The psychometric properties of the Child Feeding Questionnaire (CFQ) in Turkey

Appetite 78C (2014) 49–54

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Research report

The psychometric properties of the Child Feeding Questionnaire (CFQ) in Turkey Nurdan Camcı a, Murat Bas b,*, Aylin Hasbay Buyukkaragoz b a

Department of Nutrition and Dietetics, Health Sciences Faculty, Baskent University, Ankara 06790, Turkey Department of Nutrition and Dietetics, Health Sciences Faculty, Acıbadem University, İçerenköy Mahallesi Kayışdağı Caddesi No:32, Istanbul 34742, Turkey

b

A R T I C L E

I N F O

Article history: Received 11 December 2013 Received in revised form 5 March 2014 Accepted 10 March 2014 Available online 20 March 2014 Keywords: Child Feeding Questionnaire Turkish parents Validity and reliability Turkish CFQ

A B S T R A C T

The purpose of this study was to test the reliability and validity of the Child Feeding Questionnaire (CFQ) among Turkish parents. The questionnaire was administered to 490 participants. Construct validity was assessed by principal component factor analysis with varimax rotation and reliability was tested by Cronbach’s alpha coefficient. For testing criterion-related validity, EAT-40 with DEBQ was also administered to 490 participants. Results showed the presence of seven major factors (perceived responsibility, perceived parent weight, perceived child weight, concern about child weight, pressure to eat, monitoring and restriction) with loadings similar to those of the original questionnaire. Seven subscales of the CFQ had higher internal consistency and test–retest reliability. This study clearly demonstrates the factorial validity and the reliability of a Turkish version of the CFQ. © 2014 Elsevier Ltd. All rights reserved.

Introduction According to the World Health Organization (2006), approximately 155 million school-aged children are currently overweight or obese worldwide. The incidence of Turkish children and adolescents who are overweight is increasing at a rapid rate. Recent data indicate that the proportion of overweight or obese children of both genders has increased markedly in different areas of the world, including Turkey. It is estimated that today, 13.8% of Turkish children are overweight or obese (Cinaz & Bideci, 2003; Oner et al., 2004). The recent increase in the incidence of overweight and obese children/adolescents is a major cause for concern due to the associated morbidities of this disorder. Obesity in early life is predictive of coronary heart disease, hypertension and diabetes in adulthood (Nicklas, Baranowski, Cullen, & Berenson, 2001). Also, overweight children are also at risk of social stigmatization that can lead to abnormal psychosocial development, negative self-image and eating disorders (Davison & Birch, 2001; Mellbin & Vuille, 1989; Troiano & Flegal, 1998; World Health Organization, 2000). In addition, obesity tracks over time; 80% of overweight adolescents become obese adults (Dietz, 1983). Obesity is a multifactorial disorder influenced by genetic, behavioral, environmental and cultural factors (Garipagaoglu et al.,

* Corresponding author. E-mail address: [email protected] (M. Bas). http://dx.doi.org/10.1016/j.appet.2014.03.009 0195-6663/© 2014 Elsevier Ltd. All rights reserved.

2009). Parents can play a central role in shaping the family’s eating environment, which provides a context for the child’s early eating experience (Birch & Fisher, 1998). Some authors have begun to investigate whether the feeding practices exhibited by a parent are reflective of a broader style of parenting, or are specific to the feeding domain. There is a literature that suggests that parents’ feeding practices are broadly linked with their parenting styles (Hughes, Power, Fisher, Mueller, & Nicklas, 2005), and that parenting styles are good predictors of children’s BMI, fruit and vegetable intake, healthier eating, physical activity and sedentary behaviors (e.g. Kremers, Brug, de Vries, & Engels, 2003; Rhee, Lumeng, Appugliese, Kaciroti, & Bradley, 2006). Child-feeding parenting styles have been used to describe interactions between parents and children regarding feeding. A childcentered feeding style resembles an authoritative parenting style in which parents set concrete, age-appropriate expectations for children at meal times, but remain responsive to the child’s needs and behaviors. Parent-centered feeding style is similar to authoritarian parenting, in which there is a high level of parental control over eating and a low level of responsiveness to the child’s needs, including his or her internal hunger or satiety signals. There is an increasing body of research on the role of parenting styles and risk of obesity in young children. Authoritative parenting has generally been associated with a lower risk for child and adolescent obesity as well as an improved consumption of healthful foods when compared with children of parents who used other parenting styles (Stang & Loth, 2011). Longitudinal studies have confirmed these as-

