Pester Power: Examining Children’s Influence as an Active Intervention Ingredient

Abstract

Objective:

To determine if children’s “pester power” related to a classroom-based nutrition program, Together, We Inspire Smart Eating (WISE), is related to familial dietary habits and parental food purchases and practices.

Methods:

Classroom teachers delivered weekly WISE lessons at seven Head Start sites across two states in the Southern United States. Pre- and post-intervention, parents were interviewed on consumption of WISE fruits and vegetables, intake of nutrient-poor foods, parenting practices related to food, and exposure to WISE through the child’s “pester power”.

Results:

After controlling for baseline levels of outcome variables, child willingness to try new foods at baseline, and the effect of state, “pester power” predicated significant variance in the outcomes of consumption of WISE foods [F(3, 229) = 34.7, p<.001, ΔR² = .03, p =.002] and parenting practices that support healthy dietary intake and attitudes for young children [F(2, 264) = 77.2, p<.001, ΔR² = .02, p =.006].

Conclusions and Implications:

Findings of this study highlight the potential for children’s influence on food consumptions and habits at home.

Introduction

Children often have the ability to exert influence on familial food purchasing decisions by repeatedly asking parents and caretakers for products not routinely purchased for the family. The degree of influence varies by setting, product, and family characteristics (e.g., female or male oriented household, parenting style, parental education).^1–7 This influential phenomenon is known as ‘pester power.’⁸ A growing body of research examining the pester power children wield to influence familial purchasing within the context of children’s nutrition recognizes that most foods promoted to children are energy-dense, nutrient-poor, and contradict national and international dietary guidelines.⁹ Unfortunately, these are the types of foods parents most identify purchasing for their children when pester power is presented in a supermarket setting.^3–6,10 With childhood obesity rates continuing to climb in the United States and worldwide,¹¹ an enhanced understanding of the control pester power has on childhood nutrition is important, particularly in the early years of development.

The pester power of children is well documented in marketing and advertising research and is increasingly being considered in regards to the nutritional habits and obesogenic environments of children. In an early, groundbreaking study,¹² 58% of observed grocery store interactions were initiated by children, of which 32% resulted in demands for high-caloric foods. Another more recent study found that 80% of parents, whose children regularly accompanied them to the supermarket, admitted to spending more when children were present.⁶ In qualitative interviews, parents reported pester power as 1 of 4 strategies that children utilized to influence familial food purchases; others included ‘trolley loading,’ ‘discussion,’ and ‘bribery.’⁶ Parents stated that their children ‘tend just to whine on until I give in,’ while children stated, ‘I would just annoy her. Then, she would buy me it.’⁶

Pester power may have a long-term influence on children’s health. The consequences of pester power on child diet and weight were examined quantitatively in a sample of 13,217 parent-child dyads from 8 European countries with children 2–9 years old. In this large study, children whose parents reported sole responsibility of selecting food products for their family were healthier than children who had a say in the selection process. The latter group had a higher body mass index and higher propensities to consume sugar and fat than the former.¹³ Together, these studies illustrate the child’s influential ability on familial purchasing and the potential detrimental effect that pester power can have on a child’s nutritional health.

Marketing is likely to influence the foods that children pester parents to buy. Most foods marketed to children are structured around palatability, convenience, and novelty and are more likely to be advertised through television and digital marketing.¹⁴ In 2011, 73% of ads used familiar characters to promote foods; most of which (72%) were low in nutritional value.¹⁵ These observations are consistent with observed strategies of food marketers to target children (e.g., animation, characters, humor, hedonistic themes, incentives, competitions).⁹ Further, in a series of interviews with parents,¹⁶ participants stated that unhealthy and unplanned food purchases were prompted by several factors. These included: unavoidable displays for high-calorie, low-nutrition food at the entrance or checkout area; the placement of high-caloric, low-nutrient dense foods at eye-level and within the child’s reach from the grocery cart; and the lack of displays for and the inaccessibility of healthier alternatives for children.¹⁶ Harnessing marketing to benefit child nutrition has not been fully explored.

