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Oh baby! Motivation for healthy eating during parenthood transitions: a longitudinal examination with… Bassett-Gunter, Rebecca L; Levy-Milne, Ryna; Naylor, Patti J; Downs, Danielle S; Benoit, Cecilia; Warburton, Darren E R; Blanchard, Chris M; Rhodes, Ryan E Jul 6, 2013

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RESEARCH Open AccessOh baby! Motivation for healthy eating duringparenthood transitions: a longitudinal examinationwith a theory of planned behavior perspectiveRebecca L Bassett-Gunter1, Ryna Levy-Milne3, Patti Jean Naylor2, Danielle Symons Downs4, Cecilia Benoit2,Darren E R Warburton5, Chris M Blanchard6 and Ryan E Rhodes2*AbstractBackground: Transitioning to parenthood is a major life event that may impact parents’ personal lifestyles, yetthere is an absence of theory-based research examining the impact of parenthood on motives for dietarybehaviour. As a result, we are unaware of the social cognitive variables that predict eating behaviour among thosetransitioning to parenthood. The purpose of the study was to examine eating behaviour motives across 12 monthswithin the framework of the theory of planned behavior (TPB) and compare these across groups of new parents,non-parents, and established parents.Methods: Non-parents (n = 92), new parents (n = 135), and established parents (n = 71) completed TPB questionnairesassessing attitudes, subjective norms, perceived behavioral control (PBC), and intentions and three day food records atbaseline, and 6- and 12-months post-delivery (for parents) and 6- and 12-months post-baseline (for non-parents).Results: Repeated measures ANOVAs revealed that among men, new- and established-parents had greater intentionsto eat healthy compared to non-parents, F(2) = 3.59, p = .03. Among women, established parents had greaterintentions than new- and non-parents, F(2) = 5.33, p = .01. Among both men and women during the first 6-monthspost-delivery, new-parents experienced decreased PBC, whereas established parents experienced increased PBC.Overall, affective attitudes were the strongest predictor of intentions for men (β = 0.55, p < .001) and women (β = 0.38,p < .01). PBC predicted changes in fruit and vegetable consumption for men (β = 0.45, p = .02), and changes in fatconsumption for men (β = −0.25, p = .03) and women (β = −.24, p < .05), regardless of parent status.Conclusion: The transition to parenthood for new and established parents may impact motivation for healthy eating,especially PBC within the framework of TPB. However, regardless of parental status, affective attitudes and PBC arecritical antecedents of intentions and eating behaviour. Interventions should target affective attitudes and PBC tomotivate healthy eating and may need to be intensified during parenthood.Keywords: Theory of planned behaviour, Nutrition, Dietary behaviour, ParenthoodConsuming a diet high in fruits and vegetables and lowin fat is important for maintaining a healthy body weightand preventing obesity-related diseases such as Type-2diabetes, cancer, and cardiovascular disease [1]. Accord-ingly, Canada’s Food Guide [2] recommends that adultsconsume seven to 10 servings of fruits and vegetableseach day to achieve overall health. Further, the guiderecommends that no more than 35% of an adult’s dailycaloric intake come from dietary fat consumption. Des-pite the well-established evidence that fruit and vege-table and fat consumption are important components ofa healthy diet, approximately one half of Canadian adultsfail to meet the respective guidelines [3]. There is a crit-ical need to understand motivation for healthy eating inan effort to design and implement effective interventions[4]. Further, in order to be optimally effective, such in-terventions should be designed to target the most im-portant determinants of healthy eating [4].* Correspondence: rhodes@uvic.ca2Behavioural Medicine Laboratory, Faculty of Education, University of Victoria,PO Box 3015 STN CSC, Victoria, BC V8W 3P1, CanadaFull list of author information is available at the end of the article© 2013 Bassett-Gunter et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of theCreative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,distribution, and reproduction in any medium, provided the original work is properly cited.Bassett-Gunter et al. International Journal of BehavioralNutrition and Physical Activity 2013, 10:88http://www.ijbnpa.org/content/10/1/88Various demographic groups may need targeting fornutritional intervention and new parents may be a crit-ical group. Transitioning to parenthood is a major lifeevent that may impact parents’ personal lifestyles, healthbehaviours and health-related attitudes [5-8]. Indeed,there is a growing body of evidence demonstrating aninverse relationship between parenthood and health be-haviours such as physical activity for both mothers andfathers [9,10]. Parenthood presents increasing demandsrelated to time, finances, fatigue, and childcare, whichmay interfere with motivation for various behaviourssuch as healthy eating [9,11]. For example, 98.6% ofmothers reported that time commitments related tochildcare were a barrier to physical activity [12]. Indeed,perceived barriers are a key predictor of intentions to ex-ercise postpartum [7]. It is plausible that such increaseddemands could also reduce feelings of control overhealthy eating. Although it has not been examined em-pirically, a lack of perceived control could be particularlyevident among new parents who are faced with manyunfamiliar demands. For some people however, the tran-sition to parenthood may trigger a reappraisal of lifestyleand initiate