Systematic review of the effects of family meal frequency on psychosocial outcomes in youth

Megan E. Harrison; Mark L. Norris; Nicole Obeid; Maeghan Fu; Hannah Weinstangel; Margaret Sampson

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Figure 1
Systematic review process: Articles that were identified, excluded, and included.

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Table 1

Design and characteristics of studies reviewed

STUDY	N VALUE	DATA SOURCE AND SETTING	PARTICIPANT CHARACTERISTICS	STUDY DESIGN	OUTCOMES MEASURED	DEFINITION OFFFM	PSYCHOSOCIAL MEASURES
Franko et al,¹⁵ 2008	2379	Girls from California, Cincinnati, and Maryland aged 9 or 10 y at study entry who participated in the NGHS	Girls only Mean age at the start of the study was 9.5 y Mean age at 10 y was 18.6 y	Longitudinal data collected annually for 10 y as part of the NGHS Measures administered in alternating years Participant retention at 10 y was 89% Family meals data were obtained at 1 y and 3 y and the main outcome measures were obtained at 5 y, 6 y, and 10 y	Disordered eating behaviour, body image concern, and substance use	“How often do you eat with your parent(s)?” FFM not defined	EDI—the drive for thinness, body dissatisfaction, and bulimia subscales Perceived Stress Scale Family Adaptability and Cohesion Evaluation Scale III— the cohesion subscale Coping Strategies Inventory Various questions to assess FMF and demographic characteristics
White and Halliwell,¹⁶ 2010	550	Students (aged 11–16 y) in grades 7, 9, and 10 from comprehensive state schools based in an urban area of the UK	Ethnically and socioeconomically diverse Males (n = 274), females (n = 276) Mean (SD) age was 14.13 (1.09) y	Cross-sectional data collected Sex, date of birth, height, weight, and parental employment were self-reported by participants Self-reported questionnaires were used to assess FMF, family connectedness, family mealtime environment, and alcohol and tobacco consumption	Substance use	“During the past seven days, how many times did all, or most, of your family living in your house eat a meal together?” FFM defined as ≥ 5 times per wk	Family Eating Attitudes and Behavior Scale Various questions to assess demographic characteristics, FMF, familial factors, and alcohol and tobacco consumption
Fulkerson et al,¹⁸ 2006	99 462	Students in grades 6–12 from public and alternative schools in the US (213 cities, 25 states)	Ethnically diverse Males (n = 49 138), females (n = 49 620)	Cross-sectional data collected during the 1996–1997 school year Profiles of student life; Attitudes and Behaviors survey administered in classrooms by participating school districts	Disordered eating behaviour, depressive symptoms or suicidality, self- esteem, academic achievement, substance use, and violent behaviour	7 times per wk	Profiles of student life; Attitudes and Behaviors survey Various questions chosen to assess substance use, depressive symptoms, suicidality, violence, academic problems, FMF, and demographic variables
Neumark-Sztainer et al,¹⁹ 2004	4746	Adolescents from the urban and suburban school districts of Minneapolis who participated in Project EAT	Ethnically diverse Males and females Mean (SD) age was 14.9 (1.7) y	Cross-sectional data collected during the 1998–1999 school year Project EAT survey administered by staff (RR 81.5%); height and weight assessed	Disordered eating behaviour	“During the past 7 days, how many times did all, or most, of your family living in your house eat a meal together?” FFM defined as ≥ 5 meals per wk	Specific questions developed for the Project EAT study were based on adolescent focus group findings, a review of existing instruments, expert revisions, a social-cognitive theoretical framework, and pilot tests
