Influences on Food Away from Home 
Feeding Practices Among English and 
Spanish Speaking Parent–Child Dyads
Authors: Courtney A. Pinard, Carmen Byker, 
Samantha M. Harden, Leah R. Carpenter, Elena L. 
Serrano, Daniel J. Schober, and Amy L. Yaroch
This is a postprint of an article that originally appeared in Journal of Child and Family Studies on 
September 10, 2014. The final publication is available at Springer via 
http://dx.doi.org/10.1007/s10826-014-0011-8 
Pinard, Courtney A., Carmen Byker, Samantha M. Harden, Leah R. Carpenter, Elena L. Serrano, 
Daniel J. Schober, and Amy L. Yaroch. “Influences on Food Away from Home Feeding Practices 
Among English and Spanish Speaking Parent–Child Dyads.” Journal of Child and Family Studies 
24, no. 7 (July 18, 2014): 2099–2106. doi: 10.1007/s10826-014-0011-8.
Made available through Montana State University’s ScholarWorks 
scholarworks.montana.edu 
1 
Influences on Food Away From Home Feeding Practices among English and Spanish Speaking Parent-1 
Child Dyads 2 
Running Title: Parent-Child Dyads FAFH 3 
 4 
Authors: Pinard, C.A. 1, Byker, C. 2, Harden, S.M. 3, Carpenter, L.R.1, Serrano, E.L. 4, Schober, D.J. 1, 5 
Yaroch, A.L. 1 6 
 7 
1Gretchen Swanson Center for Nutrition, 8401 West Dodge Road, Suite 100, Omaha NE, 68114* 8 
2Department of Food and Nutrition and Sustainable Food Systems, 222 Romney Gym 9 
Montana State University, Bozeman MT, 59717-3360 10 
3School of Kinesiology, 122- 6081 University Blvd., University of British Columbia, Vancouver BC, 11 
V6T 1Z1 Canada 12 
4Department of Human Nutrition, Foods and Exercise, 201 Wallace Annex, Virginia Polytechnic 13 
Institute and State University, Blacksburg VA, 24060 14 
 15 
*interviews were conducted at this location   16 
Abstract 17 
Background: Families are increasingly consuming food away from home (FAFH), contributing to 18 
increased daily energy consumption and the obesity epidemic. The interplay between feeding styles 19 
and co-decision making between parent-child dyads when eating FAFH is not understood. The present 20 
study describes in-depth qualitative information about influential factors related to family feeding 21 
practices (e.g., parenting style) among low-income English and Spanish speaking families with school-22 
aged children when eating FAFH. 23 
Method: 20 parent-child dyads (10 English-speaking, 10 Spanish-speaking) completed key-informant 24 
interviews. Interviews were recorded and transcribed verbatim. The constant comparison methodology 25 
was utilized to analyze the data and interviews were independently coded for meaning units by two 26 
coders. The preliminary meaning units and codes were analyzed by the coders and organized into 27 
common categories.  28 
Results: Themes that emerged from the interviews included: decision making when dining out, 29 
parental practices and feeding style, use of and opinions about kid’s menus, and overall influences on 30 
food choices. Many parents had recommendations for healthier kid’s menu options and overall, 31 
Spanish-speaking families tended to eat out fewer times a week and cooked more family meals.  32 
Conclusions and implications: This research elucidated rules and policies set by parents around food 33 
away from and inside the home as well as the factors that influenced ordering at restaurants. 34 
Decision-making between parent-child dyads about menu ordering at restaurants is complex. The 35 
results of this study can be considered for future research in understanding the decision-making 36 
process for English- and Spanish- speaking parent-child dyads when ordering from a restaurant menu. 37 
 38 
 39 
  40 
3 
Introduction 41 
Tracing the etiology of childhood obesity is complex and improving the healthfulness of the American 42 
diet has become a national health priority (1–3). The U.S. Department of Agriculture (USDA) 43 
estimates that between 1985 and 2000, the daily per capita energy consumption increased by 12%, or 44 
300 calories per day among American adults (4). One trend that has contributed to increased caloric 45 
consumption is more frequent consumption of food away from home (FAFH). In 1970, only 34% of a 46 
family’s food budget was accounted for by FAFH, and by the late 1990s this rose to more than 47% 47 
(5). The types of foods and drinks children order when consuming FAFH can ultimately impact their 48 
overall diet and health. The effects of FAFH on diet and health depend on a number of factors, 49 
including frequency of eating away from home, choice of restaurant (i.e., quick-service versus full-50 
service), foods ordered and consumed, and in the case of children, food rules established and enforced 51 
by parents or caregivers (herein referred to as parents) (6–8). Additionally, low-income families tend to 52 
consume more energy-dense, nutrient-poor foods than their higher-income families (3). 53 
 54 
The degree to which both children and parents influence the decision making around FAFH restaurant 55 
and meal selection is still unknown (9). Several studies have found an association between parenting 56 
