Research report

Surgency and negative affectivity but not effortful control areuniquely associated with obesogenic eating behaviors amonglow-income preschoolers

Christy YY Leung a Julie C Lumeng abc Niko A Kaciroti ad Yu Pu Chen adKatherine Rosenblum ae Alison L Miller afa Center for Human Growth and Development University of Michigan Ann Arbor MI USAb Department of Pediatrics and Communicable Diseases University of Michigan Ann Arbor MI USAc Department of Environmental Health Sciences School of Public Health University of Michigan Ann Arbor MI USAd Department of Biostatistics School of Public Health University of Michigan Ann Arbor MI USAe Department of Psychiatry University of Michigan Ann Arbor MI USAf Department of Health Behavior and Health Education School of Public Health University of Michigan Ann Arbor MI USA

A R T I C L E I N F O

Article historyReceived 25 September 2013Received in revised form 21 March 2014Accepted 24 March 2014Available online 28 March 2014

KeywordsSurgencyNegative affectivityEffortful controlEating behaviorsPreschoolers

A B S T R A C T

Despite increased attention to the role of temperament in childrenrsquos obesogenic eating behaviors thereis a paucity of research examining whether different dimensions of temperament may be differentiallyassociated with specific eating behaviors among preschool-age children The purpose of the current studywas to examine whether three temperament dimensions (surgency negative affectivity and effortful control)were uniquely associated with six obesogenic eating behaviors (caregiver-reported food responsive-ness enjoyment of food emotional overeating satiety responsiveness and tantrums over food and ob-served eating in the absence of hunger) among low-income preschool-age children covarying homeenvironment quality Results showed that temperament dimensions were differentially associated withdifferent eating behaviors Specifically preschoolers with higher surgency were more likely to overeatin response to external cues have frequent desire to eat derive pleasure from food and eat in the absenceof hunger In contrast preschoolers with higher negative affectivity were more likely to have tantrumsover being denied food and less likely to eat in the absence of hunger Effortful control was not uniquelyassociated with obesogenic eating behavior Findings remained significant even when home chaos wasaccounted for suggesting that child surgency and negative affectivity are important to consider inde-pendent of home environment Results are discussed with regard to theoretical implications for the studyof childhood obesity and for applied prevention implications

copy 2014 Elsevier Ltd All rights reserved

Introduction

Child obesity represents a significant public health concern inthe United States Low-income children are particularly at risk nearlyone in three low-income preschool-age children are overweight orobese (Center for Disease Control and Prevention 2011) Obesogeniceating behaviors such as frequent desire to eat external eating (ieeating in response to external as opposed to internal cues) emo-tional overeating eating beyond satiety and persistent tantrums overfood have been consistently implicated in the development of child-hood overweight or obesity (Agras Hammer McNicholas amp Kraemer2004 Braet et al 2008 Jahnke amp Warschburger 2012) From a pre-

vention perspective it is important to consider factors that may con-tribute to childrenrsquos obesogenic eating behaviors in order to developstrategies to address these eating behaviors early in developmentIndividual differences in childrenrsquos eating behaviors such as eatingin the absence of hunger emerge as early as the preschool years(Fisher amp Birch 2002) Thus preschool is an important develop-mental period for examining factors that may contribute toobesogenic eating behaviors

Temperament has been suggested as a factor that may in partdetermine why some children are more likely than others to exhibitobesogenic eating behaviors (Anzman-Frasca Stifter amp Birch 2012Bergmeier Skouteris Horwood Hooley amp Richardson 2013 HaycraftFarrow Meyer Powell amp Blissett 2011) Aspects of temperament thathave been specifically proposed as potential influences on eating be-haviors include impulsivity (Braet Claus Verbeken amp Vlierberghe2007 Silveira et al 2012) and extraversion (Vollrath Stene-LarsenTonstad Rothbart amp Hampson 2012) negative emotionality

Funding All phases of this study were supported by NIH grant RC1DK086376

Corresponding authorE-mail address alimillumichedu (AL Miller)

httpdxdoiorg101016jappet2014030250195-6663copy 2014 Elsevier Ltd All rights reserved

Appetite 78 (2014) 139ndash146

Contents lists available at ScienceDirect

Appetite

journal homepage wwwelseviercom locate appet

(Anzman-Frasca et al 2012 Haycraft et al 2011 Vollrath et al2012) and self-regulation or effortful control (Anzman-Frasca et al2012 Pieper amp Laugero 2013) Rothbart describes these three broaddimensions of temperament as surgency negative affectivity andeffortful control and conceptualizes them as reflecting individualindifferences in reactivity and self-regulation that are biologicallybased and relatively stable across contexts (Rothbart Ahadi amp Evans2000) Despite increased attention to the role of temperament thepathways from each dimension of temperament to obesogenic eatingbehaviors among preschool-age children are not well-understood(Bergmeier et al 2013) Moreover no study has examined whetherdifferent dimensions of temperament may be differentially associ-ated with specific eating behaviors in early childhood Understand-ing the association of different dimensions of temperament withobesogenic eating behaviors could allow tailoring of interventionsto children particularly at risk Thus the aim of the current studywas to examine whether three temperament dimensions ndash surgencynegative affectivity and effortful control ndash were uniquely associ-ated with six obesogenic eating behaviors in a sample of low-income preschool-age children covarying home environment

Dimensions of childrenrsquos obesogenic eating behavior

Despite a lack of a conceptual framework or classification systemto identify childrenrsquos eating behaviors in the literature based on pre-vious findings various dimensions of eating behaviors have beenimplicated in the development of childhood obesity Food respon-siveness measures food consumption in response to external cuessuch as the presence of good-tasting versus less-good-tasting foodconsumed in standard conditions (Wardle Guthrie Sanderson ampRapoport 2001) Enjoyment of food captures appetitive drive desireto eat and general interest in eating (Wardle et al 2001) Emo-tional overeating refers to the tendency to seek immediate comfortthrough excessive eating in response to emotional arousal (EpelLapidus McEwen amp Brownell 2001) Satiety responsiveness re-flects ability to recognize internal satiety cues and reduce food intaketo compensate for a preload of foods Eating in the absence of hungerassesses food consumption beyond satiety in the presence of pal-atable foods (Birch Fisher amp Davison 2003 Fisher amp Birch 2002)Tantrums over food refer to persistent tantrums over being deniedfood (Agras et al 2004) In the present study a multi-method ap-proach was used to assess these six eating behaviors which in-cluded caregiver-reported food responsiveness enjoyment of foodemotional overeating satiety responsiveness and tantrums overfood and observed eating in the absence of hunger

Dimensions of child temperament surgency negativeaffectivity effortful control

Surgency is an ldquoapproachrdquo dimension of temperament charac-terized not only by impulsivity but also intense pleasure seekinghigh activity level and low levels of shyness (Rothbart amp Putnam2002) Surgency may increase individualsrsquo susceptibility toobesogenic eating (Burton et al 2011) because it may reflect a highappetitive drive and a tendency to seek pleasure from eating evenin the absence of hunger Some evidence in support of this viewcomes from studies of impulsivity an aspect of surgency Regard-less of their socioeconomic status adults and adolescents withheightened impulsivity were more likely to eat palatable foods andmore inclined to satisfy their momentary craving for foods (Guerrieriet al 2007 Hetherington 2007 Ouwens van Strien amp van Leeuwe2009) Increased impulsivity also contributed to failure to lose weightor maintain healthy weight over time in obese children possibly dueto impulsive overeating (Nederkoorn Jansen Mulkens amp Jansen2007) Most studies have typically focused on impulsivity but ne-glected other aspects of surgency such as a need for high-intensity

pleasure-seeking a high activity level and a short latency in ap-proaching novelty These surgency characteristics suggest high ap-proach motivation low shyness and high appetitive drive (Burtonet al 2011 Rothbart Ahadi Hershey amp Fisher 2001) Shyness whichis negatively related to surgent temperament has been positivelyassociated with reluctance to sample new foods (Pliner amp Loewen1997) In contrast children who are more surgent may experienceeating as a highly rewarding pleasurable activity and engage inobesogenic eating behaviors The few studies that have examinedsurgency in relation to eating behavior were of older children andalso assessed only a single aspect of eating behavior (van den Berget al 2011 Vollrath et al 2012) In the current study low-incomepreschoolers with higher surgency were expected to engage in moreeating behaviors that are specifically conceptualized as reflectingappetitive drive including food responsiveness enjoyment of foodand eating in the absence of hunger

The negative affectivity dimension of temperament which is char-acterized by mood instability angry reactivity and dysregulated neg-ative emotions (Shields amp Cicchetti 1997) may be associated withthe use of obesogenic eating behaviors as a self-soothing strategyin response to emotional stress (Epel et al 2001) A recent studyshowed that children with loss of control in eating were more likelyto use maladaptive emotion regulation strategies in response toanxiety or anger they were also prone to external and emotionaleating (Czaja Rief amp Hilbert 2009) Nonetheless associationsbetween negative affectivity and dysregulated eating behaviors havebeen documented primarily among adults and adolescents (Epelet al 2001) In children findings are more mixed Emotionally neg-ative temperament traits including anger and frustration were pos-itively associated with tantrums over being denied food in preschool-age children (Agras et al 2004) In other studies of preschool- andschool-age children a more emotionally negative temperament wasassociated with both more emotional overeating as well as morefood avoidant eating behaviors such as emotional undereating foodfussiness satiety responsiveness slowness in eating and less en-joyment of food (Haycraft et al 2011) Thus the associations betweennegative affectivity and obesogenic eating behaviors in children arerelatively inconsistent Based on the prior literature we had two com-peting hypotheses First based on the literature that individuals whoexperience stress and negative emotions tend to increase their foodintake (Groesz et al 2012 Yeomans amp Coughlan 2009) we hy-pothesized that children who experience intense negative emo-tions and have difficulty regulating such emotions may seekimmediate comfort through excessive eating The alternative hy-pothesis is that based on the literature that children with more emo-tional temperaments tend to show food avoidant eating behaviors(Haycraft et al 2011) children with greater negative affectivity maynot eat excessively In summary low-income preschoolers withhigher negative affectivity were expected to engage in more or lessobesogenic eating behaviors and the present study sought to testthese competing hypotheses

Effortful control is a temperament dimension indicated by thecapacity to refrain from a desired or dominant behavior while alsomaintaining attention on a task and resisting distraction (Rothbartamp Putnam 2002) A number of studies have implicated variousaspects of effortful control in the development of overweight andobesity among children with different racialethnic and socioeco-nomic backgrounds For example children with less self-regulatorycompetence had higher body mass index (BMI) z-scores and morerapid weight gain from age 3 to 12 years (Francis amp Susman 2009)Children who showed limited ability to delay gratification at age 4years were more likely to become overweight at age 11 years(Seeyave et al 2009) Yet these studies did not examine the asso-ciations between effortful control and obesogenic eating behav-iors Preschool- and school-age children with higher inhibitorycontrol have been found to have greater ability to self-regulate energy

140 CYY Leung et alAppetite 78 (2014) 139ndash146

intake (Pieper amp Laugero 2013 Tan amp Holub 2011) Given that in-hibitory control an aspect of effortful control has been linked toattention and compliance these individuals were probably betterat redirecting their attention away from food temptations or com-plying with prohibitions against certain foods Moreover given thatattention focusing is an aspect of effortful control childrenrsquos abilityto focus attention on their own satiety may be a mechanism throughwhich effortful control relates to satiety responsiveness Childrenwho have a short attention span may be less likely to recognizesatiety and more likely to engage in external eating (Faith amp Hittner2010) In the present study low-income preschoolers with lowereffortful control were therefore expected to engage in moreobesogenic eating behavior such as lower responsiveness to satiety

Covariate home environment quality

Finally previous studies have revealed that preschoolers are atgreater risk for overweight when their caregivers fail to maintaintheir daily routines implement appropriate control over chil-drenrsquos behaviors or provide sensitive support to address chil-drenrsquos emotional needs (Anderson amp Whitaker 2010 Olvera amp Power2010 Rhee Lumeng Appugliese Kaciroti amp Bradley 2006) Thusin order to account for the fact that home environment may relateto child overweight home environment quality (operationalized aslevel of chaos in the home) was considered as a covariate Homechaos was included in the path models to examine specifically howindividual differences in temperament may play a unique role in chil-drenrsquos obesogenic eating behaviors even accounting for the poten-tial role of home environment

In sum the goal of the present study was to examine whetherthree temperament dimensions (surgency negative affectivityand effortful control) were uniquely associated with six obesogeniceating behaviors (caregiver-reported food responsiveness enjoy-ment of food emotional overeating satiety responsiveness and tan-trums over food and observed eating in the absence of hunger)among low-income preschool-age children covarying homeenvironment

Method

Participants and recruitment

Participants included 380 primary caregivers (M = 2909 yearsSD = 695 91 mothers) and their preschool-age children (M = 410years SD = 054 190 females) attending Head Start programs inmixed rural and urban areas of Michigan between 2009 and 2011Head Start is a free federally funded preschool program for low-income children Inclusion criteria were that all caregivers had lessthan a 4-year college degree and 16 of them did not complete highschool This sample was diverse in terms of race and ethnicity (seeTable 1)

Other inclusion criteria were that the child was 3 or 4 years oldat study enrollment and was born at 35 weeks gestation or morewithout significant perinatal or neonatal complications The familywas excluded if the child was a foster child had significant devel-opmental disabilities had significant medical problems or had foodallergies or the child andor primary caregiver waswere non-English-speaking Families were informed about the study duringHead Start classroom open houses and through flyers in childrenrsquosbackpacks They were compensated for returning an initial enroll-ment packet including a questionnaire and a signed written in-formed consent form These families were then contacted by phoneto review eligibility criteria and to confirm complete understand-ing of the study and validate informed consent

Procedure

Given high levels of low literacy within the participating pop-ulation questionnaires were administered orally to the caregiversand childrenrsquos behavioral assessmentsobservations were con-ducted at the Head Start centers All research assistants were highlytrained in the study protocol implementation and questionnaireadministration so that there was little variability across researchassistants

Observed eating in the absence of hungerChildrenrsquos eating in the absence of hunger was measured im-

mediately after breakfast at Head Start using a method with ac-ceptable reliability and validity (Birch et al 2003) Given limitationsof the community setting and Head Start regulations we were unableto standardize the breakfast offered However breakfasts at HeadStart are required to meet nutritional standards for caloric contentand nutritional composition mandated by the US Department of Ag-riculture Child and Adult Care Food Program Measuring eating inthe absence of hunger following a typical meal in the school or homesetting is an approach that has been used by others which has beenproposed to increase ecological validity of the task (Hill et al 2008Wardle et al 2001) A research assistant observed and confirmedthat children had eaten at the Head Start breakfast meal prior to theeating in the absence of hunger protocol Children were given op-portunities to have additional servings of breakfast and were askedif they were finished or if they would like more breakfast to en-courage them to eat to satiety Children who did not consume anyfood during the breakfast were not invited to proceed with the eatingin the absence of hunger task that day based on concerns that chil-dren not eating may have reflected illness or substantial dislike ofthe food served for breakfast such that they would still be hungrywhen presented with the foods in the eating in the absence of hungerprotocol This approach has been used often in previous studies (egBirch et al 2003)

Immediately following breakfast the research assistant asked thechild to indicate whether shehe was ldquohungryrdquo ldquoin betweenrdquo or ldquofullrdquousing three corresponding cartoon figures and proceeded with en-gaging the child in the eating in the absence of hunger task onlywhen the child reported being ldquofullrdquo or ldquoin betweenrdquo Then the re-search assistant invited the child to a separate room and for 10minutes gave him or her free access to toys and premeasured bowlsof Trixreg cereal (32 g 120 calories) mini Chips Ahoyreg cookies (90 g435 calories) fruit snacks (164 grams 631 calories) Cheez-Itsreg (60 g300 calories) pretzel sticks (36 g 129 calories) and Chicken in aBiskitreg crackers (60 g 310 calories) Children were told ldquoYou canplay with any of the toys and eat any of the foods on this table Irsquomgoing to do some workrdquo After 10 minutes the remaining food wasweighed this value was subtracted from the initial weight and totalcalories consumed were calculated based on manufacturer-providedcalories per unit weight A larger total number of calories con-sumed represented a higher degree of eating in the absence of

Table 1Demographic characteristics of the sample

Characteristic Statistic

Child race and ethnicityWhite non-Hispanic 5579Black non-Hispanic 1553Biracialmultiracial non-Hispanic 1658Hispanic any race 1132

Caregiverrsquos educational levelDid not complete high school 1632Graduated from high school or equivalent 3210Attended fewer than 2 years of college 4000Earned 2-year degree 1158

141CYY Leung et alAppetite 78 (2014) 139ndash146

hunger Log-transformation was used for the total number ofcalories consumed outcome variable to satisfy the normalityassumption

Questionnaires

Child eating behaviorsIn addition to observed eating in the absence of hunger five other

eating behaviors were measured using questionnaires Caregiverscompleted the Childrenrsquos Eating Behavior Questionnaire (CEBQWardle et al 2001) a validated and reliable questionnaire that as-sesses childrenrsquos food approach behaviors including food respon-siveness (eg ldquomy child is always asking for foodrdquo five itemsα = 084) enjoyment of food (eg ldquomy child loves foodrdquo four itemsα = 084) emotional overeating (eg ldquomy child eats more whenanxiousrdquo four items α = 079) and satiety responsiveness (eg ldquomychild gets full easilyrdquo five items α = 073) using a 5-point scaleranging from 1 (never) to 5 (always) Four subscale scores were com-puted by taking the mean of the corresponding items Higher scoresrepresent a greater prevalence degree of that particular eatingbehavior