Fostering a nutrient-rich diet early in childhood is an important focus the prevention of adult obesity.¹⁷ Unfortunately, findings show that more and more children are not consuming recommended levels of nutrient dense foods. Thus, there is a recognized need for¹⁸ nutritional programming in the early childcare setting to regularly expose children to healthy food options.¹⁹ Together, We Inspire Smart Eating (WISE) is such a program.^20–22

This study aimed to examine if children’s pester power related to changes in intake of WISE foods (e.g., fruits, vegetables), changes in nutrition practices by parents, or changes in intake of nutrient-poor foods (i.e., sugary treats, fast food). Providing an enhanced understanding of the factors that increase the purchasing and consumption of healthy foods may better guide efforts to harness pester power as a tool to empower healthy decisions in the home.

Method

Intervention

The WISE program aims to influence parent-child discussions of food and family food purchasing decisions by equipping children with new knowledge, attitudes, and skills using hands-on food experiences. Initially designed using the USDA recommendations for low-income families,²³ WISE incorporates concepts from the socio-ecological model to address multiple determinants in children’s environments.²⁴ The WISE program also uses a puppet mascot to excite and engage children²⁵ (i.e., market) and to increase the likelihood that children will bring WISE information home; thus influencing pester power in a positive fashion, consistent with behavioral economic theory. The WISE mascot only promotes fruits and vegetables to children to ensure responsible use of marketing methods, and teachers often use the mascot to encourage children to talk with their families about WISE foods. The WISE program includes training of best nutrition practices for early childhood educators and staff, detailed hands-on classroom food experiences, extension activities, a puppet, and direct parent engagement materials. The WISE program highlights 8 fruits and vegetables, and materials are designed to build upon the skills developed in the previous unit. WISE outlines specific learning objectives in line with the curriculum standards for preschool age children for each lesson.^20–22

All study activities and consent processes were approved by the IRB at the University of Arkansas for Medical Sciences and Louisiana Tech University. For this study, classroom teachers delivered weekly WISE lessons at seven Head Start sites across two states in the Southern United states. The agency in Arkansas served families who were primarily white (70%) with an additional 18% African American and 12% other/mixed/unknown families; 17% of families were Hispanic. The agency in Louisiana served families that were primarily African American (64%) followed by white (26%) and 10% other/mixed/unknown families; 5% of families were Hispanic. See prior publications for additional intervention detail.^20–22

Measures

Parents of preschool age children were interviewed by trained research assistants before and after their child’s exposure to WISE. Parent interviews were designed to gauge the family’s purchasing habits of WISE foods and nutrient-poor foods, as well as the dynamics of parent-child conversations regarding food consumption.

Parents reported child intake of WISE foods using a modified food frequency questionnaire.²⁶ Interviewers asked about the number of times WISE fruits and vegetables were eaten by children in the past month using a 1 (never) to 9 (2+ times per day) scale. Intake of WISE foods was calculated as the mean frequency of intake of the following fruits and vegetables: apples, tomatoes, sweet potatoes, strawberries, carrots, bell peppers, spinach, greens, green beans, and blueberries. Higher scores indicated more consumption of the WISE foods.

Parents reported on child intake of nutrient-poor foods (e.g., sugary sweets, fast food, sugary drinks, and unhealthy snack foods). These four items were taken from the Family Map Inventory,²⁷ which assess strengths and needs of families served by Head Start programs or other agencies. The term “junk food” was used with parents in the interview to denote foods that are low in nutritional value. Dietary items from the Family Map have demonstrated adequate test-retest reliability in prior study.²⁷ Total intake of nutrient-poor foods was calculated as the mean frequency of intake of each of these items using a 1 (none) to 5 (more than once per day) scale as obtained from parents.

Parenting practices were assessed with a subset of items (N = 4) from the Fruit and Vegetable Parenting Practices Questionnaire.²⁸ Items assessed how often parents asked their child to select fruit and vegetables, praised their child when he/she ate fruit and vegetables, let their child decide which fruits and vegetables he/she would eat when served, and asked their child to choose fruits and vegetables for meals and snacks on a 1 (never) to 5 (always) scale. Cronbach’s alpha at baseline was .65, and post was .68. Higher scores indicated parenting practices that were more supportive of child intake of fruits and vegetables.