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sociations in children and adolescents (Berge, Wall, Loth, & NeumarkSztainer, 2010; Rhee, 2008). Vegetable intake has not been associated with parenting style, however. Authoritarian parenting style has been linked to an almost fivefold increase in risk for obesity among young children compared with the authoritative parenting style, whereas children exposed to neglectful or permissive parenting had a twofold increased risk of obesity (Rhee, 2008). Child-feeding practices consist of a wide range of behaviors, including modeling eating behaviors (both healthy and unhealthy); coercing or pressuring children to eat specific foods or meals; rewarding behaviors with highly palatable, energy-dense, favorite foods; withholding food as punishment; restricting food intake; concern about or feeling responsibility for a child’s weight; and determining the availability and accessibility of specific foods (both healthy and unhealthy). These behaviors can be assessed with a variety of validated assessment tools, most notably the Child Feeding Questionnaire (Johnson, 2001), the Parental Control Index (Wardle, Carnell, & Cooke, 2005), and the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub, 2007). There is evidence to suggest that child-feeding practices may differ among racial/ethnic groups. Black mothers have been found to recount higher self-reported levels of dietary restriction, concern, responsibility, pressure to eat, monitoring, and concern for child’s weight compared with white mothers (Spruijt-Metz et al., 2002). Research has demonstrated the important role that parent– child interactions in the feeding context have in shaping children’s food preferences and intake patterns. In particular, research demonstrates that using controlling feeding practices with children, such as coercing, rewards, or pressure related to food intake, may have negative effects on the quality of children’s diets by altering a child’s food preferences (Galloway, Fiorito, Francis, & Birch, 2006; Orlet Fisher, Mitchell, Wright, & Birch, 2002). When particular foods are used as rewards for desired behaviors (e.g. a cookie for cleaning one’s plate), the child’s preference for the reward food increases (Birch, Marlin, & Rotter, 1984). In contrast, when a child is pressured to finish eating a particular food with the promise of a reward (e.g. finish your vegetables before dessert), the child’s desire for the food they are being required to eat diminishes (Galloway et al., 2006; Orlet Fisher et al., 2002). The Child Feeding Questionnaire (CFQ) is a self-report measure that assesses parental beliefs, attitudes and practices regarding child feeding, with a focus on obesity proneness in children. The CFQ is applied to mothers with children aged 2–11 years. The original scale was developed by Birch et al. (2001). The CFQ is one of the few existing measures to assess the various aspects of child-feeding attitudes and practices (Birch et al., 2001). Therefore, the Child Feeding Quesitionnaire (CFQ) has been used in a few studies in various communities. Birch et al. (2001) tested the CFQ for mothers in Pennsylvania and found that the questionnaire’s reliability or validity is acceptable. In another study, Scaglioni, Salvioni, and Galimberti (2008) used the CFQ successfully for determining the influence of parental attitudes in the development of children’s eating behavior. Spruijt-Metz, Lindquist, Birch, Fisher, and Goran (2002) used it for evaluating the relation between mothers’ child-feeding practices and children’s adiposity. A recent research study investigated the validity of the CFQ among parents of a multiethnic sample of 10- to 19-year-old adolescents (55% African American, 35% Caucasian and 10% others) by adding one item on the monitoring of sugared beverages and by slightly modifying the specification of the seven-factor model to fit the participants of the specific age range. They concluded that the psychometric properties of the modified CFQ were similar to those of the original CFQ used among parents of 2- to 11-year-old children (Kaur et al., 2006). Following maternal feeding practices throughout childhood and self-feeding practices throughout adolescents and young adulthood would probably supply us with a better understanding of how these practices influence adulthood. However, longitudinal re-