psychological changes related to increasedmotivation for engaging in healthy behaviours [10]. Forexample, many parents have reported enhanced motiv-ation to make positive lifestyle changes following parent-hood transitions in order to create a healthy environmentfor their child(ren) [13].Despite these possibilities, there is an absence oftheory-based research examining the impact of parent-hood on motives for eating behaviour, which hasresulted in a general lack of awareness of how these vari-ables may differ from that of the general population.The use of theoretical approaches to examining thesepredictors would be useful for identifying motives ofnew parents and whether they differ across time com-pared to non-parents and established parents (i.e.,second-time parents). Gaining an understanding oftheory-based predictors of dietary behaviours will facili-tate the development of targeted interventions to im-prove, or prevent declines in, healthy eating amongpeople transitioning to parenthood.The theory of planned behaviour (TPB) [14] has beenrecommended as a valid framework for understandingdietary behaviours such as fruit and vegetable intake andfat consumption [15,16]. In fact, a recent systematic re-view suggests that the TPB is a preferred model forpredicting fruit and vegetable consumption [4]. The TPBexplains that behaviour is the result of one’s intentions(i.e., overall motivation) and perceptions of control overperformance of the behaviour (i.e., perceived behaviouralcontrol; PBC). Intentions are determined by affective (i.e.,emotion-based judgements about the behaviour) and in-strumental attitudes (i.e., perceived benefits and costs ofthe behaviour), subjective norms (i.e., perceptions of sig-nificant others’ preferences about the behaviour), and PBC.The TPB has been applied to the study of eating be-haviours (e.g., fruit and vegetable and fat consumption)across various populations. A meta-analytic reviewfound that, on average, the TPB explains 26.7% of thevariance in dietary behaviour among the general popula-tion [16]. Within individual studies however, the amountof variance in eating behaviour explained by the TPB hasranged from 9% among adult patients at a health clinic[17] to 42% among obese and overweight individuals[18]. PBC has emerged as the strongest predictor of eat-ing behaviours, while attitudes have demonstrated thestrongest prediction of intentions [16].Although TPB has not yet been applied to new parentsand their eating behaviours, it is possible that the predic-tors may be unique [19]. For example, parenthood maybring about improvements in instrumental attitudes to-ward dietary behaviour as parents may reappraise thevalue or benefit of a healthy diet given the potential im-pact it may have on their children. For example, manyparents believe it is wise to consume a healthy diet highin fruits and vegetables in order to act as role models fortheir children [13]. Accordingly, individuals transitioningto parenthood may experience an increase in intentionsto engage in healthy eating. Alternatively, transitioningto parenthood may lead to deteriorations in PBC as par-enthood may introduce or exacerbate barriers such asfatigue and a lack of time [13]. Among new mothers,self-efficacy and intentions predict postpartum exerciseand food intake at one year postpartum [19]. Althoughthis suggests that psychosocial variables such as PBCand intentions may be important predictors of healthyeating among new parents, at present, it is not known iftransitioning to parenthood impacts TPB variables in re-lation to dietary behaviour or how the model predictsdietary behaviour among individuals experiencing par-enthood transitions relative to the general population ornon-parents. Furthermore, it is not known if the effectsof parenthood transitions vary between new (i.e., firsttime parents) and established parents (i.e., second-timeparents). There is some evidence to suggest that vari-ables such as PBC may differ among first-time andestablished parents [8].Thus, the purpose of this exploratory study was toexamine changes in TPB components related to eatingbehaviour among first-time parents across their first yearof parenthood and compare these predictors to estab-lished parents and non-parents. The following explora-tory hypotheses were formed. It was hypothesized thatcompared to non-parents and established parents, newparents would have higher overall attitudes and inten-tions, and lower PBC toward healthy eating. Consistentwith the TPB and previous research [17,20] it wasBassett-Gunter et al. International Journal of Behavioral Nutrition and Physical Activity 2013, 10:88 Page 2 of 11http://www.ijbnpa.org/content/10/1/88hypothesized that attitudes and PBC would predict in-tentions to engage in healthy eating, with attitudes emer-ging as the strongest predictor. It was also hypothesizedthat intentions and PBC would predict changes in eatingbehaviour, with PBC being the strongest predictor [16].Finally because of a lack of existing literature and evi-dence examinations of the moderating role of parent sta-tus were considered exploratory.MethodParticipantsParticipants were men and women from the greaterVictoria metropolitan area in British Columbia, Canada.Participants included non-parents (i.e., individuals withno children, not pregnant; n = 94), new parents (i.e., in-dividuals expecting a first child at baseline; n = 138), andestablished parents (i.e., individuals expecting a secondchild at baseline; n = 74). These three demographicgroups were chosen in order to evaluate potentialunique group differences in motivation for healthy eat-ing. All participants were part of a married or common-law