Caregivers reported food-related tantrums in the last 4 weeksin four questions adapted from prior work (Agras et al 2004) (1)ldquoHow often did your child ask you for something to eat or get himherself something to eatrdquo which was rated on a 5-point scale (neverone time once a week once a day several times a day) (2) ldquoHow oftendid you have to say no when your child wanted something to eatrdquowhich was rated on a 4-point scale (rarelynever sometimes oftenalmost always or not applicable (if response to question 1 was ldquoneverrdquo))(3) ldquoWhen you said no how often did your child become upsetrdquowhich was rated on a 4-point scale (rarelynever sometimes oftenalmost always or not applicable (if response to either question 1 or 2was ldquoneverrdquo)) and (4) ldquoWhen you said no how frequently did yourchild have a tantrumrdquo which was rated on a 4-point scale (rarelynever sometimes often almost always or not applicable (if re-sponse to either question 1 or 2 was ldquoneverrdquo)) Based on theseresponses each child was assigned into one of the three catego-ries 1 (child never asks for food asks for food less than once a day orasks once or more than once a day and is neverrarely denied) 2 (childasks for food once or more than once a day is sometimesoftenalmost always denied and rarelyneversometimes becomes upset ortantrums) or 3 (child asks for food once or more than once a day issometimesoftenalmost always denied and oftenalmost alwaysbecomes upset or tantrums)

Child temperamentThe Childrenrsquos Behavior Questionnaire (CBQ Rothbart et al 2001)

was used to assess surgency and effortful control Subscales con-tributing to surgency are activity level (eg ldquoseems always in a bighurryrdquo seven items) high intensity pleasure (eg ldquolikes going downhigh slides or other adventurous activitiesrdquo six items) impulsiv-ity (eg ldquooften rushes into new situationsrdquo six items) and shyness(eg ldquoacts shy around new peoplerdquo six items) Subscales contrib-uting to effortful control are attention focusing (eg ldquowhen drawingor coloring in a book shows strong concentrationrdquo six items) andinhibitory control (eg ldquocan easily stop an activity when shehe istold ldquonordquo six items) Caregivers rated how well each item de-scribes the childrsquos reaction within the past 6 months on a 7-pointscale ranging from 1 (extremely untrue) to 7 (extremely true) Surgency(α = 070) and effortful control (α = 076) scale scores were com-puted as recommended by scale developers by taking the meanof the corresponding subscales (shyness was reverse-coded) Higherscores represent higher levels of the corresponding temperamentcharacteristics

The negative lability subscale from the Emotion Regulation Check-list (ERC Shields amp Cicchetti 1998) was used to assess negative af-

fectivity This subscale consists of 15 items reflecting a childrsquospropensity to become upset and display negative emotions (eg ldquoiseasily frustratedrdquo ldquoresponds angrily to limit-settingrdquo) Caregiversrated each item on a 4-point scale ranging from 1 (rarelynever) to4 (almost always) A scale score was computed by taking the meanof these 15 items (α = 085) Higher scores reflect more negativeaffectivity (four items were reverse-scored)

Covariate home environment qualityTo account for potential variability in eating behavior due to home

environment and family-level processes the 15-item ConfusionHubbub and Order Scale (CHAOS Matheny Wachs Ludwig ampPhillips 1995) was used to measure the extent to which the childrsquoshome environment is characterized by a lack of routine disorga-nization confusion and noise Caregivers indicated whether eachitem (eg ldquoitrsquos a real lsquozoorsquo in our homerdquo) was true or false for theirfamily Seven items were reverse-coded before summing the totalnumber of items endorsed by the caregiver (α = 080) Higher scoresrepresent a more disorganized confused and noisy home environ-ment (ie greater home chaos)

Statistical analysesMultivariate analysis accounting for inter-correlations among in-

dependent variables were implemented using path analyses toexamine whether the three temperament dimensions (surgency neg-ative affectivity and effortful control) were uniquely associated witheach of the six obesogenic eating behavior outcomes (food respon-siveness enjoyment of food emotional overeating satiety respon-siveness tantrums over food and eating in the absence of hunger)above and beyond home chaos All three temperament dimen-sions and home chaos were included in each model The covari-ance path between surgency and home chaos was excluded fromthe path analyses due to their nonsignificant zero-order correla-tion A statistical model for the path analyses is presented in Fig 1The marginal significant results of the Littlersquos MCAR test showedsome evidence that 890 of the data were not missing com-pletely at random χ2 (9) = 1533 P = 008 Thus we imputed themissing data using Proc MI in SAS 93 All analyses were con-ducted in AMOS 7 using the maximum-likelihood estimation pro-cedure Multiple fit indices were examined to evaluate the modelfit the chi-square goodness-of-fit statistic the comparative fit index

Effortful Control

Surgency

Negative Affectivity

Home Chaos

Obesogenic Eating Behavior

Fig 1 Statistical model testing the role of three temperament factors in obesogeniceating behaviors above and beyond home chaos Note Six obesogenic eating be-haviors including food responsiveness enjoyment of food emotional overeatingsatiety responsiveness tantrums over food and eating in the absence of hunger weretested individually in each model

142 CYY Leung et alAppetite 78 (2014) 139ndash146

(CFI) the root mean square error of approximation (RMSEA) and thestandardized root mean residual (SRMR) A model is considered agood fit when χ2 statistic is nonsignificant with a P-value gt 005CFI gt 090 RMSEA lt 008 and SRMR lt 006 (Bentler 1990 Hu ampBentler 1999)

Furthermore we examined potential interactions betweensurgency negative affectivity and effortful control in explaining eachof the six obesogenic eating behaviors above and beyond homechaos in a series of follow up analyses Multiple linear regressionanalyses were conducted with the six obesogenic eating behav-iors as the dependent variables home chaos as the covariate andsurgency negative affectivity and effortful control as the indepen-dent variables To test the potential interaction effects three inter-action terms (surgency times negative affectivity surgency times effortfulcontrol and negative affectivity times effortful control) were computedand entered in the corresponding regression models Surgency neg-ative affectivity and effortful control were mean-centered prior tocomputing the interaction terms in order to minimize potentiallyproblematic multicollinearity (Aiken amp West 1991)

Results

Means standard deviations and zero-order correlations amongall variables are presented in Table 2 Correlations among eating be-haviors were modest with the strongest associations observedamong CEBQ variables The three dimensions of temperament werealso modestly intercorrelated with the strongest association ob-served between negative affectivity and effortful control (r = minus061)There were positive correlations between home chaos and threeeating behaviors (ie food responsiveness emotional overeating andtantrums over food) Home chaos was therefore included as acovariate in the path models

All six path models fit the data well χ2 (1) = 1123 P = 0289CFI = 1000 RMSEA = 0018 SRMR ranging from 00163 to 00167 In-cluding all three temperament dimensions and controlling for home

chaos higher levels of surgency were significantly associated withmore food responsiveness β = 014 z = 266 P lt 001 enjoyment offood β = 022 z = 411 P lt 0001 and eating in the absence of hungerβ = 026 z = 491 P lt 0001 Moreover higher levels of negative af-fectivity were significantly associated with more tantrums over foodβ = 024 z = 367 P lt 0001 and less eating in the absence of hungerβ = minus016 z = minus244 P lt 005 However effortful control was not sig-nificantly associated with any of the six eating behaviors (see Table 3for all standardized path coefficients) These six path models werealso tested in boys and girls separately and no substantial differ-ences in the pattern of results were found between boys and girlsFurthermore multiple linear regression analyses revealed that therewere no significant surgency times negative affectivity surgency times effortfulcontrol or negative affectivity times effortful control interactions for anyof the six eating behavior outcomes (all Ps lt 005)

Discussion

The overall aim of the present study was to examine whetherthe three dimensions of temperament proposed as important forchild eating behavior specifically surgency negative affectivity andeffortful control were uniquely associated with six obesogenic eatingbehaviors among low-income preschool-age children Findings werethat low-income preschoolers with higher surgency or negative af-fectivity but not effortful control were more likely to engage incertain obesogenic eating behaviors above and beyond the effectof home chaos Results are discussed with regard to theoreticalimplications for the study of childhood obesity and for appliedprevention implications

Surgency

In support of the first hypothesis low-income preschoolers withhigher surgency were more inclined to overeat in response to ex-ternal cues have frequent desire to eat derive pleasure from foods

Table 2Means standard deviations and zero-order correlations

1 2 3 4 5 6 7 8 9 10

1 Food responsiveness ndash 047 055 minus016 025 019 018 016 minus016 0182 Enjoyment of food ndash 016 minus050 012 003 018 minus004 003 minus0013 Emotional overeating ndash 008 018 015 005 015 minus008 0144 Satiety responsiveness ndash 000 001 minus004 010 minus006 0075 Tantrums over food ndash 003 012 028 minus019 0196 Eating in the absence of hunger ndash 024 minus001 minus009 0057 Surgency ndash 030 minus035 0068 Negative affectivity ndash minus061 0389 Effortful control ndash minus03210 Home chaos ndashM 248 379 196 298 193 361 486 197 460 410SD 089 078 070 069 084 164 078 049 102 326

P lt 005 P lt 001 P lt 0001

Table 3Standardized path coefficients and z-values of the three temperament variables and covariate

Outcome variables Temperament variables Covariate

Surgency Negative affectivity Effortful control Home chaos

β z β z β z β z

Food responsiveness 014 266 003 050 minus006 minus087 014 262Enjoyment of food 022 411 minus006 minus090 008 124 004 070Emotional overeating 002 044 012 181 003 044 010 188Satiety responsiveness minus008 minus141 010 145 minus002 minus023 004 072Tantrums over food 005 086 024 367 000 004 009 161Eating in absence of hunger 026 491 minus016 minus244 minus006 minus099 006 108

P lt 005 P lt 001 P lt 0001

143CYY Leung et alAppetite 78 (2014) 139ndash146

and eat in the absence of hunger These findings complement andextend the current literature by examining the temperamental con-struct of surgency rather than just impulsivity or a lack of self-control in relation to the development of obesogenic eatingbehaviors in early childhood Temperamental surgency may man-ifest in the eating domain as an intense craving for food and sen-sitivity to food as a reward Surgent preschoolers may simply be moreinsistent than others in reaching their goal and be more driven byseeking and attaining high-pleasure goals that involve food In slightlyolder children reward sensitivity and impulsivity both predictedovereating suggesting that both aspects of surgency may contrib-ute (van den Berg et al 2011) Furthermore surgency may shapeparenting behavior studies have found that parents of infants tendedto feed their more surgent and externalizing children more oftenand with more sweet foods (Vollrath Tonstad Rothbart amp Hampson2011) Parents typically continue to control what their preschool-age children are eating although children this age may increase theirrequests for specific foods and become more effective at convinc-ing parents to allow them to have them (eg sweets at the storeOrsquoDougherty Story amp Stang 2006) In the current obesogenic en-vironment where large varieties of sweet and fatty foods are inex-pensive available and offered in large portion sizes (Epstein LeddyTemple amp Faith 2007) surgent children of low-income families maybe particularly vulnerable to obesogenic eating patterns and there-fore early childhood obesity Surgency may thus be an importantyet still relatively unexamined factor in predisposing low-incomepreschool-age children to obesogenic eating behaviors Consider-ing surgency may be a key element in understanding earlypathways to obesity for these children

Negative affectivity

In contrast to the patterns for surgency low-income preschool-ers who became easily upset experienced intense emotions and hademotion regulation difficulties were more likely to have tantrumsover being denied food but less likely to eat in the absence of hungerThese results were in partial support of the second hypothesis Neg-ative affectivity has been associated with disordered eating behav-iors in adults and adolescents (Epel et al 2001) even though it isnot clear that disordered eating (eg bingeing) functions to reducethe feelings of negative affect (Haedt-Matt amp Keel 2011) Althoughlongitudinal work with infants has focused on the role of negativeaffectivity in feeding (eg Farrow amp Blissett 2006) and negative affectis proposed as a risk factor for overweight (Anzman-Frasca et al2012) studies of preschoolers have mostly examined BMI and obesityoutcomes without specifically considering different eating behav-iors (Haycraft et al 2011) as we did in the current study Differenttemperament dimensions may confer obesity risk through differ-ent patterns of obesogenic eating behaviors Negative affectivity maycontribute to preschoolersrsquo inability to modulate intense negativeemotions and angry reactivity when being denied desirable foodOthers (Haycraft et al 2011) found associations of negative affec-tivity with greater responsiveness to satiety in children ages 3ndash8years which we did not find in our CEBQ measure but may be re-flected in the association between negative affectivity and less eatingin the absence of hunger in the present study Thus these findingsalso suggest that the use of observation may give us different in-formation about preschool-age childrenrsquos responsiveness to satietythan caregiver-report questionnaire Possibly preschoolers withhigher negative affectivity might be more likely to experience dis-tress andor anxiety during the observed procedure which mightcontribute to more selective eating behaviors (Pliner amp Loewen 1997)In the present study we found no unique relation between nega-tive affectivity and emotional overeating Perhaps children with anemotionally negative temperament may be likely to experienceintense aversive emotions and have difficulties regulating such emo-

tions when they have to endure distress without emotional supportin their immediate environment these children might be vulner-able to emotional overeating when facing a chaotic stressful homeenvironment Indeed the present zero-order correlations re-vealed that both negative affectivity and home chaos were posi-tively associated with emotional overeating

Effortful control

Effortful control reflects childrenrsquos ability to self-restrain froma prohibited behavior maintain attention and compliance to in-structions as well as resist distractions or temptations (Rothbart ampPutnam 2002) These temperamental characteristics have been pro-posed as essential for young children to develop effective strate-gies to regulate their food intake and eating patterns (Anzman-Frascaet al 2012 Jasinska et al 2012 Tan amp Holub 2011) especially whenthey are experiencing stress or facing food temptations Yet in thecurrent study we found no direct association between effortfulcontrol and obesogenic eating behaviors in our path models Therelatively high negative correlation between negative affectivity andeffortful control may have obscured the role of effortful control Itmay also be due to the fact that we examined obesogenic eating be-haviors concurrently and not prospectively The associations betweeneffortful control and obesogenic eating behaviors may emerge overtime the preschool years are a time of increasing independence andautonomy across domains of development (McClelland amp Morrison2003) Thus the role of effortful control specifically in relation toeating behavior may change across the preschool-to-middle child-hood years Indeed the ability to delay gratification (an aspect ofeffortful control) at age 4 years is associated with obesity at age 11even covarying prior weight status (Seeyave et al 2009) It is im-portant to note however that we did not examine effortful controlspecifically with regard to eating behaviors Thus although childsurgency and negative affectivity may play a more important rolethan effortful control in the pathways to certain obesogenic eatingbehaviors during the preschool years future studies should examinewhether effortful control during the preschool years may predictchildrenrsquos eating behaviors later on We also considered that effortfulcontrol may only exert effects on eating behavior in the context ofhigh levels of surgency or high levels of negative affectivity Howeverthis hypothesis was not supported as none of the interaction termswere tested was significant Thus our results suggested that amongpreschool-age children self-control was not significantly associ-ated with obesity-promoting eating behavior regardless of the childrsquoslevel of temperamental surgency or negative affectivity Further re-search is needed to better understand this lack of main or moder-ating effect of self-control in early childhood It is also importantto consider whether the effortful control-eating behavior associa-tion may emerge only in an environment where food temptationsare present

Home environment quality

Finally although home environment quality was not the primaryfocus of the current study we did find that low-income preschool-ers who lived in a more chaotic home environment were more likelyto engage in obesogenic eating behaviors such as external eatingemotional overeating and tantrums over food Our home chaosmeasure likely served as somewhat of a ldquoplaceholderrdquo for many ofthe family processes and features of the home environment that maycontribute to these associations as it is a brief self-report rather thana more extensive measure of home environment quality such as theHome Observation for Measurement of the Environment (HOME)Scale (Bradley amp Caldwell 1979) It makes sense however thatchaotic home environments without adequate parental involve-ment or responsiveness may impede childrenrsquos development of

144 CYY Leung et alAppetite 78 (2014) 139ndash146

self-regulation in food intake Young children have been shown tobe more susceptible to overeating in response to external stimuliwhen their mothers endorse an indulgent feeding style and provideminimal guidance over their eating behaviors (Fisher Birch ZhangGrusak amp Hughes 2013) Moreover children from families who tendto minimize emotions or who have low affective involvement tendto have lower emotional awareness experience greater emotionaldistress and develop poorer emotional self-regulation (Eisenberget al 1999 Fabes Leondard Kupanoff amp Martin 2001) these chil-dren may engage in overeating in response to negative emotions(Mellin Neumark-Sztainer Story Ireland amp Resnick 2002 Tophamet al 2011) and have tantrums over being denied food Yet somehave found that family arguments at mealtime are associated withless child intake (Burnier Dubois amp Girard 2011) suggesting theseassociations are complex Home environment quality can also includeparental monitoring and structure which have been shown to beimportant for childrenrsquos eating behaviors (eg Fisher et al 2013)Given these many possible pathways related to aspects of the homeenvironment it was notable that our findings for surgency and neg-ative affectivity remained even when home chaos was accountedfor suggesting that these child factors are important to consider in-dependent of home environment

Limitations future directions and implications

The following limitations of the present study should be notedFirst the cross-sectional nature of our design cannot allow us to inferthe etiological significance of temperamental surgency negative af-fectivity or effortful control in obesogenic eating behaviors amonglow-income preschool-age children Some researchers have hy-pothesized that the linkages between temperament and eating be-haviors may be driven by other factors such as genetic characteristicsor body weight that affect child temperament and eating(Anzman-Frasca et al 2012 Hetherington 2007 Miller et al 2013Wardle et al 2008) Future longitudinal research on this topic isnecessary