search design limitations are in the great expense and attrition inherent to the longitudinal design. Thus it is unlikely that longitudinal studies will be able to inform us on the influence of maternal childhood practices on adults (Lev-Ari & Zohar, 2013a). We believe that there is a relation between eating attitudes and behaviors of parents and feeding practices for parents. Therefore, we used the Dutch Eating Behavior Questionnaire (DEBQ) and Eating Attitudes Test (EAT) to measure eating attitudes and behaviors of parents. Emotional, external and restrained eating can be reliably and validly assessed with the DEBQ, the construction of which was described in the 1986 paper by Van Strien and colleagues. The DEBQ has been extensively used for assessing eating behaviors in normal weight, overweight or obese (Flament et al., 2012). In addition, The EAT-40 is a 40-item selfreport measure that assesses symptoms of eating disorders and other characteristics associated with eating disorders (e.g. body dissatisfaction and weight concerns). More recent research has supported the use of the EAT as a continuous measure to detect abnormal eating in nonclinical samples of adults (Mintz & O’Halloran, 2000). Lev-Ari and Zohar (2013b) reported that adult BMI, of both women and men, was successfully predicted by the retrospective CFQ, i.e. by recollected maternal feeding practices. For women, recalled maternal pressure to eat in childhood negatively predicted adult BMI, while age contributed positively to BMI, and for men, as for women, the CFQ predicted BMI in adulthood, disordered eating, drive for thinness, and body dissatisfaction. This finding is consistent with that found for adolescent boys: that parents of overweight boys reported higher concern for their sons’ weight and exerted less controlling feeding behaviors on them (pressure to eat and monitoring their food intake) (Brann & Skinner, 2005). Also, Saelens, Ernst, and Ebstein (2000) showed that a mother’s BMI and maternal uninhibited eating were greater influences on her child’s feeding behavior than the obesity or perceived obesity proneness of the child. The original CFQ is used widely in other countries (Corsini, Danthiir, Kettler, & Wilson, 2008), and has been translated into Dutch (Jansen, Mulkens, & Jansen, 2007), Spanish (Mulder, Kain, Uauy, & Seidell, 2009) and Japanese (Geng et al., 2009). Polat and Erci (2010) found that the questionnaire’s reliability and validity is acceptable among rural Turkish populations. However, nothing is known about its validity and reliability among urban Turkish populations. The purpose of this study was to test the reliability and validity of the Child Feeding Questionnaire (CFQ) among Turkish parents. Methods Participants We conducted a cross-sectional survey, with elementary schoolchildren and their parents or guardians accompanying them in Nilüfer City in Bursa Prefecture, Turkey. The children and parents were recruited from three elementary schools. The sample consisted of 490 parents and 240 boys and 250 girls aged between 6 and 12 years (mean = 8.8 years and SD = 1.5) who responded to a survey about their practices. Every student was provided with an addressed envelope containing the Turkish version of the CFQ along with the instructions to complete it. They were required to take it home to be completed by their parents or guardians and to return the completed questionnaire within a week. Neither the names of the parents/guardians or the child were displayed on the questionnaire in order to guarantee their privacy. However, the child’s school identity number was entered in order to ensure possible linkage with other data. Of the total number of students, 135 were either absent on the day of the survey or did not return the questionnaire. Altogether, 490 students and their parents/guardians participated in the current study. Secondly, 150 participants were randomly selected from 490 parents to test the test–retest reliability of the CFQ. The CFQ was administered twice to 150 parents with a one-month in-

