Family structure and risk behaviors: the role of the family meal in assessing likelihood of adolescent risk behaviors

Figures & data

Table 1 Keywords used to search the literature on family meals and adolescent risk behaviors

Sociological Abstracts/Social Sciences Full Text/PsycINFO®/PubMed/MEDLINE 1990–2013
Family Parents Mother Father	and	Meal Breakfast Lunch Dinner Eating Dining	and	Adolescent* Teen* Young adult* Juvenile Youth	and	Risk* behavior* Risk* behaviour* Problem behaviour Problem behavior Depression Violence Delinquency Unintentional injury* Suicide Self injury Self-injury Drug* Substance* Alcohol Tobacco Smoking Drinking Sexual behaviors Sexual behaviours Sexual initiation Sexual debut Unintended pregnancy Unplanned pregnancy Sexually transmitted disease* STD* HIV AIDS School Grades Student dropout* Well being Well-being

Note:

* Keyword truncation.

Abbreviations: STD, sexually transmitted disease; HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome.

Figure 1 Family structure and risk behaviors: the role of the family meal in assessing likelihood of adolescent risk behaviors flowchart.

Table 2 Study details and main effects of family meals on adolescent risk-behavior outcomes

Author	Data	Family meal variable	Outcome	Empirical approach		Significant findings
Eisenberg et al^Citation5	Project EAT (Eating Among Teens)a	“During the past 7 days, how many times did all or most of your family living in your house eat a meal together?” Response categories: never; 1–2 times; 3–4 times; 5–6 times; 7 times; more than 7 times	(1) Academic performance (2) Past-year substance use (3) Self-esteem (4) Depressive symptoms (5) Suicidal ideation/suicide attempts	Logistic regression, stratified by sex	Cross-sectional, adjusted for basic demographics*, family connectedness^, and related outcome variables (if applicable)	Per-unit increase in FMF (1) Academic performance Female aOR: 0.92; CI: 0.87–0.98 (2) Alcohol use Female aOR: 0.83; CI: 0.77–0.90 Male aOR: 0.94; CI: 0.87–1.02 (2) Cigarette use Male aOR: 0.90; CI: 0.83–0.98 (2) Marijuana use Female aOR: 0.84; CI: 0.76–0.94 (4) High depressive symptoms Female aOR: 0.92; CI: 0.86–0.98
Eisenberg et al^Citation9	Project EAT-II (Eating Among Teens)b	“During the past 7 days, how many times did all or most of your family living in your house eat a meal together?” Response categories: never; 1–2 times; 3–4 times; 5–6 times; 7 times; more than 7 times	Past-year substance use	Logistic regression, stratified by sex	Longitudinal, adjusted for basic demographics* and family connectedness^	Regular (5+/week) family meals at baseline Alcohol use (at 5-year follow-up): Female aOR: 0.52; CI: 0.30–0.91 Cigarette use (at 5-year follow-up): Female aOR: 0.48; CI: 0.29–0.81 Marijuana use (at 5-year follow-up): Female aOR: 0.49; CI: 0.25–0.95
Fisher et al^Citation12	Growing Up Today Study (GUTS)c	“How often do you sit down with other members of your family to eat dinner or supper?” Response categories: never or some days compared to 1) most days and 2) every day	(1) Initiation of alcohol use (2) Binge drinking (among initiators) (3) Stage of alcohol uptake	Logistic regression, stratified by sex	Prospective cohort study, adjusted for individual*, family^, and social+ variables	Family dinner every day vs never or some days (1) Alcohol initiation at 1-year follow-up Female aOR: 0.66; CI: 0.50–0.87