style and/or specific feeding practices (e.g., pressure to eat, restriction, availability, parental modeling, 57 
and specific dietary behaviors) (10–12). The authoritative parenting style may be more conducive to 58 
healthier food choices because limits, consequences, and expectations are set while demonstrating 59 
warmth and support (13,14). In contrast, authoritarian parenting styles are defined by high demands for 60 
self-control but low levels of sensitivity (13,14). Further, feeding practices differ across ethnic and 61 
cultural groups. For example, Latino parents have been found to engage in an indulgent feeding style, 62 
one that is characterized by warmth and acceptance in conjunction with a lack of monitoring of the 63 
child’s behavior (15,16). Another study demonstrated that, among Latino families, those that ate more 64 
frequently at Anglo-oriented restaurants (e.g., fast-food chains, buffets) were at higher risk for obesity 65 
(17). Additionally, Latino parents with authoritarian feeding styles were more likely to have children 66 
who were at risk for unhealthy eating (18).  67 
 68 
To date, few studies have been conducted to examine the intersection between parenting style and 69 
feeding practices and FAFH, including parent-child dynamics and decision-making, particularly 70 
among Latinos. Little is known about how parent-child dyads interact and make ordering decisions at 71 
restaurants. The purpose of this study was to obtain in-depth information about influential factors 72 
related to family feeding practices (e.g., parenting style) among low-income English and Spanish 73 
speaking families with school-aged children when eating FAFH.  74 
 75 
Method 76 
 77 
Recruitment 78 
Parent-child dyads were recruited through table tent advertising at a Mexican restaurant in a 79 
predominantly Latino neighborhood in South Omaha; additional participants were recruited using 80 
flyers placed across community and by word of mouth referrals. Parent-child dyads were eligible if the 81 
child was between 8 and 13 years old. This particular age group was selected since our aim was to 82 
recruit children old enough to make their own meal choices, but who may also receive significant 83 
parental input with food choices. Recruitment efforts aimed to attract a representative sample of both 84 
English- and Spanish- speaking Latino families (i.e., half of the dyads per dominant language).  85 
 86 
Interviews 87 
The authors developed a semi-structured interview guide based on a review of relevant literature 88 
related to restaurant dining habits among families (19–21). Figure 1 displays the eight domains of 89 
inquiry identified from the literature review for factors that may influence FAFH choices among 90 
English- and Spanish-speaking parent-child dyads. These eight domains of inquiry spanned from 91 
acculturation influences to restaurant ordering behaviors (see Figure 1). In addition to the interviews, a 92 
short demographic survey was collected that included self-reported height and weight which was 93 
converted to Body Mass Index (BMI) for adults and BMI percentile for age and sex for children. 94 
Following a phenomenological approach, the semi-structured interviews aimed to explore the in-depth 95 
“lived experience” of how parent-child dyads co-constructed decisions when eating FAFH (22). 96 
Beyond asking about typical family dining patterns and parental feeding style, two examples of key 97 
questions from the parent interview included: “What factors make it more likely that you and your 98 
family will eat out?” and “Please describe how you typically order dinner for your child (or teen) at a 99 
sit-down restaurant.” For the child interviews, some key questions included: “What is your favorite 100 
food or meal to order when eating in a sit-down restaurant?”, “Can you describe to me how your 101 
dinner choice is made?”, “What do you think your parents think about when choosing something for 102 
you to eat when you are dining out?”, and “What types of food/dishes do your mom/dad typically order 103 
for themselves?”. 104 
 105 
5 
Bachelors and masters level research associates conducted separate interviews with parents and 106 
children between April and December of 2012. Institutional Review Board approval was obtained from 107 
the University of Nebraska Medical Center and written parental consent and child assent were obtained 108 
onsite before the interviews began. Interviews were conducted at the research offices of the authors 109 
and in the participating parent’s preferred language (i.e., Spanish or English). All child interviews were 110 
conducted in English, as all children were fluent in English. Interviews were conducted until 111 
theoretical saturation. Each of the parent interviews lasted approximately 45 minutes, while the child 112 
interviews (conducted concurrently and in a separate room from the parent) took approximately 20 113 
minutes. Dyads received a $20 gift card as an incentive for participating. 114 
 115 
Data Analysis 116 