Parents reported on 3 items related to their child’s acceptance of new foods using items from the Toddler-Parent Mealtime Behavior Questionnaire,²⁹ which was developed and validated by the Nutrition Education Aimed at Toddlers (NEAT) team to assess behaviors in families with children between 1- and 4-years-old.³⁰ These items included the child’s willingness to try new foods, the child’s acceptance of new foods, and the child’s interest in tasting new foods on a 1 (never) to 5 (always) scale. Cronbach’s alpha at baseline was .88. Higher scores indicated greater willingness to try and this was included in analytic models as a control variable.

For pester power, the mean frequency of scores on a 1 (never) to 6 (everyday) scale was calculated from the following 3 items: ‘How often did you (1) Hear your child talk about Windy Wise?; (2) Hear your child talk about fruits and vegetables they are discussing at school?; and (3) Buy fruits and vegetables because your child asks for them?’ These items were developed to be specific to the WISE intervention. Cronbach’s alpha at post was .69. Higher scores indicate higher levels of pester power.

Analysis

To analyze the effect of pester power on WISE food intake, nutrient-poor food intake, and nutrition parenting practices, 3 hierarchical regressions were used. Hierarchical regressions were used to examine the effect of pester power on WISE outcomes above and beyond other relevant variables; a statistical test for the change in the R² value (F_change) was used to assess the contribution of pester power beyond other predictors. Assumptions for regressions were examined using recommend procedures.³¹ Normality was assessed by examining skewness (min = −0.78, max = 0.81) and kurtosis (min = −0.83, max = 1.59); scatterplots assessed linear associations between dependent and independent variables; and scatterplots assessed homoscedasticity by the shape of the distribution for plots of the predicted residual of the outcome (y-axis) against the standardized residual value (x-axis). Cronbach’s alpha was calculated as an indicator of internal consistency of scales; higher values indicate greater internal consistency.³² Significance was evaluated at the .05 alpha level.

In step 1 for the regression analyses, pre-test values of each outcome were controlled for as was the child’s pre-test value of willingness to try new foods and the effect of state. In step 2, pester power was entered to the model. For parenting practices, only the pre-test value was controlled for in step 1 followed by pester power in step 2. A sensitivity analysis was conducted to determine the impact of missing data by comparing models using listwise deletion and Full Information Maximum Likelihood (FIML) estimation. Results did not differ by approach, and results are presented using listwise deletion (N = 233–268) across the 3 regression analyses. Interclass correlation coefficients (ICC) values estimating the effect of nesting within site on the dependent variables indicated the following: ICC_WISEtfood = .01, ICC_{NutrientPoorfood} = 03, ICC_Parenting = .16. Analyses accounting for nesting provided the same results in terms of the significance of overall models and individual predictors as we report below. We report the hierarchical regressions given their ability to provide the incremental F-tests for each block of predictors, a test not possible in nested analyses.

Results

The demographics of the sample by state are presented in Table 1. The strength of the association between the pre- and post-test variables can be found in Table 2. Table 3 depicts the results of the 3 hierarchical regression models. For WISE food intake at post-test, step 1 explained a significant amount of the variance (R² = .31) and yielded a significant model (F(2, 230) = 34.7, p<.001) with pre-test WISE food intake (t = 8.8, p < .001) and state (t = 2.3, p = .02) as significant predictors. In step 2 (F(3, 229) = 29.3, p <.001), pester power was a significant predictor (t = 3.1, p = .002), and the model yielded a significant increase in variance explained (ΔR² = .03, p =.002). Pre-test WISE food intake remained a significant predictor (t = 8.6, p < .001), but state did not.

Table 1.