Furthermore caregiver-report was used as the only assess-ment of the predictor variables as well as many of the eating be-haviors which may have resulted in reporter bias The use ofobservations could increase the ecological validity of child behav-ior assessments as well as the degree of chaos in the home Otherfamilial characteristics such as parentndashchild interactions parentalfeeding practices and parental mealtime engagement have also beenshown to be associated with young childrenrsquos eating behaviors(Burnier et al 2011 Wu Dixon Dalton Tudiver amp Liu 2011) Futurestudies should consider these familial characteristics using obser-vational measures and examine their interactions with childcharacteristics in predicting young childrenrsquos obesogenic eatingbehaviors

Despite these limitations however the present study repre-sents a significant step toward understanding how multiple dimen-sions of child temperament ndash particularly surgency negativeaffectivity and effortful control ndash relate to early obesogenic eatingbehaviors which have in turn been implicated in the develop-ment of overweightobesity among low-income preschool-age chil-dren Importantly information learned from the present study maycontribute to interdisciplinary efforts between developmental sci-entists and practitioners to develop tailored evidence-based earlychildhood obesity interventions For example young children whoare characterized by high temperamental surgency or negative af-fectivity may have an increased risk for obesogenic eating thusimplementing strategies that address individual differences such asimpulsivity intense pleasure seeking and difficulties with regulat-ing emotions may increase intervention success Furthermore chil-dren with different temperamental characteristics may struggle with

different types of obesogenic eating so it is important to considerand assess different eating behaviors that a child may display

References

Agras W Hammer L McNicholas F amp Kraemer H (2004) Risk factors for childhoodoverweight A prospective study from birth to 95 years Journal of Pediatrics145(1) 20ndash25

Aiken L S amp West S G (1991) Multiple regression Testing and interpreting interactionsThousand Oaks CA Sage Publications

Anderson S E amp Whitaker R C (2010) Household routines and obesity in USpreschool-aged children Pediatrics 125(3) 420ndash428

Anzman-Frasca S S Stifter C A amp Birch L L (2012) Temperament and childhoodobesity risk A review of the literature Journal of Developmental and BehavioralPediatrics 33(9) 732ndash745

Bentler P M (1990) Comparative fit indexes in structural models PsychologicalBulletin 107 238ndash246

Bergmeier H Skouteris H Horwood S Hooley M amp Richardson B (2013)Associations between child temperament maternal feeding practices and childbody mass index during the preschool years A systematic review of the literatureObesity Reviews 1ndash10

Birch L L Fisher J O amp Davison K K (2003) Learning to overeat Maternal use ofrestrictive feeding practices promotes girlsrsquo eating in the absence of hungerAmerican Journal of Clinical Nutrition 78(2) 215ndash220

Bradley R H amp Caldwell B M (1979) Home observation for measurement of theenvironment A version of the preschool scale American Journal of MentalDeficiency 84(3) 235ndash244

Braet C Claus L Goossens L Moens E Vlierberghe L V amp Soetens B (2008)Differences in eating style between overweight and normal-weight youngstersJournal of Health Psychology 13(6) 733ndash743

Braet C Claus L Verbeken S amp Vlierberghe L V (2007) Impulsivity in overweightchildren European Child amp Adolescent Psychiatry 16(8) 473ndash483

Burnier D Dubois L amp Girard M (2011) Arguments at mealtime and child energyintake Journal of Nutrition Education and Behavior 43(6) 473ndash481

Burton P Wells J C K Kennedy K Nicholl R Khakoo A amp Fewtrell M S (2011)Association between infant correlates of impulsivity ndash surgency (extraversion)ndash and early infant growth Appetite 57 504ndash509

Center for Disease Control and Prevention (2011) Summary of trends in growthindicators by age from the pediatric nutrition surveillance system Retrieved fromhttpwwwcdcgovpednsspednss_tablestables_health_indicatorshtm

Czaja J Rief W amp Hilbert A (2009) Emotion regulation and binge eating in childrenInternational Journal of Eating Disorders 42 356ndash362

Eisenberg N Fabes R A Shepard S A Guthrie I K Murphy B C amp Rieser M(1999) Parental reactions to childrenrsquos negative emotions Longitudinal relationsto quality of childrenrsquos social functioning Child Development 70 513ndash534

Epel E Lapidus R McEwen B amp Brownell K (2001) Stress may add bite to appetitein women A laboratory study of stress-induced cortisol and eating behaviorPsychoneuroendocrinology 26 37ndash49

Epstein L H Leddy J J Temple J L amp Faith M S (2007) Food reinforcement andeating A multilevel analysis Psychology Bulletin 133(5) 884ndash906

Fabes R A Leondard S A Kupanoff K amp Martin S L (2001) Parental coping withchildrenrsquos negative emotions Relations with childrenrsquos emotional and socialresponding Child Development 72 907ndash920

Faith M S amp Hittner J B (2010) Infant temperament and eating style predict changein standardized weight status and obesity risk at 6 years of age InternationalJournal of Obesity 34 1515ndash1523

Farrow C amp Blissett J (2006) Maternal cognitions psychopathologic symptoms andinfant temperament as predictors of early infant feeding problems A longitudinalstudy International Journal of Eating Disorders 39(2) 128ndash134

Fisher J O amp Birch L L (2002) Eating in the absence of hunger and overweight ingirls from 5 to 7 y of age American Journal of Clinical Nutrition 76(1) 226ndash231

Fisher J O Birch L L Zhang J J Grusak M A amp Hughes S O (2013) Externalinfluences on childrenrsquos self-served portions at meals International Journal ofObesity 37(7) 954ndash960 doi101038ijo2012216

Francis L amp Susman EJ (2009) Self-Regulation Failure and Rapid Weight Gain inChildren from Age 3 to 12 Years Archives of Disease in Children and Adolescents163 297ndash302

Groesz L M McCoy S Carl J Saslow L Stewart J Adler N et al (2012) Whatis eating you Stress and the drive to eat Appetite 58(2) 717ndash721

Guerrieri R Nederkoorn C Stankiewicz K Alberts H Geschwind N Martijn Cet al (2007) The influence of trait and induced state impulsivity on food intakein normal-weight healthy women Appetite 49(1) 66ndash73

Haedt-Matt A A amp Keel P K (2011) Revisiting the affect regulation model of bingeeating A meta-analysis of studies using ecological momentary assessmentPsychological Bulletin 137(4) 660ndash681 doi101037a0023660

Haycraft E Farrow C Meyer C Powell F amp Blissett J (2011) Relationships betweentemperament and eating behaviours in young children Appetite 56 689ndash692

Hetherington M (2007) Individual differences in the drive to overeat NutritionBulletin 32 14ndash21

Hill C Llewellyn C H Saxton J Webber L Semmler C Carnell S et al (2008)Adiposity and ldquoeating in the absence of hungerrdquo in children International Journalof Obesity 32(10) 1499ndash1505

145CYY Leung et alAppetite 78 (2014) 139ndash146

intake (Pieper amp Laugero 2013 Tan amp Holub 2011) Given that in-hibitory control an aspect of effortful control has been linked toattention and compliance these individuals were probably betterat redirecting their attention away from food temptations or com-plying with prohibitions against certain foods Moreover given thatattention focusing is an aspect of effortful control childrenrsquos abilityto focus attention on their own satiety may be a mechanism throughwhich effortful control relates to satiety responsiveness Childrenwho have a short attention span may be less likely to recognizesatiety and more likely to engage in external eating (Faith amp Hittner2010) In the present study low-income preschoolers with lowereffortful control were therefore expected to engage in moreobesogenic eating behavior such as lower responsiveness to satiety

Covariate home environment quality

Finally previous studies have revealed that preschoolers are atgreater risk for overweight when their caregivers fail to maintaintheir daily routines implement appropriate control over chil-drenrsquos behaviors or provide sensitive support to address chil-drenrsquos emotional needs (Anderson amp Whitaker 2010 Olvera amp Power2010 Rhee Lumeng Appugliese Kaciroti amp Bradley 2006) Thusin order to account for the fact that home environment may relateto child overweight home environment quality (operationalized aslevel of chaos in the home) was considered as a covariate Homechaos was included in the path models to examine specifically howindividual differences in temperament may play a unique role in chil-drenrsquos obesogenic eating behaviors even accounting for the poten-tial role of home environment

In sum the goal of the present study was to examine whetherthree temperament dimensions (surgency negative affectivityand effortful control) were uniquely associated with six obesogeniceating behaviors (caregiver-reported food responsiveness enjoy-ment of food emotional overeating satiety responsiveness and tan-trums over food and observed eating in the absence of hunger)among low-income preschool-age children covarying homeenvironment

Method

Participants and recruitment

Participants included 380 primary caregivers (M = 2909 yearsSD = 695 91 mothers) and their preschool-age children (M = 410years SD = 054 190 females) attending Head Start programs inmixed rural and urban areas of Michigan between 2009 and 2011Head Start is a free federally funded preschool program for low-income children Inclusion criteria were that all caregivers had lessthan a 4-year college degree and 16 of them did not complete highschool This sample was diverse in terms of race and ethnicity (seeTable 1)

Other inclusion criteria were that the child was 3 or 4 years oldat study enrollment and was born at 35 weeks gestation or morewithout significant perinatal or neonatal complications The familywas excluded if the child was a foster child had significant devel-opmental disabilities had significant medical problems or had foodallergies or the child andor primary caregiver waswere non-English-speaking Families were informed about the study duringHead Start classroom open houses and through flyers in childrenrsquosbackpacks They were compensated for returning an initial enroll-ment packet including a questionnaire and a signed written in-formed consent form These families were then contacted by phoneto review eligibility criteria and to confirm complete understand-ing of the study and validate informed consent

Procedure

Given high levels of low literacy within the participating pop-ulation questionnaires were administered orally to the caregiversand childrenrsquos behavioral assessmentsobservations were con-ducted at the Head Start centers All research assistants were highlytrained in the study protocol implementation and questionnaireadministration so that there was little variability across researchassistants

Observed eating in the absence of hungerChildrenrsquos eating in the absence of hunger was measured im-

mediately after breakfast at Head Start using a method with ac-ceptable reliability and validity (Birch et al 2003) Given limitationsof the community setting and Head Start regulations we were unableto standardize the breakfast offered However breakfasts at HeadStart are required to meet nutritional standards for caloric contentand nutritional composition mandated by the US Department of Ag-riculture Child and Adult Care Food Program Measuring eating inthe absence of hunger following a typical meal in the school or homesetting is an approach that has been used by others which has beenproposed to increase ecological validity of the task (Hill et al 2008Wardle et al 2001) A research assistant observed and confirmedthat children had eaten at the Head Start breakfast meal prior to theeating in the absence of hunger protocol Children were given op-portunities to have additional servings of breakfast and were askedif they were finished or if they would like more breakfast to en-courage them to eat to satiety Children who did not consume anyfood during the breakfast were not invited to proceed with the eatingin the absence of hunger task that day based on concerns that chil-dren not eating may have reflected illness or substantial dislike ofthe food served for breakfast such that they would still be hungrywhen presented with the foods in the eating in the absence of hungerprotocol This approach has been used often in previous studies (egBirch et al 2003)

Immediately following breakfast the research assistant asked thechild to indicate whether shehe was ldquohungryrdquo ldquoin betweenrdquo or ldquofullrdquousing three corresponding cartoon figures and proceeded with en-gaging the child in the eating in the absence of hunger task onlywhen the child reported being ldquofullrdquo or ldquoin betweenrdquo Then the re-search assistant invited the child to a separate room and for 10minutes gave him or her free access to toys and premeasured bowlsof Trixreg cereal (32 g 120 calories) mini Chips Ahoyreg cookies (90 g435 calories) fruit snacks (164 grams 631 calories) Cheez-Itsreg (60 g300 calories) pretzel sticks (36 g 129 calories) and Chicken in aBiskitreg crackers (60 g 310 calories) Children were told ldquoYou canplay with any of the toys and eat any of the foods on this table Irsquomgoing to do some workrdquo After 10 minutes the remaining food wasweighed this value was subtracted from the initial weight and totalcalories consumed were calculated based on manufacturer-providedcalories per unit weight A larger total number of calories con-sumed represented a higher degree of eating in the absence of

Table 1Demographic characteristics of the sample

Characteristic Statistic

Child race and ethnicityWhite non-Hispanic 5579Black non-Hispanic 1553Biracialmultiracial non-Hispanic 1658Hispanic any race 1132

Caregiverrsquos educational levelDid not complete high school 1632Graduated from high school or equivalent 3210Attended fewer than 2 years of college 4000Earned 2-year degree 1158

141CYY Leung et alAppetite 78 (2014) 139ndash146

hunger Log-transformation was used for the total number ofcalories consumed outcome variable to satisfy the normalityassumption

Questionnaires

Child eating behaviorsIn addition to observed eating in the absence of hunger five other

eating behaviors were measured using questionnaires Caregiverscompleted the Childrenrsquos Eating Behavior Questionnaire (CEBQWardle et al 2001) a validated and reliable questionnaire that as-sesses childrenrsquos food approach behaviors including food respon-siveness (eg ldquomy child is always asking for foodrdquo five itemsα = 084) enjoyment of food (eg ldquomy child loves foodrdquo four itemsα = 084) emotional overeating (eg ldquomy child eats more whenanxiousrdquo four items α = 079) and satiety responsiveness (eg ldquomychild gets full easilyrdquo five items α = 073) using a 5-point scaleranging from 1 (never) to 5 (always) Four subscale scores were com-puted by taking the mean of the corresponding items Higher scoresrepresent a greater prevalence degree of that particular eatingbehavior

Caregivers reported food-related tantrums in the last 4 weeksin four questions adapted from prior work (Agras et al 2004) (1)ldquoHow often did your child ask you for something to eat or get himherself something to eatrdquo which was rated on a 5-point scale (neverone time once a week once a day several times a day) (2) ldquoHow oftendid you have to say no when your child wanted something to eatrdquowhich was rated on a 4-point scale (rarelynever sometimes oftenalmost always or not applicable (if response to question 1 was ldquoneverrdquo))(3) ldquoWhen you said no how often did your child become upsetrdquowhich was rated on a 4-point scale (rarelynever sometimes oftenalmost always or not applicable (if response to either question 1 or 2was ldquoneverrdquo)) and (4) ldquoWhen you said no how frequently did yourchild have a tantrumrdquo which was rated on a 4-point scale (rarelynever sometimes often almost always or not applicable (if re-sponse to either question 1 or 2 was ldquoneverrdquo)) Based on theseresponses each child was assigned into one of the three catego-ries 1 (child never asks for food asks for food less than once a day orasks once or more than once a day and is neverrarely denied) 2 (childasks for food once or more than once a day is sometimesoftenalmost always denied and rarelyneversometimes becomes upset ortantrums) or 3 (child asks for food once or more than once a day issometimesoftenalmost always denied and oftenalmost alwaysbecomes upset or tantrums)

Child temperamentThe Childrenrsquos Behavior Questionnaire (CBQ Rothbart et al 2001)

was used to assess surgency and effortful control Subscales con-tributing to surgency are activity level (eg ldquoseems always in a bighurryrdquo seven items) high intensity pleasure (eg ldquolikes going downhigh slides or other adventurous activitiesrdquo six items) impulsiv-ity (eg ldquooften rushes into new situationsrdquo six items) and shyness(eg ldquoacts shy around new peoplerdquo six items) Subscales contrib-uting to effortful control are attention focusing (eg ldquowhen drawingor coloring in a book shows strong concentrationrdquo six items) andinhibitory control (eg ldquocan easily stop an activity when shehe istold ldquonordquo six items) Caregivers rated how well each item de-scribes the childrsquos reaction within the past 6 months on a 7-pointscale ranging from 1 (extremely untrue) to 7 (extremely true) Surgency(α = 070) and effortful control (α = 076) scale scores were com-puted as recommended by scale developers by taking the meanof the corresponding subscales (shyness was reverse-coded) Higherscores represent higher levels of the corresponding temperamentcharacteristics

The negative lability subscale from the Emotion Regulation Check-list (ERC Shields amp Cicchetti 1998) was used to assess negative af-

fectivity This subscale consists of 15 items reflecting a childrsquospropensity to become upset and display negative emotions (eg ldquoiseasily frustratedrdquo ldquoresponds angrily to limit-settingrdquo) Caregiversrated each item on a 4-point scale ranging from 1 (rarelynever) to4 (almost always) A scale score was computed by taking the meanof these 15 items (α = 085) Higher scores reflect more negativeaffectivity (four items were reverse-scored)

Covariate home environment qualityTo account for potential variability in eating behavior due to home

environment and family-level processes the 15-item ConfusionHubbub and Order Scale (CHAOS Matheny Wachs Ludwig ampPhillips 1995) was used to measure the extent to which the childrsquoshome environment is characterized by a lack of routine disorga-nization confusion and noise Caregivers indicated whether eachitem (eg ldquoitrsquos a real lsquozoorsquo in our homerdquo) was true or false for theirfamily Seven items were reverse-coded before summing the totalnumber of items endorsed by the caregiver (α = 080) Higher scoresrepresent a more disorganized confused and noisy home environ-ment (ie greater home chaos)