Each interview was transcribed verbatim. Interviewers utilized constant comparison methodology (23) 117 
and interviews were independently coded for meaning units by two coders (the lead author, CP, and 118 
one other author for each interview) using the NVivo software package (Version 9, QRS International, 119 
Victoria, Australia). The preliminary meaning units and codes were analyzed by the coders and 120 
organized into common categories. These categories were examined for overlapping themes and 121 
condensed to order the data. To maintain confidentiality, quotations reproduced in this paper have been 122 
de-identified. 123 
 124 
Results 125 
 126 
In total, 20 parent-child dyads were interviewed (N=40), with ten English-speaking parents and ten 127 
Spanish-speaking parents. All child interviews were conducted in English. Table 1 shows 128 
sociodemographic information for participants. Adult BMI values ranged from 18.9 to 39.5, with 22% 129 
normal weight, 39% overweight, and 39% obese. The mean BMI percentile for children for age and 130 
sex was 63 (children were asked for their height and weight and only 10 out of 20 respondents were 131 
able to answer this). Household income ranged from less than $10,000 per year to more than $100,000 132 
per year, with the majority of participants reporting earning less than $50,000/year). There was a span 133 
of education levels. Four of the parent participants were male and the remainder (N=16) were female. 134 
Adult participants ranged in age from under 21 years to 44 years of age. Children were between the 135 
ages of 8 and 13 (x̄=10.5, SD=1.6) and 65% were male and 65% Latino.  136 
 137 
Themes and categories that emerged from the data are summarized in Table 2, including: decision 138 
making when dining out, parental practices and feeding style, use of and opinions about kid’s menus, 139 
and overall influences on food choices. Within each of these broader themes, specific categories of 140 
findings are explained below and summarized in Table 2. 141 
 142 
Decision Making When Dining Out 143 
Parents and children reported that the parent was responsible for selecting where the family will eat 144 
out. One child stated, “My mom, she just picks.” Several parents corroborated, “In my house, the food 145 
is my decision.” 146 
 147 
The degree to which the parent had control over the child’s meal choice varied. Many parent-child 148 
dyads reported a combination of co-decision making processes for meal selection. One mother 149 
described the step-by-step process for ordering a meal for her child, “I ask her ‘what do you want to 150 
eat first?” The same mother then explained that after a child suggests a food, the parent responds, 151 
“Are you sure you want this to eat today? If she [the child] wants it she says yes. The decision is my 152 
daughter’s.” Many parents tended to give their children more autonomy in selecting their meal. Some 153 
of the parents who allowed their child to display autonomy when ordering conveyed their concern with 154 
cost of the meal (n=12). One strategy that parents reported using to control cost was restricting their 155 
child’s meal choice to the kids menu, “I don’t really look at the price for the kids menu because they’re 156 
pretty much the same, set prices, and just as long as it’s something he’s going to eat.”  157 
 158 
Conversely, some parents reported exerting control over the child’s meal choice by giving guidance 159 
and suggestions. These parents seemed interested in educating their children about food choices and 160 
setting up parameters. One parent described this as, “We’ll give the kids choices. We’ll give them at 161 
least two choices.” A parent (Spanish-speaking) described how she influenced her children to order 162 
healthier things, “[There are] three things they can choose. But then they have to choose vegetable. 163 
For example, cooked vegetables or salad or French fries. I always choose salad or vegetables. So I 164 
choose like that for them.”  165 
 166 
Parenting Practices and Feeding Style 167 
The majority of parents reported that rules and choices at home were stricter than when dining out, 168 
“No, I think at a restaurant I’m more loose. At home, I’m more strict.” Many parents described 169 
allowing sugar sweetened beverages (SSBs) when dining out, but not at home, “Yeah, we don’t buy 170 
7 
like soda or anything like that, but whenever we go out, you know, the kids drink it.” Children 171 
corroborated this sentiment, agreeing that there were different rules for when they ate out when 172 
compared to meals at home.  173 
 174 
Almost all parents reported some limits on SSBs for their children. Parents reported limiting soda more 175 
in the home than when dining out at a restaurant. One parent described, “Every once in a while I’ll let 176 
them drink pop, but not very often at a restaurant. [But at home] It’s got to be like lemonade or water 177 
or milk.” Another parent described the added cost of SSBs, “We really don’t drink soda, we drink 178 