Child and Family Demographics by State

	Arkansas %	Louisiana %
Child Sex
Female	52	50
Male	48	50
Race
African American	29	20
Caucasian	70	52
Ethnicity
Hispanic	31	3
Biological Parent	93	95
Parent Education
< High School Degree	27	12
High School or GED	52	20
Vocational/Technical Certificate	9	11
Associates Degree or Some College	10	25
College Degree	3	32

Table 2.

Pearson correlation coefficient matrix of pre-test and post-test outcome variables (N = 233).

	M	SD	Pre-test WISE Food	Pre-test Nutrient-Poor food	Pre-test parenting practices	Pre-test willingness	Pester power	Post-test WISE food	Post-test nutrient-poor food	Post-test parenting practices
Pre-test WISE food	2.98	0.90
Pre-test nutrient-poor food	3.20	0.72	.12
Pre-test parenting practices	3.83	0.78	.26**	−.03
Pre-test willingness	4.00	0.85	.43**	−.03	.34**
Pester power	3.84	1.14	.21**	−.01	.48**	.36**
Post-test WISE food	3.37	1.01	.54**	.13*	.24**	.27**	.31**
Post-test nutrient-poor food	3.36	0.69	.08	.47**	.00	−.02	−.02	.12
Post-test parenting practices	3.93	0.71	.16*	.01	.67**	.31**	.50**	.25**	.02

Note.

^*p <.05,

^**p <.01,

^***p <.001

Table 3.

Hierarchical regressions with pester power predicting post-test consumption in the home and parenting practices with pre-test controls.

	Post-Intervention WISE Food Intake N =233						Post-Intervention Nutrient-Poor Food Intake N =268						Post-Intervention Parenting Practices N =267
	Model 1			Model 2			Model 1			Model 2			Model 1			Model 2
Variables	B	SEB	β	B	SEB	β	B	SEB	β	B	SEB	β	B	SEB	β	B	SEB	β
Step 1: Pre-test
Pre-test assessment of dependent variable	.60	.07	.53***	.58	0.7	.52***	.47	.06	.47***	.47	.06	.47***	.50	.05	.55***	.45	.05	.50***
Pre-test child willingness	−.03	.07	−.03	−.05	.06	−.05	.003	.04	.004	.00	.04	.00	-	-	-	-	-	-
State	.28	.12	.14*	.13	.13	.06	−.002	.10	−.002	−.02	.10	−.01	.32	.08	.21***	.26	.08	.17**
Step 2: Post-test
Pester power				.16	.05	.19**				.02	.04	.03				.09	.03	.15**
R2	.31***			.34***			.22***			.22***			45***			.47***
ΔF in R2				9.43**						0.19						7.68**

Note.

^*p <.05,

^**p <.01,

^***p<.001;

Three two-step hierarchical regressions were used. Pester power was entered in step 2 after controlling for the pre-test value of the outcome and state in step 1 along with pre-test child willingness to try new foods for the first two outcomes only.

For intake of nutrient-poor foods at post-test, the amount of variance explained did not change from step 1 after adding pester power in step 2 (R² = .21), and pester power did not emerge as a significant predictor. Only pre-test intake of nutrient-poor foods predicted post-test intake in both models (t_Model1 = 8.3, p < .001; t_Model2 = 8.2, p < .001). For parenting practices at post-test, step 1 explained a significant amount of the variance (R² = .45) and yielded a significant model (F(1, 265) = 109.3, p<.001) with both pre-test parenting practices (t = 10.7, p < .001) and state as significant predictors (t = 4.1, p < .001). The addition of pester power in step 2 (F(2, 264) = 77.2, p<.001) led to a significant increase in variance explained (ΔR² = .02, p = .006), and pester power emerged as a significant predictor (t = 2.8, p = .006). Both pre-test parenting practices (t = 9.2, p < .001) and state (t = 3.1, p = .002) remained as significant predictors. The distribution of responses to the pester power items are presented in Table 3.