Statistical analysesMultivariate analysis accounting for inter-correlations among in-

dependent variables were implemented using path analyses toexamine whether the three temperament dimensions (surgency neg-ative affectivity and effortful control) were uniquely associated witheach of the six obesogenic eating behavior outcomes (food respon-siveness enjoyment of food emotional overeating satiety respon-siveness tantrums over food and eating in the absence of hunger)above and beyond home chaos All three temperament dimen-sions and home chaos were included in each model The covari-ance path between surgency and home chaos was excluded fromthe path analyses due to their nonsignificant zero-order correla-tion A statistical model for the path analyses is presented in Fig 1The marginal significant results of the Littlersquos MCAR test showedsome evidence that 890 of the data were not missing com-pletely at random χ2 (9) = 1533 P = 008 Thus we imputed themissing data using Proc MI in SAS 93 All analyses were con-ducted in AMOS 7 using the maximum-likelihood estimation pro-cedure Multiple fit indices were examined to evaluate the modelfit the chi-square goodness-of-fit statistic the comparative fit index

Effortful Control

Surgency

Negative Affectivity

Home Chaos

Obesogenic Eating Behavior

Fig 1 Statistical model testing the role of three temperament factors in obesogeniceating behaviors above and beyond home chaos Note Six obesogenic eating be-haviors including food responsiveness enjoyment of food emotional overeatingsatiety responsiveness tantrums over food and eating in the absence of hunger weretested individually in each model

142 CYY Leung et alAppetite 78 (2014) 139ndash146

(CFI) the root mean square error of approximation (RMSEA) and thestandardized root mean residual (SRMR) A model is considered agood fit when χ2 statistic is nonsignificant with a P-value gt 005CFI gt 090 RMSEA lt 008 and SRMR lt 006 (Bentler 1990 Hu ampBentler 1999)

Furthermore we examined potential interactions betweensurgency negative affectivity and effortful control in explaining eachof the six obesogenic eating behaviors above and beyond homechaos in a series of follow up analyses Multiple linear regressionanalyses were conducted with the six obesogenic eating behav-iors as the dependent variables home chaos as the covariate andsurgency negative affectivity and effortful control as the indepen-dent variables To test the potential interaction effects three inter-action terms (surgency times negative affectivity surgency times effortfulcontrol and negative affectivity times effortful control) were computedand entered in the corresponding regression models Surgency neg-ative affectivity and effortful control were mean-centered prior tocomputing the interaction terms in order to minimize potentiallyproblematic multicollinearity (Aiken amp West 1991)

Results

Means standard deviations and zero-order correlations amongall variables are presented in Table 2 Correlations among eating be-haviors were modest with the strongest associations observedamong CEBQ variables The three dimensions of temperament werealso modestly intercorrelated with the strongest association ob-served between negative affectivity and effortful control (r = minus061)There were positive correlations between home chaos and threeeating behaviors (ie food responsiveness emotional overeating andtantrums over food) Home chaos was therefore included as acovariate in the path models

All six path models fit the data well χ2 (1) = 1123 P = 0289CFI = 1000 RMSEA = 0018 SRMR ranging from 00163 to 00167 In-cluding all three temperament dimensions and controlling for home

chaos higher levels of surgency were significantly associated withmore food responsiveness β = 014 z = 266 P lt 001 enjoyment offood β = 022 z = 411 P lt 0001 and eating in the absence of hungerβ = 026 z = 491 P lt 0001 Moreover higher levels of negative af-fectivity were significantly associated with more tantrums over foodβ = 024 z = 367 P lt 0001 and less eating in the absence of hungerβ = minus016 z = minus244 P lt 005 However effortful control was not sig-nificantly associated with any of the six eating behaviors (see Table 3for all standardized path coefficients) These six path models werealso tested in boys and girls separately and no substantial differ-ences in the pattern of results were found between boys and girlsFurthermore multiple linear regression analyses revealed that therewere no significant surgency times negative affectivity surgency times effortfulcontrol or negative affectivity times effortful control interactions for anyof the six eating behavior outcomes (all Ps lt 005)

Discussion

The overall aim of the present study was to examine whetherthe three dimensions of temperament proposed as important forchild eating behavior specifically surgency negative affectivity andeffortful control were uniquely associated with six obesogenic eatingbehaviors among low-income preschool-age children Findings werethat low-income preschoolers with higher surgency or negative af-fectivity but not effortful control were more likely to engage incertain obesogenic eating behaviors above and beyond the effectof home chaos Results are discussed with regard to theoreticalimplications for the study of childhood obesity and for appliedprevention implications

Surgency

In support of the first hypothesis low-income preschoolers withhigher surgency were more inclined to overeat in response to ex-ternal cues have frequent desire to eat derive pleasure from foods

Table 2Means standard deviations and zero-order correlations

1 2 3 4 5 6 7 8 9 10

1 Food responsiveness ndash 047 055 minus016 025 019 018 016 minus016 0182 Enjoyment of food ndash 016 minus050 012 003 018 minus004 003 minus0013 Emotional overeating ndash 008 018 015 005 015 minus008 0144 Satiety responsiveness ndash 000 001 minus004 010 minus006 0075 Tantrums over food ndash 003 012 028 minus019 0196 Eating in the absence of hunger ndash 024 minus001 minus009 0057 Surgency ndash 030 minus035 0068 Negative affectivity ndash minus061 0389 Effortful control ndash minus03210 Home chaos ndashM 248 379 196 298 193 361 486 197 460 410SD 089 078 070 069 084 164 078 049 102 326

P lt 005 P lt 001 P lt 0001

Table 3Standardized path coefficients and z-values of the three temperament variables and covariate

Outcome variables Temperament variables Covariate

Surgency Negative affectivity Effortful control Home chaos

β z β z β z β z

Food responsiveness 014 266 003 050 minus006 minus087 014 262Enjoyment of food 022 411 minus006 minus090 008 124 004 070Emotional overeating 002 044 012 181 003 044 010 188Satiety responsiveness minus008 minus141 010 145 minus002 minus023 004 072Tantrums over food 005 086 024 367 000 004 009 161Eating in absence of hunger 026 491 minus016 minus244 minus006 minus099 006 108

P lt 005 P lt 001 P lt 0001

143CYY Leung et alAppetite 78 (2014) 139ndash146

and eat in the absence of hunger These findings complement andextend the current literature by examining the temperamental con-struct of surgency rather than just impulsivity or a lack of self-control in relation to the development of obesogenic eatingbehaviors in early childhood Temperamental surgency may man-ifest in the eating domain as an intense craving for food and sen-sitivity to food as a reward Surgent preschoolers may simply be moreinsistent than others in reaching their goal and be more driven byseeking and attaining high-pleasure goals that involve food In slightlyolder children reward sensitivity and impulsivity both predictedovereating suggesting that both aspects of surgency may contrib-ute (van den Berg et al 2011) Furthermore surgency may shapeparenting behavior studies have found that parents of infants tendedto feed their more surgent and externalizing children more oftenand with more sweet foods (Vollrath Tonstad Rothbart amp Hampson2011) Parents typically continue to control what their preschool-age children are eating although children this age may increase theirrequests for specific foods and become more effective at convinc-ing parents to allow them to have them (eg sweets at the storeOrsquoDougherty Story amp Stang 2006) In the current obesogenic en-vironment where large varieties of sweet and fatty foods are inex-pensive available and offered in large portion sizes (Epstein LeddyTemple amp Faith 2007) surgent children of low-income families maybe particularly vulnerable to obesogenic eating patterns and there-fore early childhood obesity Surgency may thus be an importantyet still relatively unexamined factor in predisposing low-incomepreschool-age children to obesogenic eating behaviors Consider-ing surgency may be a key element in understanding earlypathways to obesity for these children

Negative affectivity

In contrast to the patterns for surgency low-income preschool-ers who became easily upset experienced intense emotions and hademotion regulation difficulties were more likely to have tantrumsover being denied food but less likely to eat in the absence of hungerThese results were in partial support of the second hypothesis Neg-ative affectivity has been associated with disordered eating behav-iors in adults and adolescents (Epel et al 2001) even though it isnot clear that disordered eating (eg bingeing) functions to reducethe feelings of negative affect (Haedt-Matt amp Keel 2011) Althoughlongitudinal work with infants has focused on the role of negativeaffectivity in feeding (eg Farrow amp Blissett 2006) and negative affectis proposed as a risk factor for overweight (Anzman-Frasca et al2012) studies of preschoolers have mostly examined BMI and obesityoutcomes without specifically considering different eating behav-iors (Haycraft et al 2011) as we did in the current study Differenttemperament dimensions may confer obesity risk through differ-ent patterns of obesogenic eating behaviors Negative affectivity maycontribute to preschoolersrsquo inability to modulate intense negativeemotions and angry reactivity when being denied desirable foodOthers (Haycraft et al 2011) found associations of negative affec-tivity with greater responsiveness to satiety in children ages 3ndash8years which we did not find in our CEBQ measure but may be re-flected in the association between negative affectivity and less eatingin the absence of hunger in the present study Thus these findingsalso suggest that the use of observation may give us different in-formation about preschool-age childrenrsquos responsiveness to satietythan caregiver-report questionnaire Possibly preschoolers withhigher negative affectivity might be more likely to experience dis-tress andor anxiety during the observed procedure which mightcontribute to more selective eating behaviors (Pliner amp Loewen 1997)In the present study we found no unique relation between nega-tive affectivity and emotional overeating Perhaps children with anemotionally negative temperament may be likely to experienceintense aversive emotions and have difficulties regulating such emo-

tions when they have to endure distress without emotional supportin their immediate environment these children might be vulner-able to emotional overeating when facing a chaotic stressful homeenvironment Indeed the present zero-order correlations re-vealed that both negative affectivity and home chaos were posi-tively associated with emotional overeating

Effortful control

Effortful control reflects childrenrsquos ability to self-restrain froma prohibited behavior maintain attention and compliance to in-structions as well as resist distractions or temptations (Rothbart ampPutnam 2002) These temperamental characteristics have been pro-posed as essential for young children to develop effective strate-gies to regulate their food intake and eating patterns (Anzman-Frascaet al 2012 Jasinska et al 2012 Tan amp Holub 2011) especially whenthey are experiencing stress or facing food temptations Yet in thecurrent study we found no direct association between effortfulcontrol and obesogenic eating behaviors in our path models Therelatively high negative correlation between negative affectivity andeffortful control may have obscured the role of effortful control Itmay also be due to the fact that we examined obesogenic eating be-haviors concurrently and not prospectively The associations betweeneffortful control and obesogenic eating behaviors may emerge overtime the preschool years are a time of increasing independence andautonomy across domains of development (McClelland amp Morrison2003) Thus the role of effortful control specifically in relation toeating behavior may change across the preschool-to-middle child-hood years Indeed the ability to delay gratification (an aspect ofeffortful control) at age 4 years is associated with obesity at age 11even covarying prior weight status (Seeyave et al 2009) It is im-portant to note however that we did not examine effortful controlspecifically with regard to eating behaviors Thus although childsurgency and negative affectivity may play a more important rolethan effortful control in the pathways to certain obesogenic eatingbehaviors during the preschool years future studies should examinewhether effortful control during the preschool years may predictchildrenrsquos eating behaviors later on We also considered that effortfulcontrol may only exert effects on eating behavior in the context ofhigh levels of surgency or high levels of negative affectivity Howeverthis hypothesis was not supported as none of the interaction termswere tested was significant Thus our results suggested that amongpreschool-age children self-control was not significantly associ-ated with obesity-promoting eating behavior regardless of the childrsquoslevel of temperamental surgency or negative affectivity Further re-search is needed to better understand this lack of main or moder-ating effect of self-control in early childhood It is also importantto consider whether the effortful control-eating behavior associa-tion may emerge only in an environment where food temptationsare present

Home environment quality

Finally although home environment quality was not the primaryfocus of the current study we did find that low-income preschool-ers who lived in a more chaotic home environment were more likelyto engage in obesogenic eating behaviors such as external eatingemotional overeating and tantrums over food Our home chaosmeasure likely served as somewhat of a ldquoplaceholderrdquo for many ofthe family processes and features of the home environment that maycontribute to these associations as it is a brief self-report rather thana more extensive measure of home environment quality such as theHome Observation for Measurement of the Environment (HOME)Scale (Bradley amp Caldwell 1979) It makes sense however thatchaotic home environments without adequate parental involve-ment or responsiveness may impede childrenrsquos development of

144 CYY Leung et alAppetite 78 (2014) 139ndash146

self-regulation in food intake Young children have been shown tobe more susceptible to overeating in response to external stimuliwhen their mothers endorse an indulgent feeding style and provideminimal guidance over their eating behaviors (Fisher Birch ZhangGrusak amp Hughes 2013) Moreover children from families who tendto minimize emotions or who have low affective involvement tendto have lower emotional awareness experience greater emotionaldistress and develop poorer emotional self-regulation (Eisenberget al 1999 Fabes Leondard Kupanoff amp Martin 2001) these chil-dren may engage in overeating in response to negative emotions(Mellin Neumark-Sztainer Story Ireland amp Resnick 2002 Tophamet al 2011) and have tantrums over being denied food Yet somehave found that family arguments at mealtime are associated withless child intake (Burnier Dubois amp Girard 2011) suggesting theseassociations are complex Home environment quality can also includeparental monitoring and structure which have been shown to beimportant for childrenrsquos eating behaviors (eg Fisher et al 2013)Given these many possible pathways related to aspects of the homeenvironment it was notable that our findings for surgency and neg-ative affectivity remained even when home chaos was accountedfor suggesting that these child factors are important to consider in-dependent of home environment

Limitations future directions and implications

The following limitations of the present study should be notedFirst the cross-sectional nature of our design cannot allow us to inferthe etiological significance of temperamental surgency negative af-fectivity or effortful control in obesogenic eating behaviors amonglow-income preschool-age children Some researchers have hy-pothesized that the linkages between temperament and eating be-haviors may be driven by other factors such as genetic characteristicsor body weight that affect child temperament and eating(Anzman-Frasca et al 2012 Hetherington 2007 Miller et al 2013Wardle et al 2008) Future longitudinal research on this topic isnecessary

Furthermore caregiver-report was used as the only assess-ment of the predictor variables as well as many of the eating be-haviors which may have resulted in reporter bias The use ofobservations could increase the ecological validity of child behav-ior assessments as well as the degree of chaos in the home Otherfamilial characteristics such as parentndashchild interactions parentalfeeding practices and parental mealtime engagement have also beenshown to be associated with young childrenrsquos eating behaviors(Burnier et al 2011 Wu Dixon Dalton Tudiver amp Liu 2011) Futurestudies should consider these familial characteristics using obser-vational measures and examine their interactions with childcharacteristics in predicting young childrenrsquos obesogenic eatingbehaviors

Despite these limitations however the present study repre-sents a significant step toward understanding how multiple dimen-sions of child temperament ndash particularly surgency negativeaffectivity and effortful control ndash relate to early obesogenic eatingbehaviors which have in turn been implicated in the develop-ment of overweightobesity among low-income preschool-age chil-dren Importantly information learned from the present study maycontribute to interdisciplinary efforts between developmental sci-entists and practitioners to develop tailored evidence-based earlychildhood obesity interventions For example young children whoare characterized by high temperamental surgency or negative af-fectivity may have an increased risk for obesogenic eating thusimplementing strategies that address individual differences such asimpulsivity intense pleasure seeking and difficulties with regulat-ing emotions may increase intervention success Furthermore chil-dren with different temperamental characteristics may struggle with

different types of obesogenic eating so it is important to considerand assess different eating behaviors that a child may display

References

Agras W Hammer L McNicholas F amp Kraemer H (2004) Risk factors for childhoodoverweight A prospective study from birth to 95 years Journal of Pediatrics145(1) 20ndash25

Aiken L S amp West S G (1991) Multiple regression Testing and interpreting interactionsThousand Oaks CA Sage Publications

Anderson S E amp Whitaker R C (2010) Household routines and obesity in USpreschool-aged children Pediatrics 125(3) 420ndash428

Anzman-Frasca S S Stifter C A amp Birch L L (2012) Temperament and childhoodobesity risk A review of the literature Journal of Developmental and BehavioralPediatrics 33(9) 732ndash745

Bentler P M (1990) Comparative fit indexes in structural models PsychologicalBulletin 107 238ndash246

Bergmeier H Skouteris H Horwood S Hooley M amp Richardson B (2013)Associations between child temperament maternal feeding practices and childbody mass index during the preschool years A systematic review of the literatureObesity Reviews 1ndash10

Birch L L Fisher J O amp Davison K K (2003) Learning to overeat Maternal use ofrestrictive feeding practices promotes girlsrsquo eating in the absence of hungerAmerican Journal of Clinical Nutrition 78(2) 215ndash220

Bradley R H amp Caldwell B M (1979) Home observation for measurement of theenvironment A version of the preschool scale American Journal of MentalDeficiency 84(3) 235ndash244

Braet C Claus L Goossens L Moens E Vlierberghe L V amp Soetens B (2008)Differences in eating style between overweight and normal-weight youngstersJournal of Health Psychology 13(6) 733ndash743

Braet C Claus L Verbeken S amp Vlierberghe L V (2007) Impulsivity in overweightchildren European Child amp Adolescent Psychiatry 16(8) 473ndash483

Burnier D Dubois L amp Girard M (2011) Arguments at mealtime and child energyintake Journal of Nutrition Education and Behavior 43(6) 473ndash481

Burton P Wells J C K Kennedy K Nicholl R Khakoo A amp Fewtrell M S (2011)Association between infant correlates of impulsivity ndash surgency (extraversion)ndash and early infant growth Appetite 57 504ndash509

Center for Disease Control and Prevention (2011) Summary of trends in growthindicators by age from the pediatric nutrition surveillance system Retrieved fromhttpwwwcdcgovpednsspednss_tablestables_health_indicatorshtm

Czaja J Rief W amp Hilbert A (2009) Emotion regulation and binge eating in childrenInternational Journal of Eating Disorders 42 356ndash362

Eisenberg N Fabes R A Shepard S A Guthrie I K Murphy B C amp Rieser M(1999) Parental reactions to childrenrsquos negative emotions Longitudinal relationsto quality of childrenrsquos social functioning Child Development 70 513ndash534

