Clustering of attitudes towards obesity: a mixed methods study of Australian parents and children

International Journal of Behavioral Nutrition and Physical Activity

John Petkov²  Sophie Lewis¹  Samantha Thomas³  Tim Olds² 

[1] Faculty of Health Sciences, Cumberland Campus, University of Sydney, Sydney, Australia;Health and Use of Time (HUT) Group, University of South Australia, GPO Box 2471, 5001 Adelaide, SA,Australia;School of Health and Society, Bldg 234 (iC Enterprise 1), Innovation Campus, University of Wollongong, Northfields Ave, 2522 Wollongong, NSW, Australia

关键词: Social marketing;    Family;    Adolescents;    Adults;    Attitudes;    Obesity;   

Others  :  806264
DOI  :  10.1186/1479-5868-10-117

 received in 2013-04-15, accepted in 2013-09-18,  发布年份 2013

【 摘 要 】

Background

Current population-based anti-obesity campaigns often target individuals based on either weight or socio-demographic characteristics, and give a ‘mass’ message about personal responsibility. There is a recognition that attempts to influence attitudes and opinions may be more effective if they resonate with the beliefs that different groups have about the causes of, and solutions for, obesity. Limited research has explored how attitudinal factors may inform the development of both upstream and downstream social marketing initiatives.

Methods

Computer-assisted face-to-face interviews were conducted with 159 parents and 184 of their children (aged 9–18 years old) in two Australian states. A mixed methods approach was used to assess attitudes towards obesity, and elucidate why different groups held various attitudes towards obesity. Participants were quantitatively assessed on eight dimensions relating to the severity and extent, causes and responsibility, possible remedies, and messaging strategies. Cluster analysis was used to determine attitudinal clusters. Participants were also able to qualify each answer. Qualitative responses were analysed both within and across attitudinal clusters using a constant comparative method.

Results

Three clusters were identified. Concerned Internalisers (27% of the sample) judged that obesity was a serious health problem, that Australia had among the highest levels of obesity in the world and that prevalence was rapidly increasing. They situated the causes and remedies for the obesity crisis in individual choices. Concerned Externalisers (38% of the sample) held similar views about the severity and extent of the obesity crisis. However, they saw responsibility and remedies as a societal rather than an individual issue. The final cluster, the Moderates, which contained significantly more children and males, believed that obesity was not such an important public health issue, and judged the extent of obesity to be less extreme than the other clusters.

Conclusion

Attitudinal clusters provide new information and insights which may be useful in tailoring anti-obesity social marketing initiatives.