couple (both partners of the relationship engaged asparticipants). Each couple was male–female with the ex-ception of one female-female couple. Non-parents weresignificantly younger and had significantly lower house-hold incomes than new parents and experienced parents.Recruitment of participants took place through in-person enlistment at baby fairs, word of mouth, andposters or pamphlets at parenting services venues (e.g.,prenatal classes, baby stores, fitness centres, informationcentres, and clinics), recreation and community centres,libraries, healthcare centres and doctor and mid-wife of-fices, and coffee shops. Recruitment advertisements werealso posted in local newspapers and online (e.g.,Craigslist). Individuals became ineligible and were notincluded in the final sample if a) they (or their partners)experienced health complications due to pregnancy orbirth (e.g., gestational diabetes, preeclampsia, bed-rest),b) they were non-parents who became pregnant, c) theywere new parents who became pregnant a second timeand chose to not continue as part of the established par-ents’ group. See Figure 1 for a flow diagram outliningparticipant recruitment and drop out. Table 1 displaysthe sample demographics.MeasuresDemographic variablesParticipants indicated to which of the following categor-ies they belonged at baseline: 1) non-parent, 2) new par-ent, or 3) established parent. Participants self-reportededucation by indicating the highest level of educationthey had completed: 1) ≤ 8th grade, 2) some high school,RecruitmentBaseline(pregnancy)Wave 2(6-months)Wave 3 (12-months)Couples droppedN = 6Reasons: too busy (N = 2); broke up (N = 1); no reason (N = 3)Non-parentsCouples N = 47(94 individuals: 47F/47M)New parents Established parentsCouples N = 41(82 individuals: 41F/41M)Couples N = 56(112 individuals: 58F/54M)Couples N = 36(72 individuals: 36F/36M)Couples N = 64(128 individuals: 66F/62M)Couples N = 34(68 individuals: 34F/34M)Couples N = 36 (33)(72 individuals: 36F/36M)Couples N = 69(138 individuals: 71F/67M)Couples N = 37 (35)(74 individuals: 37F/37M)Couples recruited N = 167(334 individuals: 169F/165M)Couples that signed consent then chose to not participate N = 11Couples that became pregnant while in the study (and did not transfer groups) N = 6Couples droppedN = 5Reasons: moved (N = 1); too busy (N = 1); no reason (N = 3)Couples droppedN = 1Reason: no reasonCouples droppedN = 5Reasons: broke up (N = 3); no reason (N = 2)Pregnant; group transfer* (N = 3)Couples droppedN = 5Reasons: health issue (N = 1); moved (N = 1); broke up (N = 1); no reason (N = 2)Couples droppedN = 2Reasons: moved (N = 1); too busy (N = 1)*Couples that transferred into this group N = 3Figure 1 Participant recruitment and drop out.Bassett-Gunter et al. International Journal of Behavioral Nutrition and Physical Activity 2013, 10:88 Page 3 of 11http://www.ijbnpa.org/content/10/1/883) high school diploma, 4) vocational school or somecollege, 5) college /university degree, 6) professional orgraduate degree. Participant age and annual householdincome (dollars/year) were also self-reported.Theory of planned behaviour variablesTPB variable items were in reference to “healthy eatingeach day” which was defined based on Canada’s FoodGuide [2]. Participants were given examples of theGuide’s four food groups (i.e., grain products, milk prod-ucts, fruits and vegetables, meat and alternatives), andthe size and number of daily servings recommended. Atbaseline, expectant parents (i.e., new and establishedparents) were asked to answer each item in relation to“a typical week prior to pregnancy” whereas non-parentswere asked to answer each item in relation to “a typicalweek over the next six months”. At six- and 12 monthassessments all participants were asked to answer itemswithin the context “during the next six months”. EachTPB item was anchored by a 5-point scale (1 stronglydisagree to 5 strongly agree). These items were adaptedfrom previous work examining the TPB in relation toeating behaviour [20,21] and were developed in accord-ance with the recommendations for measuring TPB vari-ables [14].AttitudesAffective attitudes were measured with two itemspresented in the statement “It would be/would havebeen extremely 1) enjoyable and 2) fun for me to eathealthy each day”. Instrumental attitudes were measuredwith two items presented in the statement “It would be/would have been extremely 1) wise and 2) beneficial forme to eat healthy each day”. The items were averaged tocalculate an overall affective attitudes score (Pearson’sr = .71; .65; .70 at baseline, wave two and wave three,respectively) and an overall instrumental attitudes score(Pearson’s r = .60; .76; .72 at baseline, wave two andwave three, respectively).Subjective normsParticipants were instructed to answer questions consid-ering what important people in their lives think theyshould do with regard to eating healthy each day. Theseitems were presented in the statement “The most im-portant people to me definitely 1) think/thought Ishould, 2) want/wanted me to, or 3) themselves eathealthy each day”. Participants then rated their agree-ment with the statement “The following people definitelywould have thought/think I should eat healthy each day:1) extended family, 2) friends, 3) health care workers 4)partner/spouse. The items were averaged to calculate anoverall subjective norms score (Cronbach’s α = .76, .77,.76 at baseline, wave two and wave three, respectively).Perceived behavioural controlParticipants were instructed to answer questions regard-ing their confidence and/or control over eating healthyeach day assuming they wanted to do so. First partici-pants rated their