water. They can have a pop if we go out, and that all depends on money, cause I think soda’s a rip 179 
off.” Similarly, one parent explained, “When eating out, I also discourage drinks because it’s 180 
expensive. However, for example, we go to fast food and the kids are getting a value meal, you know, 181 
then your choices are usually a soda, a juice, or a milk, and I usually get a chocolate milk for the kids 182 
then. I prefer for them not to get sodas in those situations.”  183 
 184 
Some of the parents (n=6) reported eating dinner as a family at a table, “So we’re usually sitting at the 185 
table, we usually have dinner together … every night but Wednesday night, … Another parent reported, 186 
“The rules are that when we sit down to eat no one can leave the table if everyone has not finished”. 187 
However, the majority of parents (N=14) reported eating meals not together at a table and typically in 188 
front of the television. This obesogenic feeding style was simply described by interviewees as 189 
normative practice, “We don’t always sit at the table, we sometimes watch a movie—have a pizza and 190 
movie night”. One child reported, “Well, my dad, he lays in bed while we’re eating. My mom she sits 191 
on the couch. Me and my brother sit at a table”.  192 
Several parents expressed concern about their child’s weight, “I feel she’s overweight. I do. [I feel it is 193 
important for my child to have a desirable weight] it’s important to me because when I was younger I 194 
was teased and I don’t want her to go through that.” Another parent explained why she thought it was 195 
important for her son to be a healthy weight in terms of lifelong health and chronic disease risk, “…if 196 
he stay[s] like that he will continue growing up with bad habits and will get fatter. I try to better him 197 
because it is he who is going to suffer with the excess weight.”  198 
 199 
Some parents explained that they made efforts to role model healthy dietary behaviors, “I at least 200 
order a salad with all my meals so maybe they’ll eat it too.” Another parent described the impact 201 
positive role modeling may have on her child, “I take him into account because he is learning to make 202 
his own decisions and I respect them.” Similarly, another parent described the teachable moment of 203 
role modeling positive dietary behaviors, “I say to him, look how I do it. I say to him I am going to eat 204 
it, its good.”  205 
 206 
Some parents reported using negotiation with their child to get them to eat more healthfully when 207 
dining out. One parent described this as a struggle, “Well basically he is the child that will always try 208 
to grab a bowl of cereal, like he doesn’t want to eat the vegetables, or he’s happier with a bag of chips. 209 
When we’re out, if he wants a dessert or something, I make him eat at least the vegetables and some of 210 
the meat off of the plate. So that is kind of a battle sometimes.” Another parent reported, “So 211 
sometimes what we’ll do, we’ll negotiate and one of us will get the French fries and one of us will get 212 
the vegetables, and then she’ll have a little bit of it.” 213 
 214 
Some parents reported engaging in an authoritative feeding style, one that is encouraging, yet 215 
instructive. One child reported how his parents encourage him to choose healthier items, “They would 216 
need to tell me whether it’s healthy, what it tastes like, and what’s in it.” A parent also explained how 217 
they described what foods are healthier to their children, “Explaining to him what is good for him. I 218 
would explain my motives. Like this will make you sick, this is not the right time to eat this food, or talk 219 
to him about the dish.” 220 
 221 
Several parents that appeared to align with an authoritative parenting style described how they 222 
provided choices for their children, “We’ve always given him a choice ever since he can talk. And I 223 
mean it’s changed now, we give him a lot more free reign than he used to have. Another parent 224 
explained how she taught her children about self-regulation, “I’ve always tried to get her to listen to 225 
her body and to listen to what she’s really hungry for.” A few parents reported trying to educate their 226 
children about healthy eating/nutrition education with their children, “I have another son that, he’s 227 
becoming overweight and we have diabetes in our family. Whenever we go grocery shopping, I’ll show 228 
him the labels and he’s starting to be able to read labels and understand that.” 229 
 230 
Several parents mentioned using food as a reward. One parent described, “I use pizza as something 231 
they have to earn.” While some of the child respondents reported recognizing that their parents used of 232 
food as a reward, “They might have to bribe me, I’m not sure, otherwise I might just say no, but, umm, 233 
I would probably get dessert.” 234 
 235 
9 
While some parents demonstrated a more “authoritative” feeding style (n=5) by setting guidelines and 236 
parameters yet allowing their children to learn about the benefits of healthful choices, other parents 237 