【 授权许可】

   
2013 Olds et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Australian Bureau of Statistics: 2007–08 National health survey. Canberra: Commonwealth of Australia; 2009.
• [2]Olds T, Tomkinson G, Maher C, Ferrar K: Trends in the prevalence of childhood overweight and obesity in Australia between 1985 and 2008. Int J Obes 2010, 34(1):57-66.
• [3]National Preventative Health Taskforce: Obesity in Australia: a need for urgent action. Canberra: National Preventative Health Taskforce; 2008.
• [4]Access Economics: The growing cost of obesity in 2008: three years on. Canberra: Diabetes Australia; 2008.
• [5]Puhl RM, Heuer CA: The stigma of obesity: a review and update. Obesity 2009, 17(5):941-964.
• [6]Puhl RM, Heuer CA, Brownell KD: Stigma and social consequences of obesity. In Clinical obesity in adults and children. 3rd edition. Edited by Kopelman PG, Caterson ID, Dietz WH. Oxford: Wiley-Blackwell; 2010:25-40.
• [7]Olds T, Maher C, Zumin S, Peneau S, Lioret S, Castetbon K, Bellisle , de Wilde J, Hohepa M, Maddison R, Lissner L, Sjoberg A, Zimmermann M, Aeberli I, Ogden C, Flegal K, Summerbell C: Evidence that the prevalence of childhood overweight is plateauing: data from nine countries. Int J Pediatr Obes 2011, 6(5–6):342-360.
• [8]Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, Mardell J, Parry V: Foresight. Tackling obesities: future choices - project report. United Kingdom: Government Office for Science; 2007.
• [9]Australian Institute of Health and Welfare: Australia’s health 2012. Canberra: AIHW; 2012.
• [10]The Social Research Centre: Evaluation of the Australian better health initiative measure Up social marketing campaign phase 1. Canberra: Department of Health and Ageing; 2010. August, Page i
• [11]Andreasen AR: Social marketing in the 21st century. Thousand Oaks, California: Sage Publications, Inc; 2006.
• [12]Brownell KD, Schwartz MB, Puhl RM, Henderson KE, Harris JL: The need for bold action to prevent adolescent obesity. J Adolesc Health 2009, 45(3 Suppl):S8-S17.
• [13]Brownell KD, Kersh R, Ludwig DS, Post RC, Puhl RM, Schwartz MB, Willett WC: Personal responsibility and obesity: a constructive approach to a controversial issue. Health Aff (Millwood) 2010, 29(3):379-387.
• [14]Dorfman L, Wallack L: Moving nutrition upstream: the case for reframing obesity. J Nutr Educ Behav 2007, 39(2 Suppl):S45-S50.
• [15]Walls HL, Peeters A, Proietto J, McNeil JJ: Public health campaigns and obesity - a critique. BMC Public Health 2011, 11:136. BioMed Central Full Text
• [16]Barry CL, Brescoll VL, Brownell KD, Schlesinger M: Obesity metaphors: How beliefs about the causes of obesity affect support for public policy. Milbank Q 2009, 87(1):7-47.
• [17]Taylor P, Funk C, Craighill P: Americans see weight problems everywhere but in the mirror. Philadelphia: Pew Foundation Social Trends Report; 2006.
• [18]Oliver JE, Lee T: Public opinion and the politics of obesity in America. J Health Polit Policy Law 2005, 30(5):923-954.
• [19]Sugerman S, Backman D, Foerster SB, Ghirardelli A, Linares A, Fong A: Using an opinion poll to build an obesity-prevention social marketing campaign for low-income Asian and hispanic immigrants: report of findings. J Nutr Educ Behav 2011, 43(4):S53-S66.
• [20]Schlesinger M: Weighting for godot. J Health Polit Policy Law 2005, 30(5):785-801.
• [21]Hardus PM, van Vuuren CL, Crawford D, Worsley A: Public perceptions of the causes and prevention of obesity among primary school children. Int J Obesity Related Metab Disorders 2003, 27(12):1465-1471.
• [22]Lund TB, Sandoe P, Lassen J: Attitudes to publicly funded obesity treatment and prevention. Obesity 2011, 19(8):1580-1585.
• [23]Covic T, Roufeil L, Dziurawiec S: Community beliefs about childhood obesity: its causes, consequences and potential solutions. J Public Health 2007, 29(2):123-131.
• [24]Sikorski C, Luppa M, Schomerus G, Werner P, König H, Riedel-Heller S: Public attitudes towards prevention of obesity. PLoS ONE 2012, 7(6):e39325.
• [25]Wang C, Coups EJ: Causal beliefs about obesity and associated health behaviors: results from a population-based survey. Int J Behav Nutr Phys Act 2010, 7:19. BioMed Central Full Text
• [26]Creswell JW, Zhang W: The application of mixed methods designs to trauma research. J Trauma Stress 2009, 22(6):612-621.
• [27]Creswell J: Research design: qualitative, quantitative, and mixed methods approaches. 3rd edition. Lincoln: Sage Publications, Inc; 2009.