agreement with the following threeitems: 1) I am/could have been completely confident, 2)I am/could have been in complete control, and 3) It willbe/would have been extremely easy for me to…eathealthy each day. Next participants rated their agree-ment with five items presented in the statement “Itwould be/would have been extremely easy for me to eathealthy each day even if 1) I had limited time to preparehealthy food, 2) I didn’t have immediate access tohealthy food, 3) I didn’t like the healthy food available,4) I didn’t have enough money to buy healthy food, 5) Ididn’t have a place to store or prepare healthy food”.The items were averaged to calculate an overall per-ceived behavioural control score (Cronbach’s α = .84, .80,.82 at baseline, wave two and wave three, respectively).Intentions to engage in healthy eatingParticipants rated their agreement with two items re-garding their intentions to eat healthy each day for thenext six months. The statements were presented as “Iam 1) definitely motivated and 2) extremely determinedTable 1 Demographic characteristics at baselineCharacteristicNon-parent (N = 94) First-time parent (N = 139) Established parent (N =74)Women Men Women Men Women MenDemographic profileMean age 27 29.07 31.03 32.98 32.26 34.22(SD) (4.84) (5.34) (4.85) (4.72) (3.98) (5.00)% Visible minority 7.14 11.36 10.45 7.81 6.25 12.5% Completed University 68.18 61.36 83.35 71.21 85.71 74.29% > $75,000 Income 5.26 7.32 6.35 20.31 15.12 20.59% Currently Employed 52.27 71.11 89.71 89.39 74.29 82.86Bassett-Gunter et al. International Journal of Behavioral Nutrition and Physical Activity 2013, 10:88 Page 4 of 11http://www.ijbnpa.org/content/10/1/88to eat healthy each day”. The items were averaged to cal-culate an overall intentions score (Pearson’s r = .72, .72,.80 at baseline, wave two and wave three, respectively).Eating behaviourParticipants completed a three day food record indicat-ing all foods consumed over the course of three con-secutive days (i.e., two weekdays and one weekend day).Participants were instructed to record everything theyconsumed and to maintain normal eating and drinkinghabits over the course of the recall days. The question-naire included detailed instructions, examples, andmeasurement guides. The three day food record hasbeen found to be a valid and reliable measure of dietquality among Canadian adults [22]. Average daily serv-ings for each of the four food groups (i.e., grain prod-ucts, milk products, fruits and vegetables, meat andalternatives) were calculated based on food frequency re-cords and serving sizes outlined by Canada’s food guide[2]. Participants were coded as Meeting the guidelines ifthe number of daily servings for each food group werewithin the recommended ranges (e.g., 2–4 servings ofmilk products). Participants were coded as Not Meetingthe guidelines if the number of daily servings for anyfood group was above or below the recommended range.ProcedureA longitudinal study design was used and included threedata collection waves: 1) Baseline; following recruitmentand during pregnancy for new and established parents,2) Wave Two; 6 months following baseline for non-parents; 6 months post-delivery for new and establishedparents, and 3) Wave Three; 12 months following base-line for non-parents; 12 months post-delivery for newand established parents. Demographic variables wereassessed at baseline. TPB and dietary behaviour wereassessed at baseline, wave two, and wave three. Partici-pants were mailed a package at each of the three datacollection points. The package included the appropriatequestionnaires and a postage-paid return envelope. Eachparticipant received a t-shirt after completing the base-line questionnaire, as well as a $25 honorarium, whichincreased by $5 for each subsequent wave of data collec-tion returned. Data collection was part of a larger study.The study protocol was approved by the institution’sHuman Research and Ethics Review Board, and all par-ticipants provided informed consent.Data analysesPotential covariatesData for men and women were analyzed separately dueto the dyadic nature of the data. Demographic variablessuch as age, income, and education may be associatedwith dietary behaviours [18]. The following analyseswere conducted to examine these potential covariates ofintentions and dietary behaviour; 1) Pearson’s cor-relations were calculated for age and income, 2) aSpearman’s rank correlation was calculated for educa-tion, and 3) an ANOVA was calculated for primarymethod of feeding. All covariates identified were con-trolled for in the appropriate analyses.Changes in TPB variables during parenthood transitionsRepeated-measures ANOVAs were calculated to exam-ine changes in attitudes, subjective norms, PBC, and in-tentions by parent status across the three data collectionwaves (i.e., baseline, 6-months, 12-months).TPB variables predicting intentions to eat healthy; parentstatus as a possible moderatorHierarchical linear regression models were calculatedwith intentions as the dependent variable. The intentionsdata were skewed and submitted to a square root trans-formation to normalize the distribution. Attitudes, sub-jective norms, and PBC variables were zero-centred [23]and entered on the first step of each regression inaddition to parent status. Interaction terms (i.e., productof parent status multiplied by each centred TPB variable)were entered on the second step of each regression usinga step-wise approach. In the presence of a significantinteraction (p < .05), post hoc analyses were conductedto determine the form of the interaction. Separate re-gression equations were calculated for each parent statusgroup, in which intentions