Fisher et al,³⁰ 2007	5511	Cohort of children who participated in GUTS across the US GUTS participants are the children of women taking part in the Nurses’ Health Study II	Males (n = 2228), females (n = 3283) Age range was 11–18 y	Longitudinal data collected in 1996 and in 1998 and 1999, examining predictors of alcohol initiation and binge drinking Starting in 1996, GUTS follow-up self-report questionnaires were mailed to participants annually In 1998 and 1999, the alcohol use section of the questionnaire was expanded and administered to participants (RR 70%)	Substance use	“How often do you sit down with other members of your family to eat dinner or supper?” FFM not defined	Alcohol Expectancy Questionnaire— adolescent version Harter Self-Perception Profile for Children Various questions to assess demographic, family, and social context variables, and alcohol use behaviour
Haines et al,³² 2010	13 448	Cohort of children who participated in GUTS across the US Participants in GUTS are the children of women taking part in the Nurses’ Health Study II	Males (n = 5913), females (n = 7535) Mean (SD) age (Time 1) was 11.9 (1.6) y	Longitudinal data collected in 1996, (Time 1, baseline), 1997 (Time 2), 1998 (Time 3), and 1999 (Time 4) Self-administered questionnaires were mailed to participants annually	Disordered eating behaviour	“How often do you sit down with other members of your family to eat dinner or supper?” FFM not defined	Youth Risk Behaviour Surveillance Questionnaire McKnight Risk Factor Survey Various questions to assess variables such as FMF, parental weight teasing, and importance of thinness to parents
Fulkerson et al,³³ 2009	145	At-risk adolescents from urban and suburban alternative high schools in Minneapolis who participated in the COOL pilot study	Ethnically diverse Males (52%), females (61%) Mean (SD) age was 17.2 (1.2) y	Cross-sectional data collected in 2006 as baseline data for the Team COOL pilot study Trained research staff administered a psychosocial survey to students during class; height and weight measurements were also recorded	Disordered eating behaviour, depressive symptoms, and substance use	“During the past week, how many days did all, or most, of the people you live with eat dinner together?” FFM defined as 5–7 meals per wk	Specific questions came from previously published surveys
Sen,³⁴ 2010	8984	Youth (aged 12–16 y) who participated in the National Longitudinal Survey of Youth	Nationally representative sample of the US population Youth aged ≤ 14 y as of December 31, 1996, who were living with at least 1 parent Sex numbers not specified	Longitudinal data collected from 1997 to 2000	Substance use and violent behaviour	Youth were asked to report the number of days in a typical week their family ate dinner together FFM not defined	Audio Computer-Assisted Self-Interview
Woodruff and Hanning,³⁵ 2009	3223^*	Students in grades 6–8 from 86 schools across northern and southern Ontario and Nova Scotia	Males (n = 1454), females (n = 1548)	Cross-sectional data collected during the 2005–2006 school year Web-based Food Behaviour Questionnaire was administered (RR varied by region or city and ranged from 34%–98%)	Disordered eating behaviour, body image concern, and self-efficacy	“Typically, how many days per week do you eat dinner or supper with at least one parent?” FFM defined as ≥ 6 d per wk	Food Behaviour Questionnaire Various questions to assess FMF, body image concern, and self-efficacy
Eisenberg et al,³⁶ 2004	4746	Adolescents from the urban and suburban school districts of Minneapolis who participated in Project EAT	Ethnically diverse Males and females Mean (SD) age was 14.9 (1.7) y	Cross-sectional data collected during the 1998–1999 school year Project EAT survey administered by staff during class (RR 81.5%); height and weight assessed	Self-esteem, academic achievement, depressive symptoms or suicidality, and substance use	“During the past 7 days, how many times did all, or most, of your family living in your house eat a meal together?” FFM defined as ≥ 5 meals per wk	Rosenberg Self-Esteem Scale Various questions to assess FMF, family factors, academic performance, depression, suicidality, and sociodemographic factors