Discussion

Our study demonstrated that children’s pester power explained a significant portion of the variance in the residual change of children’s dietary intake and parenting practices after one school year of exposure to the WISE intervention. Findings of this study suggest that pester power may be related to how children responded to the intervention. That is, after controlling for baseline levels of outcome variables and key characteristics of the child, pester power predicted significant variance in the outcomes of consumption of WISE foods and parenting practices that support healthy dietary intake and attitudes for young children. This study contributes to understanding of the influence children may have in parent-child interactions. Past studies have focused largely on the behavior of parents acting as an agent to control and define the child’s environment. By further exploring the role of a child as an agent of change on a parent’s decision-making, this study aids in laying the groundwork for future studies to explore the bi-directionality of child-parents interactions.

Intervention studies have centered on contextualizing parenting styles and practices within existing psychological perspectives to empower parents to effect healthful change for the child. Purposeful interventions to support the child in positive changes to the environment have been examined less often.³³ This study recognizes the need for a conceptual framework that encompasses nuanced aspects of the parent-child relationship regarding nutrition.³⁴ The current study assesses the pester power of children in lower socioeconomic households being served by Head Start programs, making our sample socio-economically homogenous. Increased incidence of food insecurity within our sample (relative to higher income groups) may have altered the relative influence and incidence of children pestering parents for WISE foods. The significant effect of state on the parenting practice outcome in the presence of all other predictors suggests this as a viable future consideration given the difference in racial distribution for the states in this study.

Advertisements aimed directly at children have long been an area of ethical concern.³⁵ Child marketing becomes especially concerning when familiar characters promote consumption of food that is calorically-dense and nutritionally-poor. In an analysis of television advertisements presented during major child broadcasting networks, 72% of foods promoted by characters were found to be of suboptimal quality; 53% of these suboptimal products were presented as healthy options within the ad.¹⁵ Many of the same basic concepts that have made child advertising so successful, such as mascot use, have now been incorporated into health education programs like WISE.^36–38 However, an important distinction between general child-marketing pester power and pester power brought on by programs like WISE is in the context in which the message is presented. The WISE program provides the young consumers with a knowledge base of healthy decision making first and then encourages product purchasing secondly. This is in direct opposition to most child marketing which presents product first and health cues as a secondary factor in purchasing.

This study has both limitations and strengths. First, it is limited by a relatively small sample, the self-report nature of the results, a limited number of sites of the intervention, its non-randomized, pre-post design, and the use of intervention-specific measures of the focal predictor. While the sample was small, the study included a diverse sample from 2 southern states. Further, although self-report is common, it is difficult for some parents to report on the consumption of food by very young children, and the nature of the interview by educators may have contributed to a social desirability bias. However, the use of the same method at both time points increases the likelihood that the observed residual change was not attributable to measurement characteristics. Further, the lack of a control group limits the ability to make causal claims about findings of this study. Although the association between the intake of nutrient-poor foods and pester power was weakly linear, findings for this outcome were not significant. All other assumptions were verified with clarity. Finally, this study, like many intervention studies, is limited by lack of prior validation of adapted and developed measures that were specific to the WISE intervention. WISE was developed specifically for programs and schools serving high-risk children from resource-poor backgrounds. The study was conducted in Head Starts and publicly-funded programs, which have a range of resources lacking in other childcare programs; therefore, findings may not be generalizable to other settings. An advantage of the WISE curriculum is that it is consistent with Head Start standards in preschool and the Fresh Fruit and Vegetable Program (FFVP) in Kindergarten and first grade. Both Head Start and FFVP are found in all 50 States and US territories, which creates opportunities for the expansion of WISE.

Implications for Research and Practice

This study’s findings suggest that children’s pester power may contribute to improvements in their family’s food environments. Additional studies using objective measures would be useful to confirm these findings. Future studies can also provide insight into what components of educational programs specifically predict successful pester power. More specifically, comparison of pester power effects with that of other strategies to engage families (e.g., parent nights, backpack education) may prove beneficial. Finally, future studies could benefit from analyzing the association between ethnicity, food security, socioeconomic status of families, and the influence of pester power. Practitioners of nutrition education may consider pairing learning activities with the use of a friendly, familiar character when working with children to increase the likelihood that children ask their families for healthy foods.

Figure 1.

Distribution of Responses to Pester Power Items