were regressed onto the TPBvariable from the significant interaction term. Predictedlevels of the TPB variable were then calculated and plot-ted using the mean intention score, and scores onestandard deviation above and below the mean [24].TPB variables predicting changes in eating behaviour;parent status as a possible moderatorThe original data analysis plan involved the calculationof logistic regression models examining TPB variables aspredictors of Meeting versus Not Meeting Canada’s FoodGuide [2] recommendations. However, there was limitedvariability when treating eating behaviour as a binaryvariable. For example, less than five percent of the sam-ple were meeting the recommended guidelines across allfour food groups at wave 2. Accordingly, two subsequentindicators of eating behaviour were calculated as con-tinuous variables.Average daily fruit and vegetable servingsAverage daily servings of fruits and vegetables werecalculated based on food frequency records and serv-ing sizes outlined by Canada’s food guide [2]. Fruitand vegetable consumption is an important compo-nent of healthy dietary behaviour outlined in Canada’sBassett-Gunter et al. International Journal of Behavioral Nutrition and Physical Activity 2013, 10:88 Page 5 of 11http://www.ijbnpa.org/content/10/1/88food guide recommendations and is a common indica-tor of “healthy eating” within TPB research e.g.,[17,18,20,25,26].Average daily fat consumptionAverage daily grams of fat consumed were calculatedbased on food frequency records. Fat consumption is animportant component of healthy eating behaviour andhas been considered an indicator of “healthy eating”within previous TPB research [17]. Hierarchical linearregression models were calculated with a) fruit and vege-table consumption and b) fat consumption as thedependent variables. These data were skewed and sub-mitted to square root transformations in order tonormalize the distribution. In order to examine changesin eating behaviour, baseline (or 6-month) scores of thedependent variable were entered on step one of each re-gression. Any significant covariates were also entered onstep one. Parent status, PBC, and intentions were en-tered on step two. Affective and instrumental attitudes,and subjective norms were entered on step three. Inter-action terms (the product of parent status multiplied byeach centred TPB variable) were entered on step fourusing a step-wise approach (exclusive to step four).Given the large number of potential interaction effectsand the subsequent likelihood of multicollinearity, thestep-wise approach was deemed most appropriate fortesting interaction terms in this exploratory researchquestion. This approach has been used in previous re-search e.g., [27,28]. In the presence of a significant inter-action (p < .05), post hoc analyses were conducted todetermine the form of the interaction; separate regres-sion equations were calculated for each parent statusgroup, in which the dietary behaviour variable wasregressed onto the TPB variable from the significantinteraction term. Predicted levels of the TPB variablewere then calculated and plotted using the mean dietarybehaviour score, and scores one standard deviationabove and below the mean.ResultsPotential covariatesAge (Men M age = 32.1 years; women M age = 30.1 years)and household income were not significant covariates ofany dependent variable. For men, education was signifi-cantly related to baseline intentions (Spearman’s r = 0.18,p = 0.03) and 12-month fat consumption (Spearman’sr = 0.20, p = 0.04). Analyses involving these dependentvariables were adjusted for participants’ education.Group differences and changes in TPB variables duringparenthood transitionsAdditional file 1: Table S1 displays the results of the re-peated measures ANOVAs examining group differencesand changes in TPB variables. Significant main effectsfor condition indicated that among men, new parentshad greater intentions than non-parents and establishedparents, F(2) = 3.59, p = .03. Among women, new parentshad stronger instrumental attitudes, F(2) = 3.03, p = .05,and intentions, F(2) = 5.33, p = .01, compared to estab-lished parents. Non-parents also had stronger instru-mental attitudes and intentions compared to establishedparents. Significant time by condition interaction effectswere found for PBC among men, F(4,202) = 3.79, p = .01,and women, F(4,210) = 9.64, p < .001. Post hoc analysesindicated that there was a significant decrease in PBCfrom baseline to six-months among new parents, and asignificant increase in PBC from baseline to six-monthsamong established parents.TPB variables predicting intentions to eat healthy; parentstatus as a possible moderatorTable 2 displays results of the final modela of hierarch-ical regression analyses examining predictors of inten-tions. Affective attitudes (AA) and PBC were significantpredictors of intentions among both men, (AA: β = 0.55,p < .001; PBC: β = 0.15, p = .02) and women (AA: β = 0.38,p < .01; PBC: β = 0.27, p = .02). Subjective norms pre-dicted intentions among men (β = 0.16, p = .01),whereas a significant subjective norms by parent statusTable 2 Hierarchical regression of TPB variablespredicting intentions to eat healthyR2 R2Δ p βWomen (N = 144)Final model 0.41 0.03 0.11Parent status −0.22**Affective attitudes 0.38**Instrumental Attitudes 0.22†Subjective norms −0.12PBC 0.27*Affective attitudes x parent status <0.01Instrumental attitudes x parent status −0.17Subjective norms x parent status 0.32*PBC x parent status −0.14Men (N = 145)Final model 0.54 0.53 < 0.01Parent status −0.05Affective attitudes 0.55**Instrumental attitudes 0.09Subjective norms 0.16*PBC 0.15*Note. Model for male