Epel E Lapidus R McEwen B amp Brownell K (2001) Stress may add bite to appetitein women A laboratory study of stress-induced cortisol and eating behaviorPsychoneuroendocrinology 26 37ndash49

Epstein L H Leddy J J Temple J L amp Faith M S (2007) Food reinforcement andeating A multilevel analysis Psychology Bulletin 133(5) 884ndash906

Fabes R A Leondard S A Kupanoff K amp Martin S L (2001) Parental coping withchildrenrsquos negative emotions Relations with childrenrsquos emotional and socialresponding Child Development 72 907ndash920

Faith M S amp Hittner J B (2010) Infant temperament and eating style predict changein standardized weight status and obesity risk at 6 years of age InternationalJournal of Obesity 34 1515ndash1523

Farrow C amp Blissett J (2006) Maternal cognitions psychopathologic symptoms andinfant temperament as predictors of early infant feeding problems A longitudinalstudy International Journal of Eating Disorders 39(2) 128ndash134

Fisher J O amp Birch L L (2002) Eating in the absence of hunger and overweight ingirls from 5 to 7 y of age American Journal of Clinical Nutrition 76(1) 226ndash231

Fisher J O Birch L L Zhang J J Grusak M A amp Hughes S O (2013) Externalinfluences on childrenrsquos self-served portions at meals International Journal ofObesity 37(7) 954ndash960 doi101038ijo2012216

Francis L amp Susman EJ (2009) Self-Regulation Failure and Rapid Weight Gain inChildren from Age 3 to 12 Years Archives of Disease in Children and Adolescents163 297ndash302

Groesz L M McCoy S Carl J Saslow L Stewart J Adler N et al (2012) Whatis eating you Stress and the drive to eat Appetite 58(2) 717ndash721

Guerrieri R Nederkoorn C Stankiewicz K Alberts H Geschwind N Martijn Cet al (2007) The influence of trait and induced state impulsivity on food intakein normal-weight healthy women Appetite 49(1) 66ndash73

Haedt-Matt A A amp Keel P K (2011) Revisiting the affect regulation model of bingeeating A meta-analysis of studies using ecological momentary assessmentPsychological Bulletin 137(4) 660ndash681 doi101037a0023660

Haycraft E Farrow C Meyer C Powell F amp Blissett J (2011) Relationships betweentemperament and eating behaviours in young children Appetite 56 689ndash692

Hetherington M (2007) Individual differences in the drive to overeat NutritionBulletin 32 14ndash21

Hill C Llewellyn C H Saxton J Webber L Semmler C Carnell S et al (2008)Adiposity and ldquoeating in the absence of hungerrdquo in children International Journalof Obesity 32(10) 1499ndash1505

145CYY Leung et alAppetite 78 (2014) 139ndash146

hunger Log-transformation was used for the total number ofcalories consumed outcome variable to satisfy the normalityassumption

Questionnaires

Child eating behaviorsIn addition to observed eating in the absence of hunger five other

eating behaviors were measured using questionnaires Caregiverscompleted the Childrenrsquos Eating Behavior Questionnaire (CEBQWardle et al 2001) a validated and reliable questionnaire that as-sesses childrenrsquos food approach behaviors including food respon-siveness (eg ldquomy child is always asking for foodrdquo five itemsα = 084) enjoyment of food (eg ldquomy child loves foodrdquo four itemsα = 084) emotional overeating (eg ldquomy child eats more whenanxiousrdquo four items α = 079) and satiety responsiveness (eg ldquomychild gets full easilyrdquo five items α = 073) using a 5-point scaleranging from 1 (never) to 5 (always) Four subscale scores were com-puted by taking the mean of the corresponding items Higher scoresrepresent a greater prevalence degree of that particular eatingbehavior

Caregivers reported food-related tantrums in the last 4 weeksin four questions adapted from prior work (Agras et al 2004) (1)ldquoHow often did your child ask you for something to eat or get himherself something to eatrdquo which was rated on a 5-point scale (neverone time once a week once a day several times a day) (2) ldquoHow oftendid you have to say no when your child wanted something to eatrdquowhich was rated on a 4-point scale (rarelynever sometimes oftenalmost always or not applicable (if response to question 1 was ldquoneverrdquo))(3) ldquoWhen you said no how often did your child become upsetrdquowhich was rated on a 4-point scale (rarelynever sometimes oftenalmost always or not applicable (if response to either question 1 or 2was ldquoneverrdquo)) and (4) ldquoWhen you said no how frequently did yourchild have a tantrumrdquo which was rated on a 4-point scale (rarelynever sometimes often almost always or not applicable (if re-sponse to either question 1 or 2 was ldquoneverrdquo)) Based on theseresponses each child was assigned into one of the three catego-ries 1 (child never asks for food asks for food less than once a day orasks once or more than once a day and is neverrarely denied) 2 (childasks for food once or more than once a day is sometimesoftenalmost always denied and rarelyneversometimes becomes upset ortantrums) or 3 (child asks for food once or more than once a day issometimesoftenalmost always denied and oftenalmost alwaysbecomes upset or tantrums)

Child temperamentThe Childrenrsquos Behavior Questionnaire (CBQ Rothbart et al 2001)

was used to assess surgency and effortful control Subscales con-tributing to surgency are activity level (eg ldquoseems always in a bighurryrdquo seven items) high intensity pleasure (eg ldquolikes going downhigh slides or other adventurous activitiesrdquo six items) impulsiv-ity (eg ldquooften rushes into new situationsrdquo six items) and shyness(eg ldquoacts shy around new peoplerdquo six items) Subscales contrib-uting to effortful control are attention focusing (eg ldquowhen drawingor coloring in a book shows strong concentrationrdquo six items) andinhibitory control (eg ldquocan easily stop an activity when shehe istold ldquonordquo six items) Caregivers rated how well each item de-scribes the childrsquos reaction within the past 6 months on a 7-pointscale ranging from 1 (extremely untrue) to 7 (extremely true) Surgency(α = 070) and effortful control (α = 076) scale scores were com-puted as recommended by scale developers by taking the meanof the corresponding subscales (shyness was reverse-coded) Higherscores represent higher levels of the corresponding temperamentcharacteristics

The negative lability subscale from the Emotion Regulation Check-list (ERC Shields amp Cicchetti 1998) was used to assess negative af-

fectivity This subscale consists of 15 items reflecting a childrsquospropensity to become upset and display negative emotions (eg ldquoiseasily frustratedrdquo ldquoresponds angrily to limit-settingrdquo) Caregiversrated each item on a 4-point scale ranging from 1 (rarelynever) to4 (almost always) A scale score was computed by taking the meanof these 15 items (α = 085) Higher scores reflect more negativeaffectivity (four items were reverse-scored)

Covariate home environment qualityTo account for potential variability in eating behavior due to home

environment and family-level processes the 15-item ConfusionHubbub and Order Scale (CHAOS Matheny Wachs Ludwig ampPhillips 1995) was used to measure the extent to which the childrsquoshome environment is characterized by a lack of routine disorga-nization confusion and noise Caregivers indicated whether eachitem (eg ldquoitrsquos a real lsquozoorsquo in our homerdquo) was true or false for theirfamily Seven items were reverse-coded before summing the totalnumber of items endorsed by the caregiver (α = 080) Higher scoresrepresent a more disorganized confused and noisy home environ-ment (ie greater home chaos)

Statistical analysesMultivariate analysis accounting for inter-correlations among in-

dependent variables were implemented using path analyses toexamine whether the three temperament dimensions (surgency neg-ative affectivity and effortful control) were uniquely associated witheach of the six obesogenic eating behavior outcomes (food respon-siveness enjoyment of food emotional overeating satiety respon-siveness tantrums over food and eating in the absence of hunger)above and beyond home chaos All three temperament dimen-sions and home chaos were included in each model The covari-ance path between surgency and home chaos was excluded fromthe path analyses due to their nonsignificant zero-order correla-tion A statistical model for the path analyses is presented in Fig 1The marginal significant results of the Littlersquos MCAR test showedsome evidence that 890 of the data were not missing com-pletely at random χ2 (9) = 1533 P = 008 Thus we imputed themissing data using Proc MI in SAS 93 All analyses were con-ducted in AMOS 7 using the maximum-likelihood estimation pro-cedure Multiple fit indices were examined to evaluate the modelfit the chi-square goodness-of-fit statistic the comparative fit index

Effortful Control

Surgency

Negative Affectivity

Home Chaos

Obesogenic Eating Behavior

Fig 1 Statistical model testing the role of three temperament factors in obesogeniceating behaviors above and beyond home chaos Note Six obesogenic eating be-haviors including food responsiveness enjoyment of food emotional overeatingsatiety responsiveness tantrums over food and eating in the absence of hunger weretested individually in each model

142 CYY Leung et alAppetite 78 (2014) 139ndash146

(CFI) the root mean square error of approximation (RMSEA) and thestandardized root mean residual (SRMR) A model is considered agood fit when χ2 statistic is nonsignificant with a P-value gt 005CFI gt 090 RMSEA lt 008 and SRMR lt 006 (Bentler 1990 Hu ampBentler 1999)

Furthermore we examined potential interactions betweensurgency negative affectivity and effortful control in explaining eachof the six obesogenic eating behaviors above and beyond homechaos in a series of follow up analyses Multiple linear regressionanalyses were conducted with the six obesogenic eating behav-iors as the dependent variables home chaos as the covariate andsurgency negative affectivity and effortful control as the indepen-dent variables To test the potential interaction effects three inter-action terms (surgency times negative affectivity surgency times effortfulcontrol and negative affectivity times effortful control) were computedand entered in the corresponding regression models Surgency neg-ative affectivity and effortful control were mean-centered prior tocomputing the interaction terms in order to minimize potentiallyproblematic multicollinearity (Aiken amp West 1991)

Results

Means standard deviations and zero-order correlations amongall variables are presented in Table 2 Correlations among eating be-haviors were modest with the strongest associations observedamong CEBQ variables The three dimensions of temperament werealso modestly intercorrelated with the strongest association ob-served between negative affectivity and effortful control (r = minus061)There were positive correlations between home chaos and threeeating behaviors (ie food responsiveness emotional overeating andtantrums over food) Home chaos was therefore included as acovariate in the path models

All six path models fit the data well χ2 (1) = 1123 P = 0289CFI = 1000 RMSEA = 0018 SRMR ranging from 00163 to 00167 In-cluding all three temperament dimensions and controlling for home

chaos higher levels of surgency were significantly associated withmore food responsiveness β = 014 z = 266 P lt 001 enjoyment offood β = 022 z = 411 P lt 0001 and eating in the absence of hungerβ = 026 z = 491 P lt 0001 Moreover higher levels of negative af-fectivity were significantly associated with more tantrums over foodβ = 024 z = 367 P lt 0001 and less eating in the absence of hungerβ = minus016 z = minus244 P lt 005 However effortful control was not sig-nificantly associated with any of the six eating behaviors (see Table 3for all standardized path coefficients) These six path models werealso tested in boys and girls separately and no substantial differ-ences in the pattern of results were found between boys and girlsFurthermore multiple linear regression analyses revealed that therewere no significant surgency times negative affectivity surgency times effortfulcontrol or negative affectivity times effortful control interactions for anyof the six eating behavior outcomes (all Ps lt 005)

Discussion

The overall aim of the present study was to examine whetherthe three dimensions of temperament proposed as important forchild eating behavior specifically surgency negative affectivity andeffortful control were uniquely associated with six obesogenic eatingbehaviors among low-income preschool-age children Findings werethat low-income preschoolers with higher surgency or negative af-fectivity but not effortful control were more likely to engage incertain obesogenic eating behaviors above and beyond the effectof home chaos Results are discussed with regard to theoreticalimplications for the study of childhood obesity and for appliedprevention implications

Surgency

In support of the first hypothesis low-income preschoolers withhigher surgency were more inclined to overeat in response to ex-ternal cues have frequent desire to eat derive pleasure from foods

Table 2Means standard deviations and zero-order correlations

1 2 3 4 5 6 7 8 9 10

1 Food responsiveness ndash 047 055 minus016 025 019 018 016 minus016 0182 Enjoyment of food ndash 016 minus050 012 003 018 minus004 003 minus0013 Emotional overeating ndash 008 018 015 005 015 minus008 0144 Satiety responsiveness ndash 000 001 minus004 010 minus006 0075 Tantrums over food ndash 003 012 028 minus019 0196 Eating in the absence of hunger ndash 024 minus001 minus009 0057 Surgency ndash 030 minus035 0068 Negative affectivity ndash minus061 0389 Effortful control ndash minus03210 Home chaos ndashM 248 379 196 298 193 361 486 197 460 410SD 089 078 070 069 084 164 078 049 102 326

P lt 005 P lt 001 P lt 0001

Table 3Standardized path coefficients and z-values of the three temperament variables and covariate

Outcome variables Temperament variables Covariate

Surgency Negative affectivity Effortful control Home chaos

β z β z β z β z

Food responsiveness 014 266 003 050 minus006 minus087 014 262Enjoyment of food 022 411 minus006 minus090 008 124 004 070Emotional overeating 002 044 012 181 003 044 010 188Satiety responsiveness minus008 minus141 010 145 minus002 minus023 004 072Tantrums over food 005 086 024 367 000 004 009 161Eating in absence of hunger 026 491 minus016 minus244 minus006 minus099 006 108

P lt 005 P lt 001 P lt 0001

143CYY Leung et alAppetite 78 (2014) 139ndash146

and eat in the absence of hunger These findings complement andextend the current literature by examining the temperamental con-struct of surgency rather than just impulsivity or a lack of self-control in relation to the development of obesogenic eatingbehaviors in early childhood Temperamental surgency may man-ifest in the eating domain as an intense craving for food and sen-sitivity to food as a reward Surgent preschoolers may simply be moreinsistent than others in reaching their goal and be more driven byseeking and attaining high-pleasure goals that involve food In slightlyolder children reward sensitivity and impulsivity both predictedovereating suggesting that both aspects of surgency may contrib-ute (van den Berg et al 2011) Furthermore surgency may shapeparenting behavior studies have found that parents of infants tendedto feed their more surgent and externalizing children more oftenand with more sweet foods (Vollrath Tonstad Rothbart amp Hampson2011) Parents typically continue to control what their preschool-age children are eating although children this age may increase theirrequests for specific foods and become more effective at convinc-ing parents to allow them to have them (eg sweets at the storeOrsquoDougherty Story amp Stang 2006) In the current obesogenic en-vironment where large varieties of sweet and fatty foods are inex-pensive available and offered in large portion sizes (Epstein LeddyTemple amp Faith 2007) surgent children of low-income families maybe particularly vulnerable to obesogenic eating patterns and there-fore early childhood obesity Surgency may thus be an importantyet still relatively unexamined factor in predisposing low-incomepreschool-age children to obesogenic eating behaviors Consider-ing surgency may be a key element in understanding earlypathways to obesity for these children

Negative affectivity

In contrast to the patterns for surgency low-income preschool-ers who became easily upset experienced intense emotions and hademotion regulation difficulties were more likely to have tantrumsover being denied food but less likely to eat in the absence of hungerThese results were in partial support of the second hypothesis Neg-ative affectivity has been associated with disordered eating behav-iors in adults and adolescents (Epel et al 2001) even though it isnot clear that disordered eating (eg bingeing) functions to reducethe feelings of negative affect (Haedt-Matt amp Keel 2011) Althoughlongitudinal work with infants has focused on the role of negativeaffectivity in feeding (eg Farrow amp Blissett 2006) and negative affectis proposed as a risk factor for overweight (Anzman-Frasca et al2012) studies of preschoolers have mostly examined BMI and obesityoutcomes without specifically considering different eating behav-iors (Haycraft et al 2011) as we did in the current study Differenttemperament dimensions may confer obesity risk through differ-ent patterns of obesogenic eating behaviors Negative affectivity maycontribute to preschoolersrsquo inability to modulate intense negativeemotions and angry reactivity when being denied desirable foodOthers (Haycraft et al 2011) found associations of negative affec-tivity with greater responsiveness to satiety in children ages 3ndash8years which we did not find in our CEBQ measure but may be re-flected in the association between negative affectivity and less eatingin the absence of hunger in the present study Thus these findingsalso suggest that the use of observation may give us different in-formation about preschool-age childrenrsquos responsiveness to satietythan caregiver-report questionnaire Possibly preschoolers withhigher negative affectivity might be more likely to experience dis-tress andor anxiety during the observed procedure which mightcontribute to more selective eating behaviors (Pliner amp Loewen 1997)In the present study we found no unique relation between nega-tive affectivity and emotional overeating Perhaps children with anemotionally negative temperament may be likely to experienceintense aversive emotions and have difficulties regulating such emo-

tions when they have to endure distress without emotional supportin their immediate environment these children might be vulner-able to emotional overeating when facing a chaotic stressful homeenvironment Indeed the present zero-order correlations re-vealed that both negative affectivity and home chaos were posi-tively associated with emotional overeating