Sierra-Baigrie et al,³⁷ 2009	259	Secondary school students aged 12 to 21 y from Avilés, a town in northern Spain	Males (58.3%), females (41.7%) Mean age was 14.72 y	Cross-sectional data were collected in the form of various self-reported questionnaires assessing topics including bulimic symptomatology, psychosocial competencies, emotional and behavioural problems, and family meal patterns Researchers administered the questionnaires within classrooms to students in groups of 25–30	Disordered eating behaviour	“With what frequency do you eat the midday meal at the table with the family members who are at home?” “With what frequency do you eat the evening meal at the table with the family members who are at home?” FFM not defined	Bulimic Investigatory Test, Edinburgh Youth self-report Various questions to assess FMF and binge-eating episodes
Neumark-Sztainer et al,³⁸ 2008	2516	Adolescents from urban and suburban school districts in Minneapolis who participated in Project EAT-I and Project EAT-II	Ethnically and socioeconomically diverse Males (n = 1130), females (n = 1386) Mean (SD) age of middle school participants: Time 1 was 12.8 (0.8) y; Time 2 was 17.2 (0.6) y Mean (SD) age of high school participants: Time 1 was 15.8 (0.8) y; and Time 2 was 20.4 (0.8) y	Longitudinal data collected during the 1998–1999 school year (Time 1) and again in 2003–2004 (Time 2) Time 1: Project EAT-I survey administered by staff (RR 81.5%) Time 2: Project EAT-II survey distributed via mail and self-administered (RR 68.4%)	Disordered eating behaviour	“During the past 7 days, how many times did all or most of your family living in your house eat a meal together?” FFM defined as ≥ 5 meals wk	Specific questions developed for the Project EAT study were based on adolescent focus group findings, a review of existing instruments, expert revisions, a social-cognitive theoretical framework, and pilot tests
Neumark- Sztainer et al,³⁹ 2007	2516^†	Adolescents from urban and suburban school districts in Minneapolis who participated in Project EAT-I and Project EAT-II	Ethnically and socioeconomically diverse Males (n = 1130), females (n = 1386) Mean (SD) age of middle school participants: Time 1 was 12.8 (0.8) y; Time 2 was 17.2 (0.6) y Mean (SD) age of high school participants: Time 1 was 15.8 (0.8) y; Time 2 was 20.4 (0.8) y	Longitudinal data collected during the 1998–1999 school year (Time 1) and again in 2003–2004 (Time 2) Time 1: Project EAT-I survey administered by staff (RR 81.5%) Time 2: Project EAT-II survey distributed via mail and self-administered (RR 68.4%)	Disordered eating behaviour	“During the past 7 days, how many times did all, or most, of your family living in your house eat a meal together?” FFM defined as ≥ 5 meals per wk	Specific questions developed for the Project EAT study were based on adolescent focus group findings, a review of existing instruments, expert revisions, a social-cognitive theoretical framework, and pilot tests
Eisenberg et al,⁴⁰ 2008	806	Adolescents from middle schools (grades 7–8) in Minnesota who participated in Project EAT-I and then in Project EAT-II	Ethnically and socioeconomically diverse Males (n = 366), females (n = 440) Mean (SD) age at Time 1 was 12.8 (0.8) y; at Time 2 was 17.2 (0.6) y	Longitudinal data collected during the 1998–1999 school year (Time 1) and again in 2003–2004 (Time 2) Time 1: Project EAT-I survey administered by staff Time 2: Project EAT-II survey distributed via mail and self-administered (RR 69.5%)	Substance use	“During the past 7 days, how many times did all, or most, of your family living in your house eat a meal together?” FFM defined as ≥ 5 meals wk	Specific questions developed for the Project EAT study were based on adolescent focus group findings, a review of existing instruments, expert revisions, a social-cognitive theoretical framework, and pilot tests

