Index-5, which has been used in the Chinese population with acceptable validity and reliability.[20] The measure includes the importance of religion, frequency of religious attendance, and religion affiliation. The importance of religion was assessed by the question: “In general, how important is religion in your daily life?” Response options ranged from not at all important (1) to very important (4). Frequency of religious attendance was measured with the question: “How often do you usually attend religious activities?” Responses ranged from never (1) to more than once a week (5). Religion affiliation was determined by asking: “What is your religious preference?” Religious affiliation was coded for analysis into four categories: 1 = none, 2 = Chinese religion (i.e., buddhist, daoist, etc.), 3 = western religion (i.e., protestant, catholic, etc.), and 4 = Islam. Responses for these religious variables were categorized as: Religious affiliation (yes vs. no, where “yes” indicated that the participant believed in some kind of religion and “no” indicate that they didn't believe in religion); religious attendance (frequent vs. infrequent, where “frequent” indicated attending religious activities at least once/month or more often, and “infrequent” indicated less frequent than once/month); and religious importance (important vs. not important, where “important” indicated religious belief is important or very important, and “not important” indicated religious belief was less than important).

Statistical analyses

Epidata 3.1 was used to enter and check the data, whereas the SPSS 22.0 version (IBM Corp., Armonk, NY, USA) was used to analyze the data. Differences in socio-demographic characteristics between male and female participants were examined using the t-test for continuous variables and the Chi-square statistic for categorical variables. Dietary pattern analysis was identified using factor analysis (as described above). Multivariable linear regression was used to analyze the association between parental religiosity and child dietary patterns, the four summary factor scores (balanced diet, vegetarian diet, high-fat diet, and high-salt/sugar diet) as the dependent variables examined in the data analysis separately, and the independent variables include parental religious involvement, gender, and grade were enter the regression model simultaneously.


   Results Top


The average age of child participants was 13.3 years (standard deviation 3.0) with a range from 6 to 18 years. A majority of participants were female (55.1%), and the majority of ethnicity was Chinese Han (75.2%). Over 60% of the students at least one of their parents indicate with any religion affiliation. The females slightly older than males (13.6 vs. 13.1, t = 2.12, P = 0.034) and with higher proportion being minorities than males (28.4% vs. 20.4%, χ2 = 11.57, P = 0.009).

The most popular foods in the overall sample were refined grain, milk, vegetables, and carbonated drinks (data available in supply materials 1). The results from food pattern analysis are shown in [Table 1]. According to the food factor loading patterns, four common dietary models were extracted as described earlier: (1) balanced diet (food intake is balanced and varied); (2) vegetarian diet (intake of more fruits, leafy and cooked nonleafy vegetables); (3) high-fat diet (consumption of fatty foods like meat and fried food); and (4) high salt/sugar diet (consumption of salty snacks, sugary snacks and pickles).
Table 1: Children's dietary behavioral factor loading matrix (n=960)

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The association between parental religious involvement and children's dietary behavior is shown in [Table 2]. There is significant difference between minorities and Han in the balanced diet (P = 0.043), as well as in the high-fat diet model (P = 0.003). For students whose father reported that religion is not important were more likely to consume a balanced diet than those whose father indicated that religion is important in life (P = 0.013); the same was true for the mother's religious importance (P = 0.017). Students whose mothers participated in religious activities infrequently were more likely to eat a balanced diet than those whose mothers participated frequently in religious activities (P = 0.050). No parental religious characteristics were associated with a vegetarian diet, a high-fat diet, or a high salt/sugar diet.
Table 2: Associations between parental religious involvement and child dietary behavior (n=960)

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As shown in [Table 3], under controlling for grade and gender using multivariable linear regression, no significant association was found between any parental religious characteristic and child diet behaviors in the overall sample.
Table 3: Multivariable linear regression for parental religious involvement and child dietary behaviors

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However, when the analyses were stratified by ethnic group (Hui vs. Han), frequent maternal religious attendance was negatively associated with children eating a vegetarian diet (β = −0.40, P < 0.05, R2= 0.020) in those of Hui ethnicity. No significant association was found between parental religious characteristics and child diet behaviors in Chinese Han (data not reported).