participants was adjusted for education. **p < .01,*p < .05, †p < .10.Bassett-Gunter et al. International Journal of Behavioral Nutrition and Physical Activity 2013, 10:88 Page 6 of 11http://www.ijbnpa.org/content/10/1/88interaction was observed for women (β = 0.32, p = .01).Post-hoc analyses indicated that subjective norms werea significant predictor of intentions among new (β = 0.44,p < .001) and established mothers (β = 0.55, p < .001), butnot among non-parent women.TPB variables predicting changes in eating behaviour;parent status as a possible moderatorChanges in fruit and vegetable consumptionTable 3 (women) and Table 4 (men) display results ofthe final modelsa of hierarchical regression analysesexamining predictors of changes in fruit and vegetableconsumption. PBC was the only significant predictor ofchanges in fruit and vegetable consumption from baselineto six-months (β = 0.45, p = .02) among men. Instrumentalattitudes (β = 0.25, p = .02) and parent status (β = −0.26,p < .01) predicted changes in fruit and vegetable con-sumption from 6 to 12-months among men. Amongwomen, a significant main effect of affective attitudes(β = 0.35, p = .01) was superseded by an affective attitudeby parent status interaction (β = −.40, p = .03). Post hocanalyses indicated that affective attitudes were a signifi-cant predictor of changes in fruit in vegetable consump-tion from baseline to six-months among non-parentwomen only (β = 0.58, p < .001). There were no significantpredictors of changes in fruit and vegetable consumptionfrom 6 to 12-months among women.Changes in fat consumptionTable 5 (women) and Table 6 (men) display results of thefinal modelsa of hierarchical regression analyses examiningpredictors of changes in fat consumption. Amongwomen, a significant PBC by parent status interactionwas detected (β = −.28, p = .05). Post hoc analyses indi-cated that PBC was a significant (positive) predictor ofchanges in fat consumption from baseline to six-monthsamong non-parent women only (β = 0.34, p = .04) withhigher PBC predicting higher fat consumption. PBCwas the only significant predictor of changes in fatconsumption from 6 to 12-months among women (β =−.24, p < .05) with higher PBC predicting lower fat con-sumption. Among men, PBC was a significant positivepredictor of changes in fat consumption from baseline tosix-months (β = 0.27, p = .008) and a significant negativepredictor of changes in fat consumption from 6 to 12-months (β = −0.25, p = .03).DiscussionThe purpose of the current study was to examine eatingbehaviour across time within the framework of the TPBand compare social cognitive motives within a group ofnew parents, non-parents and established parents. Toour knowledge this is one of the first studies to longitu-dinally examine eating behaviour motivation within atheoretical framework among men and women experien-cing parenthood transitions.Group differences and changes in TPB variables duringparenthood transitionsIt was hypothesized that compared to non-parents andestablished parents, new parents would have greater atti-tudes and intentions, and lower PBC toward healthy eat-ing. In partial support of our hypothesis, intentions toeat healthy varied by parent status for both men andwomen. For men, new and established parents hadgreater intentions to eat healthy compared to non-parents suggesting that parenthood may have triggeredan increased motivation for healthy eating. Consistentwith previous research, parenthood may facilitate a re-appraisal of lifestyle and initiate psychological changesrelated to increased motivation for engaging in behav-iours such as healthy eating [10]. Some fathers mayrealize that they are role models for their children’s diet-ary behaviour [29] and thus experience increased motiv-ation to eat healthy with the intention of positivelyimpacting their children’s behaviour.For women, established parents had lower intentionsto eat healthy compared to new parents and non-parentsTable 3 Hierarchical regression of TPB variables predicting fruit & vegetable consumption for womenSix-month (N = 116) R2 R2Δ P β 12-month (N = 109) R2 R2Δ p βFinal model 0.21 0.06 <.001 Final model 0.17 0.01 0.68Baseline fruit & vegetable 0.42** 6-month fruit & vegetable 0.39**Parent status −0.05 Parent status −0.02PBC 0.07 PBC 0.15Intentions to eat healthy 0.03 Intentions to eat healthy 0.02Affective attitudes 0.35* Affective attitudes 0.01Instrumental attitudes 0.14 Instrumental attitudes 0.02Subjective norms −0.08 Subjective norms −0.12Affective attitudes x parent status −0.40*Note. **p < .01, *p < .05.Bassett-Gunter et al. International Journal of Behavioral Nutrition and Physical Activity 2013, 10:88 Page 7 of 11http://www.ijbnpa.org/content/10/1/88suggesting a negative impact of multiple children onwomen’s motivation. Many women may be responsiblefor eating behaviour-related chores within a household(e.g., grocery shopping, meal planning and preparation)[30]. Some mothers may find that focusing time and en-ergy on preparing healthy meals for multiple childrenleads to subsequent decreases in motivation for theirown dietary behaviours. Perhaps for many mothers hav-ing more than one child may result in increased de-mands related to time, finances, fatigue, and socialsupport, which may interfere with motivation for healthyeating [31,32]. Further research should examine the ef-fects of multiple children on women’s experiences re-lated to parenting.For both men and women, changes in PBC varied byparent status. Consistent with our hypothesis, new par-ents experienced a decrease in PBC during the six-month post-delivery period. As has been found in thephysical activity domain, this decrease in