reported engaging in more negotiation (n=4) and using food as a reward (n=6).  238 
 239 
Spanish-speaking parents (as compared to English-speaking parents) tended to eat out fewer times a 240 
week, and watched less TV, and cooked more healthfully at home. They described their home cooking 241 
to be healthier, “Well I prefer to cook at home because what I make is more economical, better, and 242 
everyone eats till they are full.” Another parent responded, “In my house I always cook what is healthy 243 
and I try to get healthy foods that do not have a lot of fat but [high in] nutrition.” One of the other 244 
parents described, “At home, the food that mama cooks gets eaten. And what I think is healthier for the 245 
children, but always when we go out…” The skill and tradition involved with home cooking was also 246 
emphasized, “My spouse is from El Salvador. So there is always rice and salad. I always cook what I 247 
have. Including if I’m missing an ingredient for a food that is supposedly traditional—I put another 248 
one in (laughter).”  249 
 250 
Use of and Opinions About Kids’ Menu 251 
The selection from the kids’ menu did not appear to be a concern among many parents and one child 252 
described, “They don’t care as long as it’s on the children’s menu.”  Overall, parents reported that 253 
younger children ordered freely from the kids’ menu (n=7), while older children had outgrown the 254 
portion sizes and the flavors (n=5). Some parents of younger children suggested that the portion sizes 255 
were too large, “I think if they were portioned out better, I wouldn’t mind them as much. But when you 256 
go out to the restaurants, it seems like it’s bigger portions than what I would normally give them at 257 
home.” However, parents of older children tended to advocate for larger portions, “It’s not enough 258 
food for either one of my kids. They’re both in their growth spurts or something; they eat like crazy.” 259 
One potential solution suggested was to make smaller portions of adult items, “I think that they should 260 
choose food from the adult menu, but in smaller portions.  261 
 262 
A few parents commented on the lack of availability of nutritious options when dining out. As one 263 
parent explained, “They’re really not that healthy. You know they get the food groups there with added 264 
content of fat, salt, and everything … and even some of the fast food places have applesauce or apples 265 
instead of fries, but generally they’re not very healthy.” Many parents suggested including more fruits 266 
and vegetables and other healthy items, “I think they could sneak a lot more nutrition in than they do. 267 
I’m always trying to sneak in nutrition.” Another parent described, “I think that they could have 268 
healthier options, like McDonalds getting the apples, but I think that they could have healthier 269 
[options] and maybe not like the fries, they give them so many fries.”  270 
 271 
A few parents acknowledged that their child’s food preferences were less healthy than they desired, “I 272 
know that his taste buds will develop and begin appreciating, craving different things. But I think he’s 273 
on a little bit heavy of a pasta and cheese diet now.” Some children described willingness to try new 274 
foods when dining out, “Cause I think that you should try different [foods than] what you eat at home 275 
since it’s a restaurant. Cause you’re not going to eat at home; that’s the reason that you’re going to go 276 
somewhere else to eat something.” 277 
 278 
Most parent-child dyads reported using the kids’ menu, in particular driven by price. However, parents 279 
expressed dissatisfaction with the healthfulness of the options on kids’ menus and made several 280 
suggestions for improvement. Simultaneously, some parents were concerned about their child’s BMI 281 
and recognized FAFH as a way to impact weight status. Current menu options cater to basic food 282 
preferences of children (24), but children also described a willingness to try new foods. There is an 283 
opportunity for restaurants to offer more healthful options on kids’ menus, capitalizing on this 284 
willingness to try new foods. More healthful menus may result in beneficial sales for the restaurant, 285 
creating a mutually beneficial opportunity.  286 
 287 
Overall Influences on Food Choices 288 
Overall influences on food choices were comprised of five categories (Table 2). Children were asked if 289 
they could recall any food-related commercials on TV or online. They were able to identify several 290 
food-related commercials, thought they influenced their own food choices, and had negative feelings 291 
towards them. Children were easily able to identify food-related commercials, “I see McDonalds 292 
commercials a lot”, and “Well they show BK and McDonalds.” When asked if the food-related 293 
commercials make the child want specific foods, the child responded, “Well, I’d say 90% [of the 294 
time].” Most children expressed dislike towards commercials even though they influenced their 295 