Effortful control

Effortful control reflects childrenrsquos ability to self-restrain froma prohibited behavior maintain attention and compliance to in-structions as well as resist distractions or temptations (Rothbart ampPutnam 2002) These temperamental characteristics have been pro-posed as essential for young children to develop effective strate-gies to regulate their food intake and eating patterns (Anzman-Frascaet al 2012 Jasinska et al 2012 Tan amp Holub 2011) especially whenthey are experiencing stress or facing food temptations Yet in thecurrent study we found no direct association between effortfulcontrol and obesogenic eating behaviors in our path models Therelatively high negative correlation between negative affectivity andeffortful control may have obscured the role of effortful control Itmay also be due to the fact that we examined obesogenic eating be-haviors concurrently and not prospectively The associations betweeneffortful control and obesogenic eating behaviors may emerge overtime the preschool years are a time of increasing independence andautonomy across domains of development (McClelland amp Morrison2003) Thus the role of effortful control specifically in relation toeating behavior may change across the preschool-to-middle child-hood years Indeed the ability to delay gratification (an aspect ofeffortful control) at age 4 years is associated with obesity at age 11even covarying prior weight status (Seeyave et al 2009) It is im-portant to note however that we did not examine effortful controlspecifically with regard to eating behaviors Thus although childsurgency and negative affectivity may play a more important rolethan effortful control in the pathways to certain obesogenic eatingbehaviors during the preschool years future studies should examinewhether effortful control during the preschool years may predictchildrenrsquos eating behaviors later on We also considered that effortfulcontrol may only exert effects on eating behavior in the context ofhigh levels of surgency or high levels of negative affectivity Howeverthis hypothesis was not supported as none of the interaction termswere tested was significant Thus our results suggested that amongpreschool-age children self-control was not significantly associ-ated with obesity-promoting eating behavior regardless of the childrsquoslevel of temperamental surgency or negative affectivity Further re-search is needed to better understand this lack of main or moder-ating effect of self-control in early childhood It is also importantto consider whether the effortful control-eating behavior associa-tion may emerge only in an environment where food temptationsare present

Home environment quality

Finally although home environment quality was not the primaryfocus of the current study we did find that low-income preschool-ers who lived in a more chaotic home environment were more likelyto engage in obesogenic eating behaviors such as external eatingemotional overeating and tantrums over food Our home chaosmeasure likely served as somewhat of a ldquoplaceholderrdquo for many ofthe family processes and features of the home environment that maycontribute to these associations as it is a brief self-report rather thana more extensive measure of home environment quality such as theHome Observation for Measurement of the Environment (HOME)Scale (Bradley amp Caldwell 1979) It makes sense however thatchaotic home environments without adequate parental involve-ment or responsiveness may impede childrenrsquos development of

144 CYY Leung et alAppetite 78 (2014) 139ndash146

self-regulation in food intake Young children have been shown tobe more susceptible to overeating in response to external stimuliwhen their mothers endorse an indulgent feeding style and provideminimal guidance over their eating behaviors (Fisher Birch ZhangGrusak amp Hughes 2013) Moreover children from families who tendto minimize emotions or who have low affective involvement tendto have lower emotional awareness experience greater emotionaldistress and develop poorer emotional self-regulation (Eisenberget al 1999 Fabes Leondard Kupanoff amp Martin 2001) these chil-dren may engage in overeating in response to negative emotions(Mellin Neumark-Sztainer Story Ireland amp Resnick 2002 Tophamet al 2011) and have tantrums over being denied food Yet somehave found that family arguments at mealtime are associated withless child intake (Burnier Dubois amp Girard 2011) suggesting theseassociations are complex Home environment quality can also includeparental monitoring and structure which have been shown to beimportant for childrenrsquos eating behaviors (eg Fisher et al 2013)Given these many possible pathways related to aspects of the homeenvironment it was notable that our findings for surgency and neg-ative affectivity remained even when home chaos was accountedfor suggesting that these child factors are important to consider in-dependent of home environment

Limitations future directions and implications

The following limitations of the present study should be notedFirst the cross-sectional nature of our design cannot allow us to inferthe etiological significance of temperamental surgency negative af-fectivity or effortful control in obesogenic eating behaviors amonglow-income preschool-age children Some researchers have hy-pothesized that the linkages between temperament and eating be-haviors may be driven by other factors such as genetic characteristicsor body weight that affect child temperament and eating(Anzman-Frasca et al 2012 Hetherington 2007 Miller et al 2013Wardle et al 2008) Future longitudinal research on this topic isnecessary

Furthermore caregiver-report was used as the only assess-ment of the predictor variables as well as many of the eating be-haviors which may have resulted in reporter bias The use ofobservations could increase the ecological validity of child behav-ior assessments as well as the degree of chaos in the home Otherfamilial characteristics such as parentndashchild interactions parentalfeeding practices and parental mealtime engagement have also beenshown to be associated with young childrenrsquos eating behaviors(Burnier et al 2011 Wu Dixon Dalton Tudiver amp Liu 2011) Futurestudies should consider these familial characteristics using obser-vational measures and examine their interactions with childcharacteristics in predicting young childrenrsquos obesogenic eatingbehaviors

Despite these limitations however the present study repre-sents a significant step toward understanding how multiple dimen-sions of child temperament ndash particularly surgency negativeaffectivity and effortful control ndash relate to early obesogenic eatingbehaviors which have in turn been implicated in the develop-ment of overweightobesity among low-income preschool-age chil-dren Importantly information learned from the present study maycontribute to interdisciplinary efforts between developmental sci-entists and practitioners to develop tailored evidence-based earlychildhood obesity interventions For example young children whoare characterized by high temperamental surgency or negative af-fectivity may have an increased risk for obesogenic eating thusimplementing strategies that address individual differences such asimpulsivity intense pleasure seeking and difficulties with regulat-ing emotions may increase intervention success Furthermore chil-dren with different temperamental characteristics may struggle with

different types of obesogenic eating so it is important to considerand assess different eating behaviors that a child may display

References

Agras W Hammer L McNicholas F amp Kraemer H (2004) Risk factors for childhoodoverweight A prospective study from birth to 95 years Journal of Pediatrics145(1) 20ndash25

Aiken L S amp West S G (1991) Multiple regression Testing and interpreting interactionsThousand Oaks CA Sage Publications

Anderson S E amp Whitaker R C (2010) Household routines and obesity in USpreschool-aged children Pediatrics 125(3) 420ndash428

Anzman-Frasca S S Stifter C A amp Birch L L (2012) Temperament and childhoodobesity risk A review of the literature Journal of Developmental and BehavioralPediatrics 33(9) 732ndash745

Bentler P M (1990) Comparative fit indexes in structural models PsychologicalBulletin 107 238ndash246

Bergmeier H Skouteris H Horwood S Hooley M amp Richardson B (2013)Associations between child temperament maternal feeding practices and childbody mass index during the preschool years A systematic review of the literatureObesity Reviews 1ndash10

Birch L L Fisher J O amp Davison K K (2003) Learning to overeat Maternal use ofrestrictive feeding practices promotes girlsrsquo eating in the absence of hungerAmerican Journal of Clinical Nutrition 78(2) 215ndash220

Bradley R H amp Caldwell B M (1979) Home observation for measurement of theenvironment A version of the preschool scale American Journal of MentalDeficiency 84(3) 235ndash244

Braet C Claus L Goossens L Moens E Vlierberghe L V amp Soetens B (2008)Differences in eating style between overweight and normal-weight youngstersJournal of Health Psychology 13(6) 733ndash743

Braet C Claus L Verbeken S amp Vlierberghe L V (2007) Impulsivity in overweightchildren European Child amp Adolescent Psychiatry 16(8) 473ndash483

Burnier D Dubois L amp Girard M (2011) Arguments at mealtime and child energyintake Journal of Nutrition Education and Behavior 43(6) 473ndash481

Burton P Wells J C K Kennedy K Nicholl R Khakoo A amp Fewtrell M S (2011)Association between infant correlates of impulsivity ndash surgency (extraversion)ndash and early infant growth Appetite 57 504ndash509

Center for Disease Control and Prevention (2011) Summary of trends in growthindicators by age from the pediatric nutrition surveillance system Retrieved fromhttpwwwcdcgovpednsspednss_tablestables_health_indicatorshtm

Czaja J Rief W amp Hilbert A (2009) Emotion regulation and binge eating in childrenInternational Journal of Eating Disorders 42 356ndash362

Eisenberg N Fabes R A Shepard S A Guthrie I K Murphy B C amp Rieser M(1999) Parental reactions to childrenrsquos negative emotions Longitudinal relationsto quality of childrenrsquos social functioning Child Development 70 513ndash534

Epel E Lapidus R McEwen B amp Brownell K (2001) Stress may add bite to appetitein women A laboratory study of stress-induced cortisol and eating behaviorPsychoneuroendocrinology 26 37ndash49

Epstein L H Leddy J J Temple J L amp Faith M S (2007) Food reinforcement andeating A multilevel analysis Psychology Bulletin 133(5) 884ndash906

Fabes R A Leondard S A Kupanoff K amp Martin S L (2001) Parental coping withchildrenrsquos negative emotions Relations with childrenrsquos emotional and socialresponding Child Development 72 907ndash920

Faith M S amp Hittner J B (2010) Infant temperament and eating style predict changein standardized weight status and obesity risk at 6 years of age InternationalJournal of Obesity 34 1515ndash1523

Farrow C amp Blissett J (2006) Maternal cognitions psychopathologic symptoms andinfant temperament as predictors of early infant feeding problems A longitudinalstudy International Journal of Eating Disorders 39(2) 128ndash134

Fisher J O amp Birch L L (2002) Eating in the absence of hunger and overweight ingirls from 5 to 7 y of age American Journal of Clinical Nutrition 76(1) 226ndash231

Fisher J O Birch L L Zhang J J Grusak M A amp Hughes S O (2013) Externalinfluences on childrenrsquos self-served portions at meals International Journal ofObesity 37(7) 954ndash960 doi101038ijo2012216

Francis L amp Susman EJ (2009) Self-Regulation Failure and Rapid Weight Gain inChildren from Age 3 to 12 Years Archives of Disease in Children and Adolescents163 297ndash302

Groesz L M McCoy S Carl J Saslow L Stewart J Adler N et al (2012) Whatis eating you Stress and the drive to eat Appetite 58(2) 717ndash721

Guerrieri R Nederkoorn C Stankiewicz K Alberts H Geschwind N Martijn Cet al (2007) The influence of trait and induced state impulsivity on food intakein normal-weight healthy women Appetite 49(1) 66ndash73

Haedt-Matt A A amp Keel P K (2011) Revisiting the affect regulation model of bingeeating A meta-analysis of studies using ecological momentary assessmentPsychological Bulletin 137(4) 660ndash681 doi101037a0023660

Haycraft E Farrow C Meyer C Powell F amp Blissett J (2011) Relationships betweentemperament and eating behaviours in young children Appetite 56 689ndash692

Hetherington M (2007) Individual differences in the drive to overeat NutritionBulletin 32 14ndash21

Hill C Llewellyn C H Saxton J Webber L Semmler C Carnell S et al (2008)Adiposity and ldquoeating in the absence of hungerrdquo in children International Journalof Obesity 32(10) 1499ndash1505

145CYY Leung et alAppetite 78 (2014) 139ndash146

(CFI) the root mean square error of approximation (RMSEA) and thestandardized root mean residual (SRMR) A model is considered agood fit when χ2 statistic is nonsignificant with a P-value gt 005CFI gt 090 RMSEA lt 008 and SRMR lt 006 (Bentler 1990 Hu ampBentler 1999)

Furthermore we examined potential interactions betweensurgency negative affectivity and effortful control in explaining eachof the six obesogenic eating behaviors above and beyond homechaos in a series of follow up analyses Multiple linear regressionanalyses were conducted with the six obesogenic eating behav-iors as the dependent variables home chaos as the covariate andsurgency negative affectivity and effortful control as the indepen-dent variables To test the potential interaction effects three inter-action terms (surgency times negative affectivity surgency times effortfulcontrol and negative affectivity times effortful control) were computedand entered in the corresponding regression models Surgency neg-ative affectivity and effortful control were mean-centered prior tocomputing the interaction terms in order to minimize potentiallyproblematic multicollinearity (Aiken amp West 1991)

Results

Means standard deviations and zero-order correlations amongall variables are presented in Table 2 Correlations among eating be-haviors were modest with the strongest associations observedamong CEBQ variables The three dimensions of temperament werealso modestly intercorrelated with the strongest association ob-served between negative affectivity and effortful control (r = minus061)There were positive correlations between home chaos and threeeating behaviors (ie food responsiveness emotional overeating andtantrums over food) Home chaos was therefore included as acovariate in the path models

All six path models fit the data well χ2 (1) = 1123 P = 0289CFI = 1000 RMSEA = 0018 SRMR ranging from 00163 to 00167 In-cluding all three temperament dimensions and controlling for home

chaos higher levels of surgency were significantly associated withmore food responsiveness β = 014 z = 266 P lt 001 enjoyment offood β = 022 z = 411 P lt 0001 and eating in the absence of hungerβ = 026 z = 491 P lt 0001 Moreover higher levels of negative af-fectivity were significantly associated with more tantrums over foodβ = 024 z = 367 P lt 0001 and less eating in the absence of hungerβ = minus016 z = minus244 P lt 005 However effortful control was not sig-nificantly associated with any of the six eating behaviors (see Table 3for all standardized path coefficients) These six path models werealso tested in boys and girls separately and no substantial differ-ences in the pattern of results were found between boys and girlsFurthermore multiple linear regression analyses revealed that therewere no significant surgency times negative affectivity surgency times effortfulcontrol or negative affectivity times effortful control interactions for anyof the six eating behavior outcomes (all Ps lt 005)

Discussion

The overall aim of the present study was to examine whetherthe three dimensions of temperament proposed as important forchild eating behavior specifically surgency negative affectivity andeffortful control were uniquely associated with six obesogenic eatingbehaviors among low-income preschool-age children Findings werethat low-income preschoolers with higher surgency or negative af-fectivity but not effortful control were more likely to engage incertain obesogenic eating behaviors above and beyond the effectof home chaos Results are discussed with regard to theoreticalimplications for the study of childhood obesity and for appliedprevention implications

Surgency

In support of the first hypothesis low-income preschoolers withhigher surgency were more inclined to overeat in response to ex-ternal cues have frequent desire to eat derive pleasure from foods

Table 2Means standard deviations and zero-order correlations

1 2 3 4 5 6 7 8 9 10

1 Food responsiveness ndash 047 055 minus016 025 019 018 016 minus016 0182 Enjoyment of food ndash 016 minus050 012 003 018 minus004 003 minus0013 Emotional overeating ndash 008 018 015 005 015 minus008 0144 Satiety responsiveness ndash 000 001 minus004 010 minus006 0075 Tantrums over food ndash 003 012 028 minus019 0196 Eating in the absence of hunger ndash 024 minus001 minus009 0057 Surgency ndash 030 minus035 0068 Negative affectivity ndash minus061 0389 Effortful control ndash minus03210 Home chaos ndashM 248 379 196 298 193 361 486 197 460 410SD 089 078 070 069 084 164 078 049 102 326

P lt 005 P lt 001 P lt 0001

Table 3Standardized path coefficients and z-values of the three temperament variables and covariate

Outcome variables Temperament variables Covariate

Surgency Negative affectivity Effortful control Home chaos

β z β z β z β z

Food responsiveness 014 266 003 050 minus006 minus087 014 262Enjoyment of food 022 411 minus006 minus090 008 124 004 070Emotional overeating 002 044 012 181 003 044 010 188Satiety responsiveness minus008 minus141 010 145 minus002 minus023 004 072Tantrums over food 005 086 024 367 000 004 009 161Eating in absence of hunger 026 491 minus016 minus244 minus006 minus099 006 108

P lt 005 P lt 001 P lt 0001

143CYY Leung et alAppetite 78 (2014) 139ndash146

and eat in the absence of hunger These findings complement andextend the current literature by examining the temperamental con-struct of surgency rather than just impulsivity or a lack of self-control in relation to the development of obesogenic eatingbehaviors in early childhood Temperamental surgency may man-ifest in the eating domain as an intense craving for food and sen-sitivity to food as a reward Surgent preschoolers may simply be moreinsistent than others in reaching their goal and be more driven byseeking and attaining high-pleasure goals that involve food In slightlyolder children reward sensitivity and impulsivity both predictedovereating suggesting that both aspects of surgency may contrib-ute (van den Berg et al 2011) Furthermore surgency may shapeparenting behavior studies have found that parents of infants tendedto feed their more surgent and externalizing children more oftenand with more sweet foods (Vollrath Tonstad Rothbart amp Hampson2011) Parents typically continue to control what their preschool-age children are eating although children this age may increase theirrequests for specific foods and become more effective at convinc-ing parents to allow them to have them (eg sweets at the storeOrsquoDougherty Story amp Stang 2006) In the current obesogenic en-vironment where large varieties of sweet and fatty foods are inex-pensive available and offered in large portion sizes (Epstein LeddyTemple amp Faith 2007) surgent children of low-income families maybe particularly vulnerable to obesogenic eating patterns and there-fore early childhood obesity Surgency may thus be an importantyet still relatively unexamined factor in predisposing low-incomepreschool-age children to obesogenic eating behaviors Consider-ing surgency may be a key element in understanding earlypathways to obesity for these children