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terval in between. The present study was approved by the Human Research Ethics Committee at the University of Baskent. CFQ and translation procedures The CFQ developed by Birch et al. (2001) is a self-report measure used to assess parental beliefs, attitudes and practices regarding child feeding, with a focus on obesity proneness in children. The questionnaire (which in its original form is given to mothers) consists of seven subscales: (1) perceived parental responsibility regarding child’s weight, (2) perceived parental weight during parent’s childhood, (3) perceived child’s weight, (4) concern about child’s weight (concern), (5) maternal restriction of food intake (restriction), (6) maternal pressure to eat (pressure to eat), and (7) maternal monitoring of high-fat food consumption (monitoring). Back-translation techniques were employed to develop languagespecific versions of the CFQ. The translation techniques followed a standardized procedure suggested by Brislin (1986) in which the inventory items and scale were translated from English into the target language by a bilingual researcher. Thereafter, the translated inventory was back-translated by a jury of independent and proficient bilingual academics at the institutions of the authors. The backtranslated versions were then compared with the original English version and any inconsistencies, errors, biases and incongruences highlighted. These inconsistencies were removed in a further translation and the back translation comparison process was repeated until the versions were identical, as recommended by Bracken and Barona (1991). The final versions exhibited no discrepancies with the original English version of the CFQ when back-translated. As an additional check, the translated instruments were independently reviewed by the jurors to confirm whether each item served the purpose of the instrument (Brislin, 1993). The reviewers affirmed that the items from the translated instrument were satisfactory in representing the items from the original English version. Parents’ and children’s anthropometrics Anthropometric measurements of the parent and children were taken in a private room with light clothing and without shoes. Height was measured to 0.1 cm by using a stadiometer and weight was measured to 0.1 kg by weight scale. Body mass index (BMI) was calculated by using the weight (kg)/height (m)2 formula. The Centres for Disease Control 2000 growth charts for children and adolescents were used to identify BMI percentiles. BMI between the 85th and 95th percentile was defined as overweight and BMI at or above the 95th percentile was defined as obesity (Himes & Dietz, 1994). Data collection instruments Dutch Eating Behavior Questionnaire (DEBQ, Van Strien, Frijters, Bergers, & Defares, 1986). This questionnaire consists of 33 items, which measures to emotional (13 items), external and restrained eating (both 10 items). All items had to be rated on a five-point scale from 1 (never) to 5 (very often). Examples of items were: “Do you have a desire to eat when you are irritated?” (emotional eating); “If food smells and looks good, do you eat more than usual?” (external eating); and “Do you try to eat less at mealtimes than you would like to eat?” (restrained eating). The DEBQ scales have high internal consistency, high validity for food consumption, and high convergent and discriminative validity (Van Strien et al., 1986). The reliability and validity of the DEBQ for the Turkish population is determined by Bozan, Bas, and Asci (2011). The DEBQ demonstrated good internal consistency and reliability in the sample (Cronbach’s coefficient α = 0.85). Eating Attitude Test-40 (Garner & Garfinkel, 1979). The EAT-40 is a psychological measure of anorexic/bulimic-like attitudes and