Franko et al^Citation23	National Heart, Lung, and Blood Institute Growth and Health Study (NGHS), girls onlyd	“How often do you eat with your parents?” Response categories: never or almost never; sometimes; usually/always	(1) Perceived stress (2) Past-month alcohol use (3) Past-month cigarette use (4) Daily cigarette use#	Chi-square analysis	Longitudinal, adjusted for basic demographics*	FMF (mean/SD) (1) Stress score (years 5/6), P=0.03 Never/almost never: 23.56 (0.52) Sometimes: 24.35 (0.24) Usually/always: 23.41 (0.26) (1) Stress score (year 10), P=0.007 Never/almost never: 23.36 (0.54) Sometimes: 23.20 (0.24) Usually/always: 22.08 (0.26) FMF (% outcome) (3) Past-month cigarette use (years 5/6), P=0.05 Never/almost never: 13.5 Sometimes: 13.1 Usually/always: 9.9
Fulkerson et al^Citation6	Team COOL (Controlling Overweight and Obesity for Life)e	“During the past week, how many days did all or most of the people you live with eat dinner together?” Response categories (continuous): never; 1 day; …; 6 days; every day (categorical): never; 1–4 days; 5–7 days	(1) Past-year substance use (2) Depressive symptoms#	Mixed-model logistic and linear regressions	Cross-sectional, adjusted for basic demographics*, included “school” as a random effect	FDF (mean/SD) (2) Depressive symptom score, P<0.05 Never: 18.7 (0.74) 1–5 days: 17.4 (0.78) 6–7 days: 16.3 (0.52)
Fulkerson et al^Citation29	Project EAT (Eating Among Teens)a	Priority of Family Meal Scale (5 items), with higher scores indicating high priority of shared meals	(1) Depressed mood (2) Self-esteem#	Hierarchical multiple regression, stratified by sex	Cross-sectional, adjusted for basic demographics* and family connectedness^	High priority of family meal (1) Depressed mood Male β=−0.14, P<0.01 (2) Self-esteem Male β=0.09, P<0.05
Fulkerson et al^Citation7	Nationwide (nonrepresentative) studyf	“In an average week, how many times do all of the people in your family who live with you eat dinner together?” Response categories (recoded): 0–1 time; 2–4 times; 5–7 times	(1) Alcohol use (2) Tobacco use (3) Illicit drug use (4) Sexual intercourse (5) Depression/suicide (6) Antisocial behavior (7) Violence (8) School problems (9) Self-esteem (10) Sense of purpose (11) Positive view/personal future#	Logistic regression	Cross-sectional, adjusted for basic demographics* and family connectedness^	5+ Family dinners/week (1) Alcohol use aOR: 0.57; CI: 0.52–0.62 (2) Tobacco use aOR: 0.48; CI: 0.43–0.53 (3) Illicit drug use aOR: 0.46; CI: 0.42–0.51 (4) Sexual intercourse aOR: 0.42; CI: 0.38–0.47 (5) Depression/suicide aOR: 0.60; CI: 0.54–0.65 (6) Antisocial aOR: 0.63; CI: 0.58–0.69 (7) Violence aOR: 0.74; CI: 0.68–0.81 (8) School problems aOR: 0.50; CI: 0.44–0.55 (9) Self-esteem aOR: 1.4; CI: 1.27–1.49 (10) Sense of purpose aOR: 1.5; CI: 1.37–1.61 (11) Positive view/personal future aOR: 1.3; CI: 1.23–1.46
Griffin et al^Citation24	New York City public school studyg	“How often does the family eat dinner together?” (parent report) Response categories: 6-point scale from never (0) to every day (5)	(1) Lifetime substance use (2) Interpersonal aggression (3) Delinquency	Hierarchical multiple regression	Cross-sectional, adjusted for basic demographics* and family connectedness^	Parent-reported dinner together (2) Interpersonal aggression (5-point scale) β=−0.18, P<0.01
Hoffmann and Warnick^Citation25	National Longitudinal Study of Youth (NLSY)h	“In a typical week, how many days from 0 to 7 do you eat dinner with your family?” Response categories (binary): 0–4 days vs 5–7 days Response categories (categorical): 0–2 days; 3–5 days; 6–7 days Response categories (continuous): 0 days; 1 day; …; 7 days	(1) Past-month alcohol use (2) Past-month tobacco use (3) Past-month marijuana use	Multinomial regression models	Longitudinal, adjusted for propensity score matching based on individual, family, and social characteristics+	FDF (categorical) 6–7 dinners/week compared to 0–2 dinners/week: (3) Marijuana use β=−0.038, P<0.05 FDF (continuous) One-unit increase in family dinners/week: (3) Marijuana use β=−0.014, P<0.01