Negative affectivity

In contrast to the patterns for surgency low-income preschool-ers who became easily upset experienced intense emotions and hademotion regulation difficulties were more likely to have tantrumsover being denied food but less likely to eat in the absence of hungerThese results were in partial support of the second hypothesis Neg-ative affectivity has been associated with disordered eating behav-iors in adults and adolescents (Epel et al 2001) even though it isnot clear that disordered eating (eg bingeing) functions to reducethe feelings of negative affect (Haedt-Matt amp Keel 2011) Althoughlongitudinal work with infants has focused on the role of negativeaffectivity in feeding (eg Farrow amp Blissett 2006) and negative affectis proposed as a risk factor for overweight (Anzman-Frasca et al2012) studies of preschoolers have mostly examined BMI and obesityoutcomes without specifically considering different eating behav-iors (Haycraft et al 2011) as we did in the current study Differenttemperament dimensions may confer obesity risk through differ-ent patterns of obesogenic eating behaviors Negative affectivity maycontribute to preschoolersrsquo inability to modulate intense negativeemotions and angry reactivity when being denied desirable foodOthers (Haycraft et al 2011) found associations of negative affec-tivity with greater responsiveness to satiety in children ages 3ndash8years which we did not find in our CEBQ measure but may be re-flected in the association between negative affectivity and less eatingin the absence of hunger in the present study Thus these findingsalso suggest that the use of observation may give us different in-formation about preschool-age childrenrsquos responsiveness to satietythan caregiver-report questionnaire Possibly preschoolers withhigher negative affectivity might be more likely to experience dis-tress andor anxiety during the observed procedure which mightcontribute to more selective eating behaviors (Pliner amp Loewen 1997)In the present study we found no unique relation between nega-tive affectivity and emotional overeating Perhaps children with anemotionally negative temperament may be likely to experienceintense aversive emotions and have difficulties regulating such emo-

tions when they have to endure distress without emotional supportin their immediate environment these children might be vulner-able to emotional overeating when facing a chaotic stressful homeenvironment Indeed the present zero-order correlations re-vealed that both negative affectivity and home chaos were posi-tively associated with emotional overeating

Effortful control

Effortful control reflects childrenrsquos ability to self-restrain froma prohibited behavior maintain attention and compliance to in-structions as well as resist distractions or temptations (Rothbart ampPutnam 2002) These temperamental characteristics have been pro-posed as essential for young children to develop effective strate-gies to regulate their food intake and eating patterns (Anzman-Frascaet al 2012 Jasinska et al 2012 Tan amp Holub 2011) especially whenthey are experiencing stress or facing food temptations Yet in thecurrent study we found no direct association between effortfulcontrol and obesogenic eating behaviors in our path models Therelatively high negative correlation between negative affectivity andeffortful control may have obscured the role of effortful control Itmay also be due to the fact that we examined obesogenic eating be-haviors concurrently and not prospectively The associations betweeneffortful control and obesogenic eating behaviors may emerge overtime the preschool years are a time of increasing independence andautonomy across domains of development (McClelland amp Morrison2003) Thus the role of effortful control specifically in relation toeating behavior may change across the preschool-to-middle child-hood years Indeed the ability to delay gratification (an aspect ofeffortful control) at age 4 years is associated with obesity at age 11even covarying prior weight status (Seeyave et al 2009) It is im-portant to note however that we did not examine effortful controlspecifically with regard to eating behaviors Thus although childsurgency and negative affectivity may play a more important rolethan effortful control in the pathways to certain obesogenic eatingbehaviors during the preschool years future studies should examinewhether effortful control during the preschool years may predictchildrenrsquos eating behaviors later on We also considered that effortfulcontrol may only exert effects on eating behavior in the context ofhigh levels of surgency or high levels of negative affectivity Howeverthis hypothesis was not supported as none of the interaction termswere tested was significant Thus our results suggested that amongpreschool-age children self-control was not significantly associ-ated with obesity-promoting eating behavior regardless of the childrsquoslevel of temperamental surgency or negative affectivity Further re-search is needed to better understand this lack of main or moder-ating effect of self-control in early childhood It is also importantto consider whether the effortful control-eating behavior associa-tion may emerge only in an environment where food temptationsare present

Home environment quality

Finally although home environment quality was not the primaryfocus of the current study we did find that low-income preschool-ers who lived in a more chaotic home environment were more likelyto engage in obesogenic eating behaviors such as external eatingemotional overeating and tantrums over food Our home chaosmeasure likely served as somewhat of a ldquoplaceholderrdquo for many ofthe family processes and features of the home environment that maycontribute to these associations as it is a brief self-report rather thana more extensive measure of home environment quality such as theHome Observation for Measurement of the Environment (HOME)Scale (Bradley amp Caldwell 1979) It makes sense however thatchaotic home environments without adequate parental involve-ment or responsiveness may impede childrenrsquos development of

144 CYY Leung et alAppetite 78 (2014) 139ndash146

self-regulation in food intake Young children have been shown tobe more susceptible to overeating in response to external stimuliwhen their mothers endorse an indulgent feeding style and provideminimal guidance over their eating behaviors (Fisher Birch ZhangGrusak amp Hughes 2013) Moreover children from families who tendto minimize emotions or who have low affective involvement tendto have lower emotional awareness experience greater emotionaldistress and develop poorer emotional self-regulation (Eisenberget al 1999 Fabes Leondard Kupanoff amp Martin 2001) these chil-dren may engage in overeating in response to negative emotions(Mellin Neumark-Sztainer Story Ireland amp Resnick 2002 Tophamet al 2011) and have tantrums over being denied food Yet somehave found that family arguments at mealtime are associated withless child intake (Burnier Dubois amp Girard 2011) suggesting theseassociations are complex Home environment quality can also includeparental monitoring and structure which have been shown to beimportant for childrenrsquos eating behaviors (eg Fisher et al 2013)Given these many possible pathways related to aspects of the homeenvironment it was notable that our findings for surgency and neg-ative affectivity remained even when home chaos was accountedfor suggesting that these child factors are important to consider in-dependent of home environment

Limitations future directions and implications

The following limitations of the present study should be notedFirst the cross-sectional nature of our design cannot allow us to inferthe etiological significance of temperamental surgency negative af-fectivity or effortful control in obesogenic eating behaviors amonglow-income preschool-age children Some researchers have hy-pothesized that the linkages between temperament and eating be-haviors may be driven by other factors such as genetic characteristicsor body weight that affect child temperament and eating(Anzman-Frasca et al 2012 Hetherington 2007 Miller et al 2013Wardle et al 2008) Future longitudinal research on this topic isnecessary

Furthermore caregiver-report was used as the only assess-ment of the predictor variables as well as many of the eating be-haviors which may have resulted in reporter bias The use ofobservations could increase the ecological validity of child behav-ior assessments as well as the degree of chaos in the home Otherfamilial characteristics such as parentndashchild interactions parentalfeeding practices and parental mealtime engagement have also beenshown to be associated with young childrenrsquos eating behaviors(Burnier et al 2011 Wu Dixon Dalton Tudiver amp Liu 2011) Futurestudies should consider these familial characteristics using obser-vational measures and examine their interactions with childcharacteristics in predicting young childrenrsquos obesogenic eatingbehaviors

Despite these limitations however the present study repre-sents a significant step toward understanding how multiple dimen-sions of child temperament ndash particularly surgency negativeaffectivity and effortful control ndash relate to early obesogenic eatingbehaviors which have in turn been implicated in the develop-ment of overweightobesity among low-income preschool-age chil-dren Importantly information learned from the present study maycontribute to interdisciplinary efforts between developmental sci-entists and practitioners to develop tailored evidence-based earlychildhood obesity interventions For example young children whoare characterized by high temperamental surgency or negative af-fectivity may have an increased risk for obesogenic eating thusimplementing strategies that address individual differences such asimpulsivity intense pleasure seeking and difficulties with regulat-ing emotions may increase intervention success Furthermore chil-dren with different temperamental characteristics may struggle with

different types of obesogenic eating so it is important to considerand assess different eating behaviors that a child may display

References

Agras W Hammer L McNicholas F amp Kraemer H (2004) Risk factors for childhoodoverweight A prospective study from birth to 95 years Journal of Pediatrics145(1) 20ndash25

Aiken L S amp West S G (1991) Multiple regression Testing and interpreting interactionsThousand Oaks CA Sage Publications

Anderson S E amp Whitaker R C (2010) Household routines and obesity in USpreschool-aged children Pediatrics 125(3) 420ndash428

Anzman-Frasca S S Stifter C A amp Birch L L (2012) Temperament and childhoodobesity risk A review of the literature Journal of Developmental and BehavioralPediatrics 33(9) 732ndash745

Bentler P M (1990) Comparative fit indexes in structural models PsychologicalBulletin 107 238ndash246

Bergmeier H Skouteris H Horwood S Hooley M amp Richardson B (2013)Associations between child temperament maternal feeding practices and childbody mass index during the preschool years A systematic review of the literatureObesity Reviews 1ndash10

Birch L L Fisher J O amp Davison K K (2003) Learning to overeat Maternal use ofrestrictive feeding practices promotes girlsrsquo eating in the absence of hungerAmerican Journal of Clinical Nutrition 78(2) 215ndash220

Bradley R H amp Caldwell B M (1979) Home observation for measurement of theenvironment A version of the preschool scale American Journal of MentalDeficiency 84(3) 235ndash244

Braet C Claus L Goossens L Moens E Vlierberghe L V amp Soetens B (2008)Differences in eating style between overweight and normal-weight youngstersJournal of Health Psychology 13(6) 733ndash743

Braet C Claus L Verbeken S amp Vlierberghe L V (2007) Impulsivity in overweightchildren European Child amp Adolescent Psychiatry 16(8) 473ndash483

Burnier D Dubois L amp Girard M (2011) Arguments at mealtime and child energyintake Journal of Nutrition Education and Behavior 43(6) 473ndash481

Burton P Wells J C K Kennedy K Nicholl R Khakoo A amp Fewtrell M S (2011)Association between infant correlates of impulsivity ndash surgency (extraversion)ndash and early infant growth Appetite 57 504ndash509

Center for Disease Control and Prevention (2011) Summary of trends in growthindicators by age from the pediatric nutrition surveillance system Retrieved fromhttpwwwcdcgovpednsspednss_tablestables_health_indicatorshtm

Czaja J Rief W amp Hilbert A (2009) Emotion regulation and binge eating in childrenInternational Journal of Eating Disorders 42 356ndash362

Eisenberg N Fabes R A Shepard S A Guthrie I K Murphy B C amp Rieser M(1999) Parental reactions to childrenrsquos negative emotions Longitudinal relationsto quality of childrenrsquos social functioning Child Development 70 513ndash534

Epel E Lapidus R McEwen B amp Brownell K (2001) Stress may add bite to appetitein women A laboratory study of stress-induced cortisol and eating behaviorPsychoneuroendocrinology 26 37ndash49

Epstein L H Leddy J J Temple J L amp Faith M S (2007) Food reinforcement andeating A multilevel analysis Psychology Bulletin 133(5) 884ndash906

Fabes R A Leondard S A Kupanoff K amp Martin S L (2001) Parental coping withchildrenrsquos negative emotions Relations with childrenrsquos emotional and socialresponding Child Development 72 907ndash920

Faith M S amp Hittner J B (2010) Infant temperament and eating style predict changein standardized weight status and obesity risk at 6 years of age InternationalJournal of Obesity 34 1515ndash1523

Farrow C amp Blissett J (2006) Maternal cognitions psychopathologic symptoms andinfant temperament as predictors of early infant feeding problems A longitudinalstudy International Journal of Eating Disorders 39(2) 128ndash134

Fisher J O amp Birch L L (2002) Eating in the absence of hunger and overweight ingirls from 5 to 7 y of age American Journal of Clinical Nutrition 76(1) 226ndash231

Fisher J O Birch L L Zhang J J Grusak M A amp Hughes S O (2013) Externalinfluences on childrenrsquos self-served portions at meals International Journal ofObesity 37(7) 954ndash960 doi101038ijo2012216

Francis L amp Susman EJ (2009) Self-Regulation Failure and Rapid Weight Gain inChildren from Age 3 to 12 Years Archives of Disease in Children and Adolescents163 297ndash302

Groesz L M McCoy S Carl J Saslow L Stewart J Adler N et al (2012) Whatis eating you Stress and the drive to eat Appetite 58(2) 717ndash721

Guerrieri R Nederkoorn C Stankiewicz K Alberts H Geschwind N Martijn Cet al (2007) The influence of trait and induced state impulsivity on food intakein normal-weight healthy women Appetite 49(1) 66ndash73

Haedt-Matt A A amp Keel P K (2011) Revisiting the affect regulation model of bingeeating A meta-analysis of studies using ecological momentary assessmentPsychological Bulletin 137(4) 660ndash681 doi101037a0023660

Haycraft E Farrow C Meyer C Powell F amp Blissett J (2011) Relationships betweentemperament and eating behaviours in young children Appetite 56 689ndash692

Hetherington M (2007) Individual differences in the drive to overeat NutritionBulletin 32 14ndash21

Hill C Llewellyn C H Saxton J Webber L Semmler C Carnell S et al (2008)Adiposity and ldquoeating in the absence of hungerrdquo in children International Journalof Obesity 32(10) 1499ndash1505

145CYY Leung et alAppetite 78 (2014) 139ndash146

and eat in the absence of hunger These findings complement andextend the current literature by examining the temperamental con-struct of surgency rather than just impulsivity or a lack of self-control in relation to the development of obesogenic eatingbehaviors in early childhood Temperamental surgency may man-ifest in the eating domain as an intense craving for food and sen-sitivity to food as a reward Surgent preschoolers may simply be moreinsistent than others in reaching their goal and be more driven byseeking and attaining high-pleasure goals that involve food In slightlyolder children reward sensitivity and impulsivity both predictedovereating suggesting that both aspects of surgency may contrib-ute (van den Berg et al 2011) Furthermore surgency may shapeparenting behavior studies have found that parents of infants tendedto feed their more surgent and externalizing children more oftenand with more sweet foods (Vollrath Tonstad Rothbart amp Hampson2011) Parents typically continue to control what their preschool-age children are eating although children this age may increase theirrequests for specific foods and become more effective at convinc-ing parents to allow them to have them (eg sweets at the storeOrsquoDougherty Story amp Stang 2006) In the current obesogenic en-vironment where large varieties of sweet and fatty foods are inex-pensive available and offered in large portion sizes (Epstein LeddyTemple amp Faith 2007) surgent children of low-income families maybe particularly vulnerable to obesogenic eating patterns and there-fore early childhood obesity Surgency may thus be an importantyet still relatively unexamined factor in predisposing low-incomepreschool-age children to obesogenic eating behaviors Consider-ing surgency may be a key element in understanding earlypathways to obesity for these children

Negative affectivity

In contrast to the patterns for surgency low-income preschool-ers who became easily upset experienced intense emotions and hademotion regulation difficulties were more likely to have tantrumsover being denied food but less likely to eat in the absence of hungerThese results were in partial support of the second hypothesis Neg-ative affectivity has been associated with disordered eating behav-iors in adults and adolescents (Epel et al 2001) even though it isnot clear that disordered eating (eg bingeing) functions to reducethe feelings of negative affect (Haedt-Matt amp Keel 2011) Althoughlongitudinal work with infants has focused on the role of negativeaffectivity in feeding (eg Farrow amp Blissett 2006) and negative affectis proposed as a risk factor for overweight (Anzman-Frasca et al2012) studies of preschoolers have mostly examined BMI and obesityoutcomes without specifically considering different eating behav-iors (Haycraft et al 2011) as we did in the current study Differenttemperament dimensions may confer obesity risk through differ-ent patterns of obesogenic eating behaviors Negative affectivity maycontribute to preschoolersrsquo inability to modulate intense negativeemotions and angry reactivity when being denied desirable foodOthers (Haycraft et al 2011) found associations of negative affec-tivity with greater responsiveness to satiety in children ages 3ndash8years which we did not find in our CEBQ measure but may be re-flected in the association between negative affectivity and less eatingin the absence of hunger in the present study Thus these findingsalso suggest that the use of observation may give us different in-formation about preschool-age childrenrsquos responsiveness to satietythan caregiver-report questionnaire Possibly preschoolers withhigher negative affectivity might be more likely to experience dis-tress andor anxiety during the observed procedure which mightcontribute to more selective eating behaviors (Pliner amp Loewen 1997)In the present study we found no unique relation between nega-tive affectivity and emotional overeating Perhaps children with anemotionally negative temperament may be likely to experienceintense aversive emotions and have difficulties regulating such emo-

tions when they have to endure distress without emotional supportin their immediate environment these children might be vulner-able to emotional overeating when facing a chaotic stressful homeenvironment Indeed the present zero-order correlations re-vealed that both negative affectivity and home chaos were posi-tively associated with emotional overeating

Effortful control

Effortful control reflects childrenrsquos ability to self-restrain froma prohibited behavior maintain attention and compliance to in-structions as well as resist distractions or temptations (Rothbart ampPutnam 2002) These temperamental characteristics have been pro-posed as essential for young children to develop effective strate-gies to regulate their food intake and eating patterns (Anzman-Frascaet al 2012 Jasinska et al 2012 Tan amp Holub 2011) especially whenthey are experiencing stress or facing food temptations Yet in thecurrent study we found no direct association between effortfulcontrol and obesogenic eating behaviors in our path models Therelatively high negative correlation between negative affectivity andeffortful control may have obscured the role of effortful control Itmay also be due to the fact that we examined obesogenic eating be-haviors concurrently and not prospectively The associations betweeneffortful control and obesogenic eating behaviors may emerge overtime the preschool years are a time of increasing independence andautonomy across domains of development (McClelland amp Morrison2003) Thus the role of effortful control specifically in relation toeating behavior may change across the preschool-to-middle child-hood years Indeed the ability to delay gratification (an aspect ofeffortful control) at age 4 years is associated with obesity at age 11even covarying prior weight status (Seeyave et al 2009) It is im-portant to note however that we did not examine effortful controlspecifically with regard to eating behaviors Thus although childsurgency and negative affectivity may play a more important rolethan effortful control in the pathways to certain obesogenic eatingbehaviors during the preschool years future studies should examinewhether effortful control during the preschool years may predictchildrenrsquos eating behaviors later on We also considered that effortfulcontrol may only exert effects on eating behavior in the context ofhigh levels of surgency or high levels of negative affectivity Howeverthis hypothesis was not supported as none of the interaction termswere tested was significant Thus our results suggested that amongpreschool-age children self-control was not significantly associ-ated with obesity-promoting eating behavior regardless of the childrsquoslevel of temperamental surgency or negative affectivity Further re-search is needed to better understand this lack of main or moder-ating effect of self-control in early childhood It is also importantto consider whether the effortful control-eating behavior associa-tion may emerge only in an environment where food temptationsare present