COOL—Controlling Overweight and Obesity for Life, EDI—Eating Disorders Inventory, FFM—frequent family meals, FMF—family meal frequency, GUTS—Growing Up Today Study, NGHS—National Heart, Lung, and Blood Institute Growth and Health Study, Project EAT—Project Eating Among Teens, RR—response rate, UK—United Kingdom, US—United States.
↵* Results based on a sample size of N = 3025 owing to participant exclusions.
↵† Results are based on a subset of patients who were overweight or who participated in binge eating or extreme weight-control behaviour, which consisted of 577 females and 312 males (total N = 889).

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Table 2

Main findings of studies reviewed: A) Studies in which results differed between sexes; B) Studies in which sex was not specified.

A) STUDY IN WHICH RESULTS DIFFERED BETWEEN SEXES	OUTCOMES MEASURED	MAIN FINDINGS
A) STUDY IN WHICH RESULTS DIFFERED BETWEEN SEXES	OUTCOMES MEASURED	FEMALES	MALES
Franko et al,¹⁵ 2008	Disordered eating behaviour, body image concern, and substance use	There was a statistically significant inverse association between FMF and bulimia symptoms, body dissatisfaction, drive for thinness, and cigarette smoking FMF was not significantly associated with extreme weight-control behaviour nor with alcohol consumption	NA
Neumark-Sztainer et al,¹⁹ 2004	Disordered eating behaviour	There was a statistically significant inverse association between FMF and extreme and less extreme weight-control behaviour and chronic dieting FMF was not significantly associated with binge eating	There was a statistically significant inverse association between FMF and extreme and less extreme weight-control behaviour (this relationship with less extreme weight-control behaviour was only present after adjusting for BMI and sociodemographic factors) FMF was not significantly associated with binge eating nor with chronic dieting
Fisher et al,³⁰ 2007	Substance use	There was a statistically significant inverse association between FMF and alcohol initiation (ie, girls who ate a family meal every day were 50% less likely to initiate alcohol use than those who ate a family meal some days or never)	FMF was not significantly associated with alcohol initiation
Haines et al,³² 2010	Disordered eating behaviour	There was a statistically significant inverse association between FMF and purging, binge eating, and chronic dieting	There was a statistically significant inverse association between FMF and binge eating and FMF and chronic dieting FMF was not significantly associated with purging
Sen,³⁴ 2010	Substance use and violent behaviour	There was a statistically significant inverse association between FMF and smoking, marijuana use, alcohol use, and physical violence	There was a statistically significant inverse association between FMF and smoking, marijuana use, alcohol use, and physical violence
Neumark-Sztainer et al,³⁸ 2008	Disordered eating behaviour	There was a statistically significant inverse association between FMF and extreme and less extreme weight-control behaviour, binge eating, and chronic dieting	FMF was not significantly associated with extreme weight-control behaviour, binge eating, or chronic dieting FMF was statistically significantly associated with an increased likelihood of less extreme weight-control behaviour (ie, skipping meals and eating very little food)
Eisenberg et al,³⁶ 2004	Self-esteem, academic achievement, depressive symptoms or suicidality, and substance use	There was a statistically significant inverse association between FMF and low self-esteem, a low grade point average, high depressive symptoms, suicidal thoughts, suicide attempts, cigarette use, marijuana use, and alcohol use	There was a statistically significant inverse association between FMF and a low grade point average, high depressive symptoms, suicidal thoughts, cigarette use, marijuana use, and alcohol use FMF was not significantly associated with low self-esteem
Neumark-Sztainer et al,³⁹ 2007	Disordered eating behaviour	FMF was statistically significantly associated with extreme weight-control behaviour and binge eating	FMF was not significantly associated with extreme weight- control behaviour nor with binge eating
Eisenberg et al,⁴⁰ 2008	Substance use	There was a statistically significant inverse association between FMF and cigarette, marijuana, and alcohol use	FMF was not significantly associated with cigarette, marijuana, and alcohol use

B) STUDY IN WHICH SEX WAS NOT SPECIFIED	OUTCOMES MEASURED	MAIN FINDINGS

White and Halliwell,¹⁶ 2010	Substance use	There was a statistically significant inverse association between FMF and tobacco smoking and alcohol use
Fulkerson et al,¹⁸ 2006	Disordered eating behaviour, depressive symptoms or suicidality, self-esteem, academic achievement, substance use, and violent behaviour	There was a statistically significant inverse association between FMF and purging, binge eating, depression or suicide risk, alcohol use, drug use, tobacco use, and violent behaviour FMF was statistically significantly positively associated with increased self-esteem and increased commitment to learning
Woodruff and Hanning,³⁵ 2009	Disordered eating behaviour, body image concern, and self-efficacy	No association was found between FMF and dieting There was a statistically significant inverse association between FMF and skipping meals (specifically breakfast) and with concern about high body weight FMF was statistically significantly positively associated with increased self-efficacy for healthy eating both at home with family and at social events with friends
Fulkerson et al,³³ 2009	Disordered eating behaviour, depressive symptoms, and substance use	There was a statistically significant inverse association between FMF and skipping a meal (specifically breakfast) and depressive symptoms FMF was not significantly associated with extreme and less extreme weight-control behaviour, nor with cigarette, marijuana, alcohol, or illicit drug use
Sierra-Baigrie et al,³⁷ 2008	Disordered eating behaviour	FMF was not significantly associated with binge eating