Musick and Meier^Citation8	National Longitudinal Survey of Adolescent Health (Add Health)i	“On how many of the past 7 days was at least one of your parents in the room with you while you ate your evening meal?” Response categories: no days; 1 day; …; 7 days	(1) Depressive symptoms (2) Substance use (ever, since last interview, in past year) (3) Delinquency	Multivariate regression models	Longitudinal, adjusted for basic demographics* and family connectedness^, fixed effects to control for time-invariant individual-level heterogeneity	FDF (fixed effects) (1) Depressive symptoms β=−0.005, P<0.05
Offer^Citation26	Sloan 500 Family Studyj	Per experience sampling method (ESM), respondents report on current activities, specifically if they were eating meals, and if so, who they were with (mom, dad, both parents)	(1) Positive affect (2) Engagement (3) Negative affect (4) Stress	Hierarchal linear models	Adjusted for basic demographics* and family connectedness^	Mealtime with any/both parents (1) Positive affect β=0.16, SE: 0.04 (2) Engagement β=0.22, SE: 0.05 (3) Negative affect β=−0.13, SE: 0.03 (4) Stress β=−0.09, SE: 0.03
Offer^Citation27	Sloan 500 Family Studyj	Per ESM, respondents report on current activities, specifically if they were eating meals, and if so, who they were with (mom, dad, both parents)	(1) Positive affect (2) Engagement (3) Negative affect (4) Stress	Hierarchal linear models, stratified by meal with mom only, dad only, or both parents	Adjusted for basic demographics* and family connectedness^	Meal with mother only (2) Engagement β=0.17, SE: 0.09 Meal with father only (2) Engagement β=0.17, SE: 0.09 (3) Negative affect β=−0.25, SE: 0.05 (4) Stress β=−0.15, SE: 0.06 Meal with both parents (1) Positive affect β=0.18, SE: 0.05 (2) Engagement β=0.27, SE: 0.07 (4) Stress β=−0.16, SE: 0.04
Pearson et al^Citation28	National Longitudinal Survey of Adolescent Health (Add Health)i	“On how many of the past 7 days was at least one of your parents in the room with you while you ate your evening meal?” Response categories: no days; 1 day; …; 7 days	Sexual initiation	Logistic regression	Longitudinal, adjusted for basic demographics* and family connectedness^	FDF (continuous) One-unit increase in family dinners/week: Sexual initiation Total aOR: 0.937; P<0.001 Male aOR: 0.913; P<0.01 Female aOR: 0.961; P<0.05 Non-Latino/white aOR: 0.948; P<0.05
Sen^Citation10	National Longitudinal Survey of Youth (NLSY)h	“In a typical week, how many days from 0 to 7 do you eat dinner with your family?” Response categories: 0 days; 1 day; …; 7 days	(1) Smoking (2) Alcohol consumption (3) Binge drinking (4) Marijuana use (5) Engaging in physical violence (6) Deliberately destroying others’ property (7) Stealing (8) Running away from home (9) Belonging to a gang	Two-part model: (1) binary logistic regression (results presented as “marginal effects” or ME) and (2) log-linear regression	Longitudinal, adjusted for basic demographics*, family connectedness^, and adolescent’s own personal attributes (proxy: FFD in year t + 1)	FDF (continuous) One-unit increase in family dinners/week Part 1 (probability): (1) Smoking Female ME: −0.006, P<0.05 (2) Alcohol consumption Female ME: −0.008, P<0.001 Male ME: −0.005, P<0.10 (3) Binge drinking Female ME: −0.004, P<0.05 Male ME: −0.005, P<0.001 (4) Marijuana use Female ME: −0.003, P<0.10 (5) Engaging in physical violence Male ME: −0.004, P<0.10 (6) Deliberately destroying others’ property Male ME: −0.005, P<0.05 (7) Stealing Male ME: −0.004, P<0.05 (8) Running away from home Female ME: −0.002, P<0.10 Male ME: −0.003, P<0.05 Part 2 (frequency among those with problems): (1) Smoking Male β=−0.043, P<0.05 (4) Marijuana use Female β=−0.054, P<0.05 Male β=−0.052, P<0.05