   Discussion Top


A healthy diet is an essential predictor for the prevention of many chronic diseases. Thus, developing healthy dietary habits during childhood (when growth is most rapid) is crucial to future health and minimization of chronic disease. There is evidence that behaviors (e.g., dietary intake) established during childhood will be maintained into adolescence and adulthood.[21],[22] An unhealthy diet is associated with a higher risk of obesity in both children and adults.[23],[24] Furthermore, obesity is etiologically related to cardiovascular diseases, such as dyslipidemia, hypertension, and type II diabetes.[25] Studies indicate that parental behaviors and lifestyle play an important role in the development of childhood obesity.[26]

The current study among Chinese children and adolescents found that parental religious involvement was to a certain degree related to child dietary behavior. Students with more religious parents were less likely to consume a balanced diet. While this association disappeared when adjusting for gender and grade in the overall sample, stratified analyses by ethnicity revealed that parental religious involvement had a negative influence on the children's eating a vegetarian diet among those of Hui ethnicity (one of the ethnic groups that is almost entirely Muslim). These findings from China are inconsistent with previous reports in the literature, largely conducted in Western countries. Several studies link religious involvement to physical activity and healthy diets among adults[27],[28],[29] and adolescents.[30] These studies have suggested that having support for a healthy lifestyle through informal or formal religious rules, social norms within a religious group, and other congregation- and individual-level factors cause religious individuals to make healthier choices.[31]

There are several possible explanations for why parental religiosity might influence child outcomes. Social support is one aspect of religious participation that has been associated with improved health behaviors.[32] It is also possible that religious organizations provide a sense of cohesion and support, which may help to improve health practices, including dietary behaviors. Many religions have specific dietary laws, which fall into two categories: “temporal abstinence from all or certain foods” and “stable and distinctive dietary habits that differ from the general population.”[33] In addition, children are also affected by parental religious beliefs and may form their own religious beliefs, thus influencing their own behavior. Research suggests that adolescent religiosity mediates the relationship between parents' religiosity and adolescent health outcomes such as drug and alcohol use and depression.[34]

In a recent systematic review, nearly half of the 46 studies included in the review reported no significant relationship between religiosity and intake of fruit, vegetables, or fat.[35] The results of a study on dietary habits of Han and Hui ethnicities in China indicated significantly higher vegetable intake in Han than Hui,[36] which is consistent the finding in the current study of a negative correlation between religiosity and intake of fruits and vegetables in Hui. Although we are not suggesting that religious activity be prescribed for the people of China, further research is needed to determine to what extent these cultural factors impact the dietary behaviors in the community. However, there few faith-based community prevention programs have developed in obesity control in the American community,[37],[38] those programs showed promising implementation through strengthening community-academic partnerships to build community capacity.

Like so many other empirical studies, the current study was conducted in a limited geographical region, thus affecting the generalizability of these findings to children/adolescents and their parents living in other regions of China. In addition, given the cross-sectional nature of this study, no causal relationship can be inferred between parental religious involvement and the dietary behavior of their children. Finally, as in all studies of dietary behavior, recall bias exists due to the self-report of dietary practices and the heavy burden placed on respondents who must answer questions from memory on the quantity and frequency of food consumed. However, despite these limitations, there are also numerous study strengths that should be considered. First, this study involved a relatively large sample that was systematically identified; second, the effort was made to carefully control for demographic characteristics using multivariable regression modeling; and third, to the best of our knowledge, this is the first study to examine the relationship between parental religiosity and dietary behaviors of children in a less religious country.


   Conclusion Top


We concluded that four dietary patterns were identified among Chinese school-age children. Parental religious involvement was associated with the dietary behavior of their children, particularly among those of Hui (largely Muslim) ethnicity. Possible explanations for this pattern of results were provided and discussed. Public health professionals should be aware of the relationship between religious involvement and diet in both adults and children, particularly the influence that parental religious behaviors have on the kinds of foods that children eat that may influence their future risk of disease and chronic illness.

Acknowledgment

The authors are grateful to all those who participated in the collection, analysis and interpretation of data, and those who help with the writing of this paper.

Financial support and sponsorship

This study was funded by the National Natural Science Foundation of China (81660565) and Project for Top Discipline of Public Health and Preventive Medicine (NXYLXK2017B08), Education Department of Ningxia, China. The funders had no role in the design, data collection, analysis or interpretation of the data; and in the writing of the manuscript; or in the decision of where to submit the paper for publication.

Conflicts of interest

There are no conflicts of interest.



 
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