choices, “They’re really stupid actually so they’re pointless.”  296 
 297 
At the same time, many parents expressed concern about the influences of food marketing on their 298 
child’s dietary preferences, “He is picky, he’s a big kid, he eats what he wants not what you want, if I 299 
give him a salad he will not eat it at all, if I give him a hotdog and chips he will eat it right away, its 300 
really difficult, you live here in America. It’s hard. There are more commercials all the time and kid 301 
11 
want to eat at fast food.”  302 
 303 
For most families in the current study, dining out was considered a treat, and not part of regular family 304 
meal patterns. However, some families in this study also reported eating fast food more regularly 305 
(several times a week), indicating that they did not consider fast food to be part of “dining out.”  306 
 307 
Although cost and flavor were often ranked ahead of nutrition as competing factors when deciding 308 
where to eat, some parents did explain concern for nutrition, “Nutrition has to be like something 309 
healthy, not too much sugar and because he’d rather order a pop instead of milk or juice. So it has to 310 
be nutritious and the taste. It has to taste good in order to eat.” With regard to their own nutrition 311 
knowledge, some parents gained confidence through “Consult[ing] lots of books.” Some books about 312 
“Cholesterol fighting foods, foods that fight cholesterol” and others that include “practical, quick, 313 
healthy foods for the family.” The participant stated that she was “Not an expert, but [she was] 314 
learning.” Other parents were confident in their ability to identify nutritious meals and practices, 315 
“Spaghetti, fish, vegetables, red meat, pork. They are nutritious because there are carbohydrates, 316 
proteins and vegetables.”  317 
 318 
Discussion 319 
 320 
As an increasing number of families are consuming FAFH (1,2), which can potentially result in added 321 
calories and poorer dietary outcomes (25). The current study obtained detailed qualitative data on 322 
parenting practices and decision-making among low-income English and Spanish speaking families 323 
with school-aged children when dining away from home. The themes and categories that emerged 324 
elucidated rules and policies set by parents around food away from and inside the home as well as the 325 
factors that influenced ordering at restaurants. For most families in the current study, dining out was 326 
considered a treat and not part of regular family meal patterns. However, some families also reported 327 
eating fast food more regularly (several times a week), indicating that they did not consider fast food to 328 
be part of “dining out.” This parallels other studies that have found that children and adolescents are 329 
consuming fast food increasingly and it accounts for a large portion of their daily caloric intake (5,7). 330 
Coupled with this, an observational study found that fast food restaurant meals were on average lower 331 
in calories than non-fast food meals (26). Together, these findings support the continuation of policy 332 
efforts impacting large chain restaurants as an obesity prevention strategy. 333 
 334 
The impact of kids’ menus is far reaching, especially since families in this study allowed their children 335 
to order freely from the kids’ menu. Children were given a high level of autonomy when deciding what 336 
to order from restaurants. It has been described by other interviews with parent-child dyads that food 337 
choices are co-constructed between parent and child and nutrition education approaches should take 338 
this into consideration (27). Despite a high level of reliance on kids menus from the families that were 339 
interviewed, many highlighted the need for improvements to be more healthy (e.g., fruits and 340 
vegetables), as well as portioned appropriately.  341 
 342 
Many parents expressed concern for their child while dining out (i.e., acknowledging kids’ menus were 343 
less than desirable, role modeling positive dietary behaviors), yet also were challenged by competing 344 
interests that limited their healthy choices (e.g., price, what foods their child would eat). Efforts are 345 
being made to remedy this. The World Health Organization and the Institute of Medicine have called 346 
for tighter controls on marketing unhealthy foods to children (28,29). The food landscape is ever 347 
changing and more families are seeking healthier options. This increased consumer demand has likely 348 
contributed to corporations making changes. For example, McDonalds recently announced plans to 349 
offer more fruits and vegetables at no added cost to meals and to promote milk and juice as beverages 350 
for kids’ meals (30).  351 
 352 
However, kids meals (including less healthy ones) are likely not to disappear from menus. One 353 
probable reason for reliance on kids menus are they are typically cost controlled for families (i.e., one 354 
set price for items from the kids menu). In larger studies, price has been noted as a major determinant 355 