Notes:

a Project EAT was a survey administered to 31 public middle and high schools in ethnically and socioeconomically diverse communities in urban/suburban areas of Minneapolis/St Paul. 1,608 middle school and 3,074 high school students aged 11–18 years participated during the 1998–1999 school year. Fulkerson et al²⁹ included only a subsample of participants (1,351) who were at risk for being overweight or were overweight (BMI ≥85th percentile based on sex- and age-specific cutoffs)

b project EAT-II attempted to resurvey Project EAT-I sample of middle school students (grades 7 and 8, n=1,608) in Twin Cities, Minnesota during the 1998–1999 school year. Follow-up sample (346 male, 440 female) surveyed at two time points 5 years apart

c GUTS is a prospective cohort study of mothers recruited in 1996 from the ongoing Nurses’ Health Study who had children aged 9–14 years. Final sample is from follow-up questionnaire in 1998 and 1999: 3,283 girls and 2,228 boys

d NGHS is a 10-year longitudinal study of 2,379 black and white girls who were 9 or 10 years old at study entry in 1992. Participants were recruited from three study sites: University of California, Berkeley, University of Cincinnati/Cincinnati Children’s Hospital Medical Center, and Westat/Group Health in Rockville, MD, USA. Girls were interviewed annually between study year 1 and study year 10

e Team COOL is a group randomized trial to evaluate a high school-based intervention to combat obesity by promoting physical activity and healthy eating. Four urban and two suburban alternative high schools in Minneapolis/St Paul metro area participated in 2006 (n=145 students)

f nationwide survey of 99,642 sixth to twelfth grade students from public and alternative schools in 213 cities and 25 states across the US. Most students in the sample were Caucasian, from small towns with educated parents. This sample is not representative, because school districts self-selected to administer the surveys during the 1996–1997 academic year

g survey of two New York City public middle school students. Sample included 228 sixth grade students. Participating parents were also interviewed by phone, and their responses were matched to their child’s survey responses

h NLSY is a nationally representative sample of adolescents aged 12–16 years (n=6,748) on December 31, 1996, coupled with a supplemental oversample of 2,236 black and Hispanic adolescents that are nationally representative of their respective race/ethnicity. Participants have been surveyed repeatedly since 1997, with a low attrition rate

i add Health is a nationally representative sample of adolescents in grades 7–12 in 1994–1995 (wave 1). Wave 2 was conducted in 1996 and wave 3 in 2001–2002. Combination of self-administered, in-school questionnaires and in-home interviews (n=13,841)

j Sloan 500 Family Study is a nonrandom sample of dual-earner middle-class families with children, designed to collect in-depth information about daily experiences of family members at home, work, and school. Families recruited in 1999 and 2000 in eight urban and suburban communities across the US through local ads and posts at local schools. As a mixed-methods study, teenagers (aged 11–18 years) were asked to complete a survey and fill in a time diary using the ESM (alarm watches that signal [beeps] respondents during their waking hours for 7 consecutive days to report and evaluate their activities and emotions in a self-report questionnaire)

# this study also measured other outcome variables, which included some of the following categories: dietary intake, eating disorder behavior, weight status, family support/involvement, peer influence, and school engagement

* basic demographics include most or all of the following: age/school level, race/ethnicity, socioeconomic status (family income, parent education/employment status, family eligibility for public assistance/free or reduced-cost school meals), family composition/structure, number of children in household, study site, and type/size of community

^ family connectedness includes one or more of the following: parental monitoring, parental caring, family support, family communication, family activities, family arguments, parental control, parent–child relationship, and parent involvement

+ social context variables include one or more of the following: peer substance use, own or willing to use an alcohol promotional item (API), talked about alcohol advertisement, Alcohol Expectancy Questionnaire – Adolescent score (propensity to initiate alcohol use), adolescent time use, and physical environment.

Abbreviations: aOR, adjusted odds ratio; CI, confidence interval; BMI, body mass index; FMF, family meal frequency; FDF, family dinner frequency; SE, standard error; ME, marginal effect.