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beliefs. It includes 40 items in which the frequencies of attitudes and beliefs are rated using a six-point scale. A score of 30 and above is commonly used as a cutoff point to identify individuals with anorexia or bulimia (Garner & Garfinkel, 1979). The reliability and validity of the EAT-40 for a Turkish population is determined by Savasir and Erol (1989). The internal consistency coefficient (Cronbach’s alpha) and test–retest reliability of the EAT-40 for a Turkish sample were 0.70 and 0.60, respectively. Savasir and Erol (1989) reported that the EAT-40 has acceptable construct validity. The EAT-40 demonstrated good internal consistency reliability in the sample (Cronbach’s coefficient α = 0.82). Data analysis The factorial structure of the CFQ was examined by exploratory factor analysis. Principal component factor analysis with varimax rotation was conducted. The reliability was tested using Cronbach’s alpha. Pearson product–moment correlation analysis was used to test the criterion-related validity of the CFQ and its test–retest reliability. Results Table 1 indicates the factor structure and standardized loadings for the original CFQ. The factorial validity of the CFQ was tested with principal component factor analysis with varimax rotation. A Kaiser–Meyer–Olkin (KMO) measure of 0.75 indicated a high sampling adequacy for the factor analysis. Bartlett’s test of sphericity, which tests whether the correlation matrix is an identity matrix, yields a high chi-square value of 5988.45 and significance level of P < 0.01. This indicates that the factor model is appropriate. Principal component analysis with varimax rotation determined seven factors, which are perceived responsibility, perceived parent weight, perceived child weight, concern about child weight, pressure to eat, monitoring and restriction. The analysis of data revealed seven factors that in total explain 73.1% of the variance among the scale items. Factor loadings ranged between 0.68 and 0.93. Table 2 indicates the factor–factor correlations. Perceived responsibility was slightly correlated with concern about child weight, pressure to eat and monitoring (P < 0.05). Pressure to eat was slightly correlated with monitoring and restriction (P < 0.05). Criterion-related validity is shown in Table 3. For testing criterion reliability, the Pearson product–moment correlation coefficients were computed among the CFQ scores, child’s BMI, parent’s BMI, EAT-40 and DEBQ scores for participants. The results of the correlation analyses were significant correlation of restraint eating subscale of DEBQ with restraint subscale of the CFQ (r = 0.24; P < 0.01), and child’s BMI with the perceived parent weight (r = 0.13; P < 0.01), perceived child weight (r = 0.23; P < 0.01), pressure to eat (r = –0.29; P < 0.01) and restriction (r = 0.14; P < 0.01) subscales of the CFQ. Also, the results of the correlation analyses showed significant correlation of the EAT-40 score of parents with the perceived parent weight (r = 0.15; P < 0.01), perceived child weight (r = –0.10; P < 0.01), concern about child weight (r = –0.14; P < 0.01) and restriction (r = 0.31; P < 0.01) subscales of the CFQ. Results from the Turkish samples indicated that the CFQ subscales have a high internal consistency and test–retest reliability coefficient. The test– retest reliability of the CFQ was 0.87 for the perceived responsibility subscale, 0.88 for perceived parent weight, 0.91 for perceived child weight, 0.85 for concern about child weight, 0.75 for pressure to eat, 0.91 for monitoring and 0.80 for restriction. Discussion The purpose of this study was to determine the cross-cultural validity and the reliability of the CFQ for Turkish parents. Factor anal-

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Table 1 Factor structure and standardized loadings for the original CFQ. Item

Factor Perceived responsibility

When your child is at home, how often are you responsible for feeding her? How often are you responsible for deciding what your child’s portion sizes are? How often are you responsible for deciding if your child has eaten the right kind of foods? Your childhood (5–10 years old) Your adolescence Your 20s At present Your child during the first year of life Your child as a toddler Your child as a preschooler Your child from kindergarten through second grade Your from child third grade through fifth grade Your child from sixth through eighth grade How concerned are you about your child eating too much when you are not around her? How concerned are you about your child having to diet to maintain a desirable weight? How concerned are you about your child becoming over weight? My child should always eat all of the food on her plate I have to be especially careful to make sure my child eats enough. If my child says “I’m not hungry,” I try to get her to eat anyway. If I did not guide or regulate my child’s eating, she would eat much less than she should. How much do you keep track of the sweets (candy, ice cream cake, pies, pastries) that your child eats? How much do you keep track of the snack food (potato chips, Doritos, cheese puffs) that your child eats? How much do you keep track of the high-fat foods that your child eats? I have to be sure that my child does not eat too many sweets (candy, ice cream, cake or pastries). I have to be sure that my child does not eat too many high-fat foods. I have to be sure that my child does not eat too much of her favorite foods. I intentionally keep some foods out of my child’s reach. I offer sweets (candy, ice cream, cake, pastries) to my child as a reward for good behavior. I offer my child her favorite foods in exchange for good behavior. If I did not guide or regulate my child’s eating, she would eat too many junk foods. If I did not guide or regulate my child’s eating, she would eat too much of her favorite foods.