of purchasing and consumption (31). Pricing interventions may have promise in ultimately affecting 356 
American’s weight outcomes (32). Some real world pricing interventions have been tested with 357 
children (33), but further research in the restaurant setting is needed to establish ideal pricing and menu 358 
options that will be most healthful for consumers. 359 
 360 
Also highlighted in the current paper is the difference between feeding styles at home when compared 361 
to FAFH. Parent participants generally reported allowing more autonomy for their child when selecting 362 
meals at a restaurant when compared to rules and guidelines followed at home, acknowledging less 363 
healthy meal patterns outside of the home. SSBs represent a large portion of the increase in caloric 364 
consumption seen over last few decades (34). Many parent-child dyads in the current study described 365 
limiting SSBs at home, but not as much while eating out. In light of our findings, there still remains an 366 
opportunity to educate parents about SSBs and providing healthier default offerings on menus. 367 
13 
Interventions should target differences between FAFH and foods prepared and consumed in the home, 368 
perhaps with a focus on decreasing SSB consumption outside of the home.  369 
 370 
Many participants in the current study indicated consuming meals in front of the TV. Previous studies 371 
have documented the benefits of family meal time at a table and not in front of the TV (i.e., in terms of 372 
weight, dietary consumption, and social outcomes) (30,31). A concurrent issue, was that parents 373 
expressed concern about the marketing influences on their child’s food preferences and consumption. 374 
Even brief exposures to televised food commercials can influence preschool children's food 375 
preferences (37). As children mature, they become independent consumers, making exposure to 376 
marketing and development of taste preferences very important in these early years. Therefore 377 
interventions aimed at increasing quality family meal time, along with other strategies for increasing 378 
consumption of more healthful foods is warranted.  379 
 380 
Fostering a more positive nutrition environment via parents and role modeling should also be further 381 
examined in the context of consuming more FAFH. Many parents in the current study acknowledged 382 
some nutrition knowledge. Golan and colleagues describe a parent’s nutrition knowledge as one of the 383 
key predictors of the home food environment that helps determine a child’s dietary patterns and 384 
ultimately body weight (38,39). Role modeling positive dietary behaviors (as obtained through 385 
nutrition knowledge) is beneficial and has been demonstrated to results in more healthful dietary 386 
patterns and lower BMIs for youth (40).  387 
 388 
Parents in the current study engaged in a range of feeding styles. An authoritative feeding style has 389 
been shown to be most beneficial in terms of encouraging children to eat dairy, fruit, and vegetables 390 
(41). Alternatively, an authoritarian feeding style has been show to be negatively associated with 391 
child's vegetable consumption (41). Specific to Latino families, healthy eating has been shown to be 392 
greater in children whose parents use positive reinforcement and monitoring, less controlling styles 393 
(18).  394 
 395 
When comparing English- and Spanish- speaking families in the current study, Spanish-speaking 396 
families demonstrated more home cooking and families meals, and less FAFH. Home food availability 397 
is a large determinant of meals consumed at home (42), a simple way that parents are influencing their 398 
children’s meals at home. Previous studies have demonstrated that Latino parents generally have an 399 
awareness and understanding of positive feeding styles and tend to cook more traditional foods at 400 
home (43,44). Differences in feeding style between English- and Spanish-speaking parents were also 401 
revealed in the current study. Similar to other findings, Spanish speaking families reported dining out 402 
fewer times per week and expressed the importance of home cooking, both in terms of tradition and 403 
healthfulness (43,44). Despite this, growing rates of health disparities and obesity exist in Latino 404 
populations (45). Further studies should explore the cultural value of food in Latino cultures and the 405 
resultant dietary behaviors.  406 
 407 
The current study has limitations. The responses from parent-child dyads are only representative of 408 
those 20 parent-child dyads (N=40 participants) sampled in Omaha, NE. However, sampling strategies 409 
targeted a diverse audience, including low-income and English or Spanish participants. Children who 410 
participated in this study were 8-13 year old and these results may not be generalizable to younger or 411 
older age groups. In general, the child interviews were shorter (on average 15 minutes, compared to the 412 