Table 3 Frequency of significant associations between family meals and outcomes of interest

Outcome	Total times analyzed*	Times using unadjusted model	Times controlling for demographic and family characteristics	Times controlling for family/parent connectedness	Times using propensity score matching	Times used other empirical methods to control for time-invariant individual characteristics
Alcohol use	57	5 of 8 significant	11 of 15 significant	14 of 21 significant	0 of 3 significant	5 of 10 significant
Tobacco use	43	6 of 10 significant	6 of 7 significant	12 of 17 significant	0 of 3 significant	3 of 6 significant
Marijuana/illicit drug use	38	6 of 6 significant	6 of 7 significant	12 of 16 significant	2 of 3 significant	4 of 6 significant
Sexual activity	8	–	1 of 1 significant	5 of 7 significant	–	–
Depression/suicide ideation	34	6 of 7 significant	3 of 3 significant	12 of 22 significant	–	2 of 2 significant
Violence/delinquency	53	1 of 1 significant	14 of 17 significant	8 of 19 significant	–	5 of 16 significant
School-related issues	8	2 of 2 significant	1 of 1 significant	3 of 5 significant	–	–
Well-being	32	3 of 4 significant	3 of 3 significant	15 of 25 significant	–	–

Note:

* Note: Total times analyzed includes repeat analyses from the same study if that study was done separately by sex, included separate analysis with multiple measures of family meal variables, or conducted separate analyses for participation versus frequency of outcome variables.

EisenbergMEOlsonRENeumark-SztainerDStoryMBearingerLHCorrelations between family meals and psychosocial well-being among adolescentsArch Pediatr Adolesc Med2004158879279615289253

 PubMed Web of Science ®Google Scholar

EisenbergMENeumark-SztainerDFulkersonJAStoryMFamily meals and substance use: is there a long-term protective association?J Adolesc Health200843215115618639788

 PubMed Web of Science ®Google Scholar

FisherLBMilesIWAustinSBCamargoCAJrColditzGAPredictors of initiation of alcohol use among US adolescents: findings from a prospective cohort studyArch Pediatr Adolesc Med20071611095996617909139

 PubMedGoogle Scholar

FrankoDLThompsonDAffenitoSGBartonBAStriegel-MooreRHWhat mediates the relationship between family meals and adolescent health issuesHealth Psychol200827Suppl 2S109S11718377152

 PubMed Web of Science ®Google Scholar

FulkersonJAKubikMYStoryMLytleLArcanCAre there nutritional and other benefits associated with family meals among at-risk youth?J Adolesc Health200945438939519766944

 PubMed Web of Science ®Google Scholar

FulkersonJAStraussJNeumark-SztainerDStoryMBoutelleKCorrelates of psychosocial well-being among overweight adolescents: the role of the familyJ Consult Clin Psychol200775118118617295578

 PubMed Web of Science ®Google Scholar

FulkersonJAStoryMMellinALeffertNNeumark-SztainerDFrenchSAFamily dinner meal frequency and adolescent development: relationships with developmental assets and high-risk behaviorsJ Adolesc Health200639333734516919794

 PubMed Web of Science ®Google Scholar

GriffinKWBotvinGJScheierLMDiazTMillerNLParenting practices as predictors of substance use, delinquency, and aggression among urban minority youth: moderating effects of family structure and genderPsychol Addict Behav200014217418410860116

 PubMed Web of Science ®Google Scholar

HoffmannJPWarnickEDo family dinners reduce the risk for early adolescent substance use? A propensity score analysisJ Health Soc Behav201354333535223956358

 PubMed Web of Science ®Google Scholar

MusickKMeierAAssessing causality and persistence in associations between family dinners and adolescent well-beingJ Marriage Fam201274347649323794750

 PubMed Web of Science ®Google Scholar

OfferSAssessing the relationship between family mealtime communication and adolescent emotional well-being using the experience sampling methodJ Adolesc201336357758523601623

 PubMed Web of Science ®Google Scholar

OfferSFamily time activities and adolescents’ emotional well-beingJ Marriage Fam20137512641

 Web of Science ®Google Scholar

PearsonJMullerCFriscoMLParental involvement, family structure, and adolescent sexual decision makingSociol Perspect20064916790

 Web of Science ®Google Scholar

SenBThe relationship between frequency of family dinner and adolescent problem behaviors after adjusting for other family characteristicsJ Adolesc201033118719619476994

 PubMed Web of Science ®Google Scholar