feelings of con-fidence and control regarding healthy dietary behaviourmay not be surprising as new mothers and fathers facethe demands of parenthood that may impact health be-haviour motivation (e.g., fatigue, limited time) [9]. Newparents may benefit from targeted interventions that aimto enhance PBC during the first six months. Alterna-tively, established parents experienced increased PBCduring the six months following the birth of their secondchild. Based on their experience with the birth of theirfirst child, many established parents may have lackedconfidence and feelings of control as they anticipatedthe demands of a new baby. However, after the arrival ofa second child, these parents may have drawn on previ-ous experience to better cope. PBC as a predictor of ex-ercise behaviour has also been found to vary among firsttime and established parents [8].TPB variables predicting intentions to eat healthy; parentstatus as a possible moderatorIt was hypothesized that attitudes and PBC would pre-dict intentions to engage in healthy eating, with attitudesTable 4 Hierarchical regression of TPB variables predicting fruit & vegetable consumption for menSix-month (N = 119) R2 R2Δ p β 12-month (N = 101) R2 R2Δ p βFinal model 0.09 0.19 0.06 Final model 0.19 0.08 0.05Baseline fruit & vegetable 0.20* 6 −month fruit & vegetable 0.38*Parent status 0.05 Parent status −0.26*PBC 0.45* PBC −0.02Intentions to eat healthy 0.15 Intentions to eat healthy 0.09Affective attitudes −0.01 Affective attitudes −0.21†Instrumental attitudes 0.25 Instrumental attitudes 0.25*Subjective norms −0.19 Subjective norms −0.05PBC x parent status −0.27Intentions x parent status 0.05Affective Attitudes x parent status 0.07Instrumental attitudes x parent status 0.06Subjective norms x parent status 0.20Note. *p < .05, †p < .10.Table 5 Hierarchical regression of TPB variables predicting fat consumption for womenSix-month (N = 121) R2 R2Δ p β 12-month (N = 108) R2 R2Δ p βFinal model 0.07 0.03 0.05 Final model 0.14 0.02 0.44Baseline fat 0.19* 6-month fat 0.38**Parent status 0.12 Parent status 0.11PBC 0.22 PBC −0.24*Intentions to eat healthy −0.11 Intentions to Eat healthy 0.17Affective attitudes 0.07 Affective attitudes −0.13Instrumental attitudes 0.02 Instrumental attitudes 0.11Subjective norms 0.11 Subjective norms 0.07PBC x parent status −0.28*Note. **p < .01, *p < .05.Bassett-Gunter et al. International Journal of Behavioral Nutrition and Physical Activity 2013, 10:88 Page 8 of 11http://www.ijbnpa.org/content/10/1/88emerging as the strongest predictor. In support of ourhypothesis, affective attitudes, instrumental attitudes,and PBC were significant predictors of intentions to eathealthy among men and women. Consistent with previ-ous research [16], affective attitudes were the strongestpredictor of intentions for men (large effect size) andwomen (medium effect size), regardless of parent status.Regardless of parenthood status, it would seem thataffective attitudes should remain the focus of interven-tions targeting motivation for healthy eating for alladults [31]. For example, health messages that emphasisthe enjoyment one may experience from healthy eatingmay be useful to enhance dietary behaviour motivation.Interestingly, subjective norms were a predictor of in-tentions to eat healthy among women who were newparents (medium-large effect size) and established par-ents (large effect size) but not fathers. Previous researchhas demonstrated that subjective norms do not generallypredict intentions to eat healthy among adults [17,20].However, women who are parents may rely on the per-ceived normative beliefs of important others (e.g., healthcare worker, spouse) when forming their intentions toeat healthy. There is evidence that subjective norms areimportant in determining other behaviours such asbreastfeeding among mothers [33,34]. This tendency torely on the perceived beliefs of important others mayrepresent a unique characteristic that warrants targetedintervention to enhance subjective norms (and thusmaximize dietary behaviour motivation) among new andestablished mothers.TPB variables predicting changes in eating behaviour;parent status as a possible moderatorContrary to hypothesis, intentions to eat healthy did notpredict changes in dietary behaviour for men or women,regardless of parent status. This was unexpected giventhat intentions are a key predictor of behaviour withinthe TPB and have been found to predict dietary behav-iour in previous research [17,20,26]. However, this find-ing highlights to the intention-behaviour gap [35] oftenobserved when considering health behaviours within theframework of the TPB and speaks to the relatively weakevidence for intentions as an actual antecedent of behav-iour [35,36]. Future research should continue to examinemotivation for dietary behaviour while also investigatinginterventions to reduce the intention-behaviour gap. Fur-ther, future research should examine other theoreticalconstructs such as planning, self-regulation, habit, andgoal-conflict that may predict health behaviours [37-41].In support of our hypothesis, however, PBC was a sig-nificant predictor of changes in eating behaviour undercertain circumstances. For men, PBC was a positive pre-dictor of changes in fruit and vegetable consumption atsix months suggesting that men who had greater PBCincreased their fruit and vegetable consumption (largeeffect size). For both men and women, PBC was a nega-tive predictor of changes in fat consumption at12 months suggesting that those who had greater PBCdecreased their fat consumption (small-medium effectsize). The relationship between PBC and changes in eat-ing behaviour did not vary by