adult interviews which averaged 30 minutes), which generated fewer meaning units from the children. 413 
 414 
Decision-making between parent-child dyads about menu ordering at restaurants is complex. Factors 415 
span the socioecological model – from the individual level (e.g., taste preferences) to the 416 
environmental level (e.g., food marketing). The results of this study can be considered for future 417 
research in understanding the decision-making process for English- and Spanish- speaking parent-child 418 
dyads when ordering from a restaurant menu. Efforts should include understanding the decision-419 
making process and influences at every level of the socioecological model. Findings from this study, 420 
others, and future research will be valuable for families, restaurant owners, nutrition educators, and 421 
policy makers to encourage healthier food choices while eating FAFH in a changing food environment. 422 
Further, intervention studies targeting healthy eating and FAFH can be tailored to address some of the 423 
nuances in feeding style and parent-child co-decision making.  424 
15 
Table 1. Sociodemographics of participants and key characteristics related to foods consumed outside 425 
the home (N=40) 426 
Adults (n=20) Children (n=20) 
Age, n (%)  Age, mean (SD) 10.5 (1.6) 
21 and under 5 (25%)   
22 to 34 10 (50%) BMI percentile, mean (SD) 63 (38.55) 
35 to 44 4 (20%)   
Missing 1 (5%) Sex, n (%)  
Education, n (%)  Male  13 (65%) 
Never Attended 0 Female 7 (35%) 
Grades 1-8 4 (20%) Latino, n (%)  
Grades 9-11 2 (10%) Yes 13 (65%) 
Grades 12 or GED 2 (10%) Race, n (%)  
Some College 3 (15%) White 5 (25%) 
College Graduate 8 (40%) Black 2 (10%) 
Missing 1 (5%) Asian 1 (5%) 
Household Income, n (%)  American Indian or 
Alaskan Native 
1 (5%) 
Less than $10,000 3 (15%) Other 3 (15%) 
$10,000-$19,000 3 (15%) I Don’t Know 2 (10%) 
$20,000-$50,000 7 (35%) Missing 4 (20%) 
$50,000-$100,000 2 (10%)   
Greater than $100,000 3 (15%)   
Missing 2 (10%)   
BMI, mean (SD) 29.1 (6.5)   
Relationship to Child, n (%)    
Mother 15 (75%)   
Father 4 (20%)   
Missing  1 (5%)   
Sex, n (%)    
Male 4 (20%)   
Female 16 (80%) 
 
  
Latino, n (%)    
Yes 11 (55%)   
Race, n (%)    
White 6 (30%)   
Black 2 (10%)   
Asian 1 (5%)   
Other 7 (35%)   
Missing 4 (40%)   
Employment Status, n (%)    
Employed 12 (60%)   
Not Employed 7 (35%)   
Missing 1 (5%)   
 427 
  428 
17 
Table 2. Summary of Key Themes and Categories 429 
Theme Category Example Meaning Unit 
Decision making when dining out 
- Choice of restaurant 
- Choice of meal for child 
“I don’t look at the nutrition. Uh, 
should, but I don’t. I don’t really 
look at the price for the kids 
menu because they’re pretty 
much the same, set prices, and 
just as long as it’s something he’s 
going to eat”. 
Parenting practices and feeding 
style 
 
- Mealtime at home 
- Concern about child’s weight 
status 
- Food as a reward 
- Parents role modeled healthy 
dietary behaviors 
- Negotiation 
- Authoritative Feeding Style 
- Control sugar sweetened 
beverages consumption 
- Overall feeding style 
differences of Spanish-speaking 
parents 
“I’ll try to get her to get the 
vegetable and she’ll want the 
French fries. So sometimes what 
we’ll do, we’ll negotiate and one 
of us will get the French fries and 
one of us will get the vegetables, 
and then she’ll have a little bit of 
it. Like I said, I don’t want her 
sneaking, I don’t want her 
feeling, like, I feel like 
moderation in everything is a 
good idea.” 
Use of and opinions about kid’s 
menu 
- Use of kids menus 
- Lack of healthfulness of menu 
items and changes wanted  
- Decrease portion size 
- Child food preferences 
“I think that they could have 
healthier options, like McDonalds 
getting the apples, but I think that 
they could have healthier and 
maybe not like the fries, they give 
them so many fries, sometimes 
they get more fries than I do and 
that should be the opposite I 
think.” 
Overall influences on food 
choices 
- Marketing’s influence on food 
choices 
- Child as independent consumer 
- Dining out is considered a treat 
- Different feeding styles at home 
compared to restaurant eating 
- Parents concern for nutrition 
and nutrition knowledge 
“…he is picky, he’s a big kid, he 
eats what he wants not what you 
want, if I give him a salad he will 
not eat it at all, if I give him a 
hotdog and chips he will eat it 
right away, its really difficult, you 
live here in American its more 
hard there are more commercials 
all the time and kid want to eat at 
fast food”. 
 430 
 431 
  432 
19 
  433 
• Acculturation 
• Family dining habits at home and outside of the home  
• Parental policies and role modeling related to food 
• Child as an independent consumer 
• Restaurant ordering behaviors (level of autonomy) 
• Perceptions of healthy versus unhealthy foods 
• Perceptions of options available on kids menus 
• Marketing influences on dietary choices 
Figure 1. Domains of Inquiry For Influences on Food Away from Home Among English- and Spanish-Speaking Parent-Child Dyads 
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