Perceived parent weight

Perceived child weight

Concern about child weight

Pressure to eat

Monitoring

Restriction

.91 .93 .81 .86 .88 .86 .81 .93 .95 .85 .83 .91 .82 .89 .82 .88 .75 .68 .71 .81 .87 .92 .90 .70 .78 .71 .75 .69 .73 .74 .78

PR, Perceived responsibility; PPW, Perceived parent weight; PCW, Perceived child weight; CN, Concern about child weight; PE, Pressure to eat; MN, Monitoring; RST, Restriction. All loadings were significant at P < .001.

ysis results for determining the validity of the CFQ indicated seven main factors. These seven factors were the same as the sevenfactor structure of Birch et al. (2001). In other words, these Turkish data indicated strong support for the dominant seven-factor structure originally proposed by Birch et al. (2001), with the resultant seven factors explaining 73.1% of the variance. The presence of seven

major factors was in line with the previous study (Geng et al., 2009). Another study among a rural population in Turkey indicated that the seven factors altogether explained 57.6% of the total variance (Polat & Erci, 2010). Most of the items loaded as expected and the factor loadings were comparable to those obtained in the studies of Birch et al. (2001) and Kaur et al. (2006). Similar to Kaur et al.’s

Table 2 Estimated factor–factor correlations for final seven-factor model. Factor

1

2

3

4

5

6

1. Perceived responsibility 2. Perceived parent weight 3. Perceived child weight 4. Concern about child weight 5. Pressure to eat 6. Monitoring 7. Restriction

– 0.01 −0.01 0.14* 0.17* 0.26* −0.01

0.09 −0.10* −0.09* −0.05 0.11*

0.05 −0.14* 0.02 0.02

0.04 0.17* −0.01

0.19* 0.09*

0.20*

Correlations were significant at * P < 0.05.

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Table 3 Descriptive statistics, internal consistency estimates of CFQ subscales, and their correlations with child’s BMI, parent’s BMI, EAT-40 and DEBQ. Factor

PR PPW PCW CN RST PE M

Mean ± SD

3.8 ± 0.7 2.8 ± 0.6 3.0 ± 0.5 3.1 ± 0.5 3.7 ± 0.9 3.4 ± 1.0 4.2 ± 0.8

Range

1–5 1–5 1–5 1–5 1–5 1–5 1–5

Internal consistencya

Correlation coeffcients BMI-C

BMI-P

EAT-40

DEBQ-R

DEBQ-EX

DEBQ-E

0.87 0.88 0.91 0.85 0.80 0.75 0.91

−.04 .13** .23** −.02 .14** −.29** .02

−.04 .17** −.01 −.11* −.27** −.06 −.01

.08 .15** .10* .14** .31** .05 .04

.04 .07 −.07 .02 .24** .01 .09*

.05 .07 −.01 .02 .12** .02 .06

.02 .06 −.01 −.03 .07 .02 −.07

BMI-C, child’s body mass index; BMI-P, parent’s body mass index; EAT-40, Eating Attitudes Test; DEBQ-R, Dutch Eating Behavior Questionnaire-Restraint; DEBQ-EX, Dutch Eating Behavior Questionnaire-External; DEBQ-E, Dutch Eating Behavior Questionnaire-Emotional; PR, perceived responsibility; PPW, perceived parent weight; PCW, perceived child weight; CN, concern about child weight; PE, pressure to eat; MN, monitoring; RST, restriction. ** P < 0.0; * P < 0.05. a Standardized Cronbach’s alpha.