• [28]Department of Health and Ageing: Australian national children’s nutrition and physical activity survey: main findings. Canberra: ACT: Prepared by the Commonwealth Scientific and Industrial Research Organisation (CSIRO) and the University of South Australia for the Department of Health and Ageing; 2008.
• [29]Cole TJ, Flegal KM, Nicholls D, Jackson AA: Body mass index cut offs to define thinness in children and adolescents. Br Med J 2007, 335(7612):194.
• [30]Malik H, Garrett R, Olds T: Mums, media and fat kids: from placenta to lunchbox. In Children and childhoods 2: images of childhood. Edited by Wyver S, Whiteman P. Newcastle upon Tyne: Cambridge Scholars Press; 2012:114-132.
• [31]Thomas SL, Lewis S, Hyde J, Castle D, Komesaroff P: “The solution needs to be complex.” obese adults’ attitudes about the effectiveness of individual and population based interventions for obesity. BMC Public Health 2010, 10:420. BioMed Central Full Text
• [32]Thomas S, Hyde J, Karunaratne A, Herbert D, Komesaroff P: Being ‘fat’ in today’s world: a qualitative study of the lived experiences of people with obesity in Australia. Health Expect 2008, 11(4):321-330.
• [33]Hartigan JA, Wong MA: Algorithm AS 136: a k-means clustering algorithm. J R Stat Soc Ser C Appl Stat 1979, 28(1):100-108.
• [34]Bishop C: Neural networks for pattern recognition. Oxford: Oxford University Press; 1995.
• [35]Strauss AL, Corbin JM: Basics of qualitative research: techniques and procedures for developing grounded theory. Thousand Oaks: Sage Publications; 1998.
• [36]Barr ELM, Magliano DJ, Zimmet PZ, Polkinghorne KR, Atkins RC, Dunstan DW, Murray SG, Shaw JE: AusDiab 2005: the Australian diabetes, obesity and lifestyle study. Tracking the accelerating epidemic: its causes and outcomes. Melbourne: International Diabetes Institute; 2006.
• [37]Australian Bureau of Statistics: Year book Australia. Canberra: Commonwealth of Australia; 2001.
• [38]World Health Organization: WHO global infobase: data for saving lives. Geneva: World Health Organization; 2012. https://apps.who.int/infobase/ webcite
• [39]Bonfiglioli CM, Smith BJ, King LA, Chapman SF, Holding SJ: Choice and voice: obesity debates in television news. Med J Aust 2007, 187(8):442-445.
• [40]Holland K, Blood R, Thomas S, Lewis S, Komesaroff P, Castle D: ‘Our girth is plain to see’: an analysis of newspaper coverage of Australia’s future ‘Fat Bomb’. Health Risk Soc 2011, 13(1):31-46.
• [41]Lewis S, Thomas S, Hyde J, Castle D, Blood RW, Komesaroff P: “I don’t eat a hamburger and large chips every day!” a qualitative study of the impact of public health messages about obesity on obese adults. BMC Public Health 2010, 10(1):309. BioMed Central Full Text
• [42]Thomas S, Lewis S, Westberg K: ‘You just change the channel if you don’t like what you’re going to hear’: Gamblers’ attitudes towards, and interactions with, social marketing campaigns. Health Expect 2012. 2012 Sep 11:doi: 10.1111/hex.12018. [Epub ahead of print]
• [43]Mattson M, Batsu A: The message development tool: a case for effective operationalization of messaging in social marketing practice. Health Mark Q 2010, 27(3):275-290.
• [44]Puhl R, Peterson J, Luedicke J: Fighting obesity or obese persons? public perceptions of obesity-related health messages. Int J Obes (Lond) 2012. doi: 10.1038/ijo.2012.1156. [Epub ahead of print]
• [45]Australian Better Health Initiative: Measure Up campaign. Canberra: Australian Government; 2009. http://www.health.gov.au/internet/abhi/publishing.nsf/Content/About+the+campaign-lp webcite
• [46]Israel B: Social networks and social support: implications for natural helper and community level interventions. Health Educ Q 1985, 12(1):65-80.
• [47]Tompson T, Benz J, Agiesta J, Brewer KH, Bye L, Reimer R, Junius D: Obesity in the United States: public perceptions. The Associated Press-NORC Center for Public Affairs Research; 2013. http://www.apnorc.org/PDFs/Obesity/AP-NORC-Obesity-Research-Highlights.pdf webcite
• [48]Randolph W, Viswanath K: Lessons learned from public health mass media campaigns: marketing health in a crowded media world. Annu Rev Public Health 2004, 25:419-437.
• [49]Minkler M: Personal responsibility for health? a review of the arguments and the evidence at century’s end. Health Educ Behav 1999, 26(1):121-140.
• [50]Lefebvre R: An integrative model for social marketing. J Soc Marketing 2011, 1(1):54-72.