parent status suggestingthat PBC is an important predictor for non-parents, newparents, and established parents. Indeed, evidence froma meta-analysis suggests that PBC is the most importantpredictor of adult eating behaviour [16]. PBC should bea main focus of TPB-based dietary interventions for alladults. Despite having positive attitudes toward healthyeating and intentions to eat healthy, the results of thecurrent study suggest that PBC is critical for im-plementing dietary behaviour change. Although parentstatus did not generally play a significant role inpredicting changes in dietary behaviour, the observed de-crease in PBC among new parents during the first sixmonths post-partum suggests that new parents particu-larly may benefit from interventions that enhance PBCfor healthy eating.Limitations and future directionsDespite the numerous strengths of this work includingthe theoretical framework and longitudinal design, thereTable 6 Hierarchical regression of TPB variables predicting fat consumption for menSix-month (N = 119) R2 R2Δ p β 12-month (N = 101) R2 R2Δ p ΒFinal model 0.06 0.01 0.74 Final model 0.16 0.01 0.66Baseline fat 0.24** 6-month fat 0.38**Parent status 0.04 Parent status 0.15PBC 0.27** PBC −0.25*Intentions to eat healthy 0.05 Intentions to eat healthy 0.12Affective attitudes −0.13 Affective attitudes −0.08Instrumental attitudes 0.02 Instrumental attitudes 0.07Subjective norms −0.05 Subjective norms 0.09Note. 12-Month model adjusted for participants’ education. **p < .01, *p < .05.Bassett-Gunter et al. International Journal of Behavioral Nutrition and Physical Activity 2013, 10:88 Page 9 of 11http://www.ijbnpa.org/content/10/1/88are limitations which warrant mention. As a result of thelow variability when eating behaviour was classified as abinary variable, we used alternative sub-classifications,which may have resulted in reduced correspondenceframing between the TPB and the dependent variable. Inorder to assess variables pre-pregnancy, parents recalleda typical week prior to pregnancy. Alternatively, vari-ables were assessed in the traditional manner for non-parents (i.e., non-parents predicted a typical week in thenext six-months). This methodological difference mayhave introduced a bias in reference to time and could bea potential limitation. Further, there could be additionalbiases between the samples (i.e., beyond parent status)that may account for some of the group-differencespresented in Additional file 1: Table S1. Finally, thelength of the study design permitted measurement ofeating behaviour motivation for only 12-months beyondinitial parenthood. Accordingly, changes in behaviourmotivation beyond 12-months post-partum were notassessed. Future longitudinal research is necessary tofurther understand the long-term impact of parenthoodon eating behaviour motivation.ConclusionIn summary, this is one of the first known studies toexamine eating behaviour across time within the frame-work of the TPB and comparing motives within a groupof new parents, non-parents, and established parents.New and established parents may experience changes inmotivation for healthy eating, especially PBC. However,the same critical antecedents of affective attitude andPBC predict eating behaviour regardless of parent sta-tus. This suggests that TPB interventions are appropri-ate but may need to be intensified during parenthoodtransitions.EndnoteaSee supplementary material (Additional file 2) for allmodels of the hierarchical regression analyses.Additional filesAdditional file 1: Table S1. Repeated Measures ANOVA of TPBVariables by Parent Status.Additional file 2: Table S2. Hierarchical Regression of TPB VariablesPredicting Intentions to Eat Healthy. Table S3. Hierarchical Regression ofTPB Variables Predicting Fruit & Vegetable Consumption for Women.Table S4. Hierarchical Regression of TPB Variables Predicting Fruit &Vegetable Consumption for Men. Table S5. Hierarchical Regression of TPBVariables Predicting Fat Consumption for Women. Table S6. HierarchicalRegression of TPB Variables Predicting Fat Consumption for Men.Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsRBG carried out data analyses and was the primary author responsible formanuscript preparation. RLM, PJN, DSD, DW, CB and RR conceived anddeveloped the study and design, as well as edited the manuscript. RR alsoconsulted on the data analyses and directed data collection. All authors readand approved the final manuscript.Author details1York University, Toronto, ON, Canada. 2Behavioural Medicine Laboratory,Faculty of Education, University of Victoria, PO Box 3015 STN CSC, Victoria, BCV8W 3P1, Canada. 3BC Cancer Agency, Vancouver, BC, Canada. 4ThePennsylvania State University, State College, Pennsylvania, USA. 5University ofBritish Columbia, Vancouver, BC, Canada. 6Dalhousie University, Halifax, NovaScotia, Canada.Received: 17 September 2012 Accepted: 19 June 2013Published: 6 July 2013References1. 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Sniehotta FF: Towards a theory of intentional behaviour change: plans,planning, and self-regulation. Brit J Health Psych 2009, 14:261–273.doi:10.1186/1479-5868-10-88Cite this article as: Bassett-Gunter et al.: Oh baby! Motivation for healthyeating during parenthood transitions: a longitudinal examination with atheory of planned behavior perspective. International Journal of BehavioralNutrition and Physical Activity 2013 10:88.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitBassett-Gunter et al. International Journal of Behavioral Nutrition and Physical Activity 2013, 10:88 Page 11 of 11http://www.ijbnpa.org/content/10/1/88

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