(2006) study with adolescents and Geng et al.’s (2009) study with children, the items of offering food as a reward did not load strongly on the restriction factor. Similar to Japanese parents, it is possible that Turkish parents may not be inclined to reward children of this age with food in exchange for good behavior. The acceptable minimum point was 0.40 for factor loading (Polit & Beck, 2004). Factor analysis yielded that all of the factor loadings were above .40 and factor loading of the items in the scale ranged from .68 to .93. Factor loadings were reported to range from .37 to .95 on the original scale (Birch et al., 2001). The criterion-related validity of the CFQ was tested by examining the relationship between EAT-40 and the DEBQ and subscales of the CFQ. The correlational analysis indicated a significant relationship between EAT-40 and the perceived parent weight, perceived child weight, concern about child weight and restriction subscales of the CFQ. Results indicated that highly disordered eating of parents was related to higher maternal controlling behavior. Similarly, Lev-Ari and Zohar (2013a) reported that the correlations were positive and significant, indicating that retrospective maternal childfeeding practices were related to a less positive outcome for adults; those who perceive themselves as less attractive and have more disordered eating reported higher maternal controlling behavior. Similar to Birch’s work with predominantly Caucasian samples (Birch et al., 2001) and Geng’s work with Japanese samples, we found a positive correlation between parents’ restriction and child BMI in the Turkish sample. Conversely, pressure to eat was negatively correlated with child BMI. The internal consistency values that were obtained in this study were higher than the results of Birch et al. (2001). In addition, the obtained internal consistency was higher than that obtained in the Japanese version (Geng et al., 2009). Alpha coefficients are affected by many factors and therefore may be unsatisfactory in some study groups. George and Mallery (2003) stated that an alpha of .60–.65 may be unsatisfactory, and if the alpha coefficient is .65– .70 it may be acceptable at a minimal level. In our study, the obtained Cronbach’s alpha coefficient was above the cutoff values for an adequate consistency of 0.8 for each scale. These results suggest that no major problems were caused by translating the original CFQ into Turkish. In other words, all individual items contributed to the functioning of their subscale and language differences appeared not to compromise the effectiveness of items. The test– retest reliability coefficients with one month were acceptable ranges. According to Bloxom and Knapp, the acceptable test–retest reliability correlation was within the range 0.55–0.85 (as cited in Waite, Gansneder, & Rotella, 1990). The obtained test–retest reliability values for the CFQ in this study fell within that range. If the items in the Turkish scale were compared with the original scale, the scale was found to be the same as the original scale. This result also questions the procedure of the KMO, which was .75 in this study.

These results indicated that the sample was average enough for performing a satisfactory factor analysis and that further validation (factor solution) could proceed with a similar sample size in the current study. The sample size in this study was adequate for factor analysis. The present paper also examined the relationships between parental practices assessed by the adapted CFQ and child body mass index. Parents’ feeding practices have been found to be related to children’s individual characteristics, including age, sex, weight status and eating behavior (Birch & Ventura, 2009). In general, parental control of feeding practices, especially restrictive feeding practices, tends to be associated with overeating and poorer selfregulation of energy intake in preschool-age children (Savage, Fisher, & Birch, 2007). As expected, this study demonstrated that children’s BMI was positively related to restriction, perceived parent weight and perceived child weight scores. Using parents’ reports, positive associations were found between restriction and BMI, and negative ones between pressure to eat and BMI in young children (Davison & Birch, 2001; Birch & Fisher, 20001; Geng et al., 2009, Monnery-Patris et al., 2011) and in adolescents (Kaur et al., 2006). In a recent study, Musher-Eizenman and Holub (2007) showed that parents who are concerned by their child’s overweight status reported more restriction. By contrast, parents concerned by their child’s thinness reported less restriction of weight control and more pressure to eat. Excessive parental control and pressure to eat may also influence dietary intake and disrupt children’s short-term behavioral control of food intake. In our study, negative significant correlations were observed between BMI and pressure-to-eat scores. Longitudinal studies have reported that higher levels of parental control and pressure to eat were associated with lower fruit and vegetable intakes (Orlet Fisher et al., 2002) and higher intake of dietary fat (Lee & Birch, 2002) among young girls. Finally, feeding styles involving low demand and low responsiveness to the child are considered neglectful, whereas those with low demand and high responsiveness to the child are indulgent. These permissive styles of feeding would logically appear to engender overnutrition and overweight among those children exposed to the current dietary environment of abundance (Savage et al., 2007). This study has some limitations. The most important limitation is its retrospective nature. It could be argued that retrospective reports are prone to innate bias. This study clearly demonstrates the factorial validity and the reliability of a Turkish version of the CFQ. The CFQ has useful implications in clinical practice. The Turkish version of the CFQ will enable identification of parental beliefs or attitude related to child’s obesity proneness, and parental control practices and attitudes regarding child feeding. Assessment of the CFQ of mothers should be an essential part of healthcare practice. In conclusion, the findings support further item development and adaptation of the instrument to improve its internal consistencies

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