Home environment quality

Finally although home environment quality was not the primaryfocus of the current study we did find that low-income preschool-ers who lived in a more chaotic home environment were more likelyto engage in obesogenic eating behaviors such as external eatingemotional overeating and tantrums over food Our home chaosmeasure likely served as somewhat of a ldquoplaceholderrdquo for many ofthe family processes and features of the home environment that maycontribute to these associations as it is a brief self-report rather thana more extensive measure of home environment quality such as theHome Observation for Measurement of the Environment (HOME)Scale (Bradley amp Caldwell 1979) It makes sense however thatchaotic home environments without adequate parental involve-ment or responsiveness may impede childrenrsquos development of

144 CYY Leung et alAppetite 78 (2014) 139ndash146

self-regulation in food intake Young children have been shown tobe more susceptible to overeating in response to external stimuliwhen their mothers endorse an indulgent feeding style and provideminimal guidance over their eating behaviors (Fisher Birch ZhangGrusak amp Hughes 2013) Moreover children from families who tendto minimize emotions or who have low affective involvement tendto have lower emotional awareness experience greater emotionaldistress and develop poorer emotional self-regulation (Eisenberget al 1999 Fabes Leondard Kupanoff amp Martin 2001) these chil-dren may engage in overeating in response to negative emotions(Mellin Neumark-Sztainer Story Ireland amp Resnick 2002 Tophamet al 2011) and have tantrums over being denied food Yet somehave found that family arguments at mealtime are associated withless child intake (Burnier Dubois amp Girard 2011) suggesting theseassociations are complex Home environment quality can also includeparental monitoring and structure which have been shown to beimportant for childrenrsquos eating behaviors (eg Fisher et al 2013)Given these many possible pathways related to aspects of the homeenvironment it was notable that our findings for surgency and neg-ative affectivity remained even when home chaos was accountedfor suggesting that these child factors are important to consider in-dependent of home environment

Limitations future directions and implications

The following limitations of the present study should be notedFirst the cross-sectional nature of our design cannot allow us to inferthe etiological significance of temperamental surgency negative af-fectivity or effortful control in obesogenic eating behaviors amonglow-income preschool-age children Some researchers have hy-pothesized that the linkages between temperament and eating be-haviors may be driven by other factors such as genetic characteristicsor body weight that affect child temperament and eating(Anzman-Frasca et al 2012 Hetherington 2007 Miller et al 2013Wardle et al 2008) Future longitudinal research on this topic isnecessary

Furthermore caregiver-report was used as the only assess-ment of the predictor variables as well as many of the eating be-haviors which may have resulted in reporter bias The use ofobservations could increase the ecological validity of child behav-ior assessments as well as the degree of chaos in the home Otherfamilial characteristics such as parentndashchild interactions parentalfeeding practices and parental mealtime engagement have also beenshown to be associated with young childrenrsquos eating behaviors(Burnier et al 2011 Wu Dixon Dalton Tudiver amp Liu 2011) Futurestudies should consider these familial characteristics using obser-vational measures and examine their interactions with childcharacteristics in predicting young childrenrsquos obesogenic eatingbehaviors

Despite these limitations however the present study repre-sents a significant step toward understanding how multiple dimen-sions of child temperament ndash particularly surgency negativeaffectivity and effortful control ndash relate to early obesogenic eatingbehaviors which have in turn been implicated in the develop-ment of overweightobesity among low-income preschool-age chil-dren Importantly information learned from the present study maycontribute to interdisciplinary efforts between developmental sci-entists and practitioners to develop tailored evidence-based earlychildhood obesity interventions For example young children whoare characterized by high temperamental surgency or negative af-fectivity may have an increased risk for obesogenic eating thusimplementing strategies that address individual differences such asimpulsivity intense pleasure seeking and difficulties with regulat-ing emotions may increase intervention success Furthermore chil-dren with different temperamental characteristics may struggle with

different types of obesogenic eating so it is important to considerand assess different eating behaviors that a child may display

References

Agras W Hammer L McNicholas F amp Kraemer H (2004) Risk factors for childhoodoverweight A prospective study from birth to 95 years Journal of Pediatrics145(1) 20ndash25

Aiken L S amp West S G (1991) Multiple regression Testing and interpreting interactionsThousand Oaks CA Sage Publications

Anderson S E amp Whitaker R C (2010) Household routines and obesity in USpreschool-aged children Pediatrics 125(3) 420ndash428

Anzman-Frasca S S Stifter C A amp Birch L L (2012) Temperament and childhoodobesity risk A review of the literature Journal of Developmental and BehavioralPediatrics 33(9) 732ndash745

Bentler P M (1990) Comparative fit indexes in structural models PsychologicalBulletin 107 238ndash246

Bergmeier H Skouteris H Horwood S Hooley M amp Richardson B (2013)Associations between child temperament maternal feeding practices and childbody mass index during the preschool years A systematic review of the literatureObesity Reviews 1ndash10

Birch L L Fisher J O amp Davison K K (2003) Learning to overeat Maternal use ofrestrictive feeding practices promotes girlsrsquo eating in the absence of hungerAmerican Journal of Clinical Nutrition 78(2) 215ndash220

Bradley R H amp Caldwell B M (1979) Home observation for measurement of theenvironment A version of the preschool scale American Journal of MentalDeficiency 84(3) 235ndash244

Braet C Claus L Goossens L Moens E Vlierberghe L V amp Soetens B (2008)Differences in eating style between overweight and normal-weight youngstersJournal of Health Psychology 13(6) 733ndash743

Braet C Claus L Verbeken S amp Vlierberghe L V (2007) Impulsivity in overweightchildren European Child amp Adolescent Psychiatry 16(8) 473ndash483

Burnier D Dubois L amp Girard M (2011) Arguments at mealtime and child energyintake Journal of Nutrition Education and Behavior 43(6) 473ndash481

Burton P Wells J C K Kennedy K Nicholl R Khakoo A amp Fewtrell M S (2011)Association between infant correlates of impulsivity ndash surgency (extraversion)ndash and early infant growth Appetite 57 504ndash509

Center for Disease Control and Prevention (2011) Summary of trends in growthindicators by age from the pediatric nutrition surveillance system Retrieved fromhttpwwwcdcgovpednsspednss_tablestables_health_indicatorshtm

Czaja J Rief W amp Hilbert A (2009) Emotion regulation and binge eating in childrenInternational Journal of Eating Disorders 42 356ndash362

Eisenberg N Fabes R A Shepard S A Guthrie I K Murphy B C amp Rieser M(1999) Parental reactions to childrenrsquos negative emotions Longitudinal relationsto quality of childrenrsquos social functioning Child Development 70 513ndash534

Epel E Lapidus R McEwen B amp Brownell K (2001) Stress may add bite to appetitein women A laboratory study of stress-induced cortisol and eating behaviorPsychoneuroendocrinology 26 37ndash49

Epstein L H Leddy J J Temple J L amp Faith M S (2007) Food reinforcement andeating A multilevel analysis Psychology Bulletin 133(5) 884ndash906

Fabes R A Leondard S A Kupanoff K amp Martin S L (2001) Parental coping withchildrenrsquos negative emotions Relations with childrenrsquos emotional and socialresponding Child Development 72 907ndash920

Faith M S amp Hittner J B (2010) Infant temperament and eating style predict changein standardized weight status and obesity risk at 6 years of age InternationalJournal of Obesity 34 1515ndash1523

Farrow C amp Blissett J (2006) Maternal cognitions psychopathologic symptoms andinfant temperament as predictors of early infant feeding problems A longitudinalstudy International Journal of Eating Disorders 39(2) 128ndash134

Fisher J O amp Birch L L (2002) Eating in the absence of hunger and overweight ingirls from 5 to 7 y of age American Journal of Clinical Nutrition 76(1) 226ndash231

Fisher J O Birch L L Zhang J J Grusak M A amp Hughes S O (2013) Externalinfluences on childrenrsquos self-served portions at meals International Journal ofObesity 37(7) 954ndash960 doi101038ijo2012216

Francis L amp Susman EJ (2009) Self-Regulation Failure and Rapid Weight Gain inChildren from Age 3 to 12 Years Archives of Disease in Children and Adolescents163 297ndash302

Groesz L M McCoy S Carl J Saslow L Stewart J Adler N et al (2012) Whatis eating you Stress and the drive to eat Appetite 58(2) 717ndash721

Guerrieri R Nederkoorn C Stankiewicz K Alberts H Geschwind N Martijn Cet al (2007) The influence of trait and induced state impulsivity on food intakein normal-weight healthy women Appetite 49(1) 66ndash73

Haedt-Matt A A amp Keel P K (2011) Revisiting the affect regulation model of bingeeating A meta-analysis of studies using ecological momentary assessmentPsychological Bulletin 137(4) 660ndash681 doi101037a0023660

Haycraft E Farrow C Meyer C Powell F amp Blissett J (2011) Relationships betweentemperament and eating behaviours in young children Appetite 56 689ndash692

Hetherington M (2007) Individual differences in the drive to overeat NutritionBulletin 32 14ndash21

Hill C Llewellyn C H Saxton J Webber L Semmler C Carnell S et al (2008)Adiposity and ldquoeating in the absence of hungerrdquo in children International Journalof Obesity 32(10) 1499ndash1505

145CYY Leung et alAppetite 78 (2014) 139ndash146

self-regulation in food intake Young children have been shown tobe more susceptible to overeating in response to external stimuliwhen their mothers endorse an indulgent feeding style and provideminimal guidance over their eating behaviors (Fisher Birch ZhangGrusak amp Hughes 2013) Moreover children from families who tendto minimize emotions or who have low affective involvement tendto have lower emotional awareness experience greater emotionaldistress and develop poorer emotional self-regulation (Eisenberget al 1999 Fabes Leondard Kupanoff amp Martin 2001) these chil-dren may engage in overeating in response to negative emotions(Mellin Neumark-Sztainer Story Ireland amp Resnick 2002 Tophamet al 2011) and have tantrums over being denied food Yet somehave found that family arguments at mealtime are associated withless child intake (Burnier Dubois amp Girard 2011) suggesting theseassociations are complex Home environment quality can also includeparental monitoring and structure which have been shown to beimportant for childrenrsquos eating behaviors (eg Fisher et al 2013)Given these many possible pathways related to aspects of the homeenvironment it was notable that our findings for surgency and neg-ative affectivity remained even when home chaos was accountedfor suggesting that these child factors are important to consider in-dependent of home environment

Limitations future directions and implications

The following limitations of the present study should be notedFirst the cross-sectional nature of our design cannot allow us to inferthe etiological significance of temperamental surgency negative af-fectivity or effortful control in obesogenic eating behaviors amonglow-income preschool-age children Some researchers have hy-pothesized that the linkages between temperament and eating be-haviors may be driven by other factors such as genetic characteristicsor body weight that affect child temperament and eating(Anzman-Frasca et al 2012 Hetherington 2007 Miller et al 2013Wardle et al 2008) Future longitudinal research on this topic isnecessary

Furthermore caregiver-report was used as the only assess-ment of the predictor variables as well as many of the eating be-haviors which may have resulted in reporter bias The use ofobservations could increase the ecological validity of child behav-ior assessments as well as the degree of chaos in the home Otherfamilial characteristics such as parentndashchild interactions parentalfeeding practices and parental mealtime engagement have also beenshown to be associated with young childrenrsquos eating behaviors(Burnier et al 2011 Wu Dixon Dalton Tudiver amp Liu 2011) Futurestudies should consider these familial characteristics using obser-vational measures and examine their interactions with childcharacteristics in predicting young childrenrsquos obesogenic eatingbehaviors

Despite these limitations however the present study repre-sents a significant step toward understanding how multiple dimen-sions of child temperament ndash particularly surgency negativeaffectivity and effortful control ndash relate to early obesogenic eatingbehaviors which have in turn been implicated in the develop-ment of overweightobesity among low-income preschool-age chil-dren Importantly information learned from the present study maycontribute to interdisciplinary efforts between developmental sci-entists and practitioners to develop tailored evidence-based earlychildhood obesity interventions For example young children whoare characterized by high temperamental surgency or negative af-fectivity may have an increased risk for obesogenic eating thusimplementing strategies that address individual differences such asimpulsivity intense pleasure seeking and difficulties with regulat-ing emotions may increase intervention success Furthermore chil-dren with different temperamental characteristics may struggle with

different types of obesogenic eating so it is important to considerand assess different eating behaviors that a child may display

References

Agras W Hammer L McNicholas F amp Kraemer H (2004) Risk factors for childhoodoverweight A prospective study from birth to 95 years Journal of Pediatrics145(1) 20ndash25

Aiken L S amp West S G (1991) Multiple regression Testing and interpreting interactionsThousand Oaks CA Sage Publications

Anderson S E amp Whitaker R C (2010) Household routines and obesity in USpreschool-aged children Pediatrics 125(3) 420ndash428

Anzman-Frasca S S Stifter C A amp Birch L L (2012) Temperament and childhoodobesity risk A review of the literature Journal of Developmental and BehavioralPediatrics 33(9) 732ndash745

Bentler P M (1990) Comparative fit indexes in structural models PsychologicalBulletin 107 238ndash246

Bergmeier H Skouteris H Horwood S Hooley M amp Richardson B (2013)Associations between child temperament maternal feeding practices and childbody mass index during the preschool years A systematic review of the literatureObesity Reviews 1ndash10

Birch L L Fisher J O amp Davison K K (2003) Learning to overeat Maternal use ofrestrictive feeding practices promotes girlsrsquo eating in the absence of hungerAmerican Journal of Clinical Nutrition 78(2) 215ndash220

Bradley R H amp Caldwell B M (1979) Home observation for measurement of theenvironment A version of the preschool scale American Journal of MentalDeficiency 84(3) 235ndash244

Braet C Claus L Goossens L Moens E Vlierberghe L V amp Soetens B (2008)Differences in eating style between overweight and normal-weight youngstersJournal of Health Psychology 13(6) 733ndash743

Braet C Claus L Verbeken S amp Vlierberghe L V (2007) Impulsivity in overweightchildren European Child amp Adolescent Psychiatry 16(8) 473ndash483

Burnier D Dubois L amp Girard M (2011) Arguments at mealtime and child energyintake Journal of Nutrition Education and Behavior 43(6) 473ndash481

Burton P Wells J C K Kennedy K Nicholl R Khakoo A amp Fewtrell M S (2011)Association between infant correlates of impulsivity ndash surgency (extraversion)ndash and early infant growth Appetite 57 504ndash509

Center for Disease Control and Prevention (2011) Summary of trends in growthindicators by age from the pediatric nutrition surveillance system Retrieved fromhttpwwwcdcgovpednsspednss_tablestables_health_indicatorshtm

Czaja J Rief W amp Hilbert A (2009) Emotion regulation and binge eating in childrenInternational Journal of Eating Disorders 42 356ndash362

Eisenberg N Fabes R A Shepard S A Guthrie I K Murphy B C amp Rieser M(1999) Parental reactions to childrenrsquos negative emotions Longitudinal relationsto quality of childrenrsquos social functioning Child Development 70 513ndash534

Epel E Lapidus R McEwen B amp Brownell K (2001) Stress may add bite to appetitein women A laboratory study of stress-induced cortisol and eating behaviorPsychoneuroendocrinology 26 37ndash49

Epstein L H Leddy J J Temple J L amp Faith M S (2007) Food reinforcement andeating A multilevel analysis Psychology Bulletin 133(5) 884ndash906

Fabes R A Leondard S A Kupanoff K amp Martin S L (2001) Parental coping withchildrenrsquos negative emotions Relations with childrenrsquos emotional and socialresponding Child Development 72 907ndash920

Faith M S amp Hittner J B (2010) Infant temperament and eating style predict changein standardized weight status and obesity risk at 6 years of age InternationalJournal of Obesity 34 1515ndash1523

Farrow C amp Blissett J (2006) Maternal cognitions psychopathologic symptoms andinfant temperament as predictors of early infant feeding problems A longitudinalstudy International Journal of Eating Disorders 39(2) 128ndash134

Fisher J O amp Birch L L (2002) Eating in the absence of hunger and overweight ingirls from 5 to 7 y of age American Journal of Clinical Nutrition 76(1) 226ndash231

Fisher J O Birch L L Zhang J J Grusak M A amp Hughes S O (2013) Externalinfluences on childrenrsquos self-served portions at meals International Journal ofObesity 37(7) 954ndash960 doi101038ijo2012216

Francis L amp Susman EJ (2009) Self-Regulation Failure and Rapid Weight Gain inChildren from Age 3 to 12 Years Archives of Disease in Children and Adolescents163 297ndash302

Groesz L M McCoy S Carl J Saslow L Stewart J Adler N et al (2012) Whatis eating you Stress and the drive to eat Appetite 58(2) 717ndash721

Guerrieri R Nederkoorn C Stankiewicz K Alberts H Geschwind N Martijn Cet al (2007) The influence of trait and induced state impulsivity on food intakein normal-weight healthy women Appetite 49(1) 66ndash73

Haedt-Matt A A amp Keel P K (2011) Revisiting the affect regulation model of bingeeating A meta-analysis of studies using ecological momentary assessmentPsychological Bulletin 137(4) 660ndash681 doi101037a0023660

Haycraft E Farrow C Meyer C Powell F amp Blissett J (2011) Relationships betweentemperament and eating behaviours in young children Appetite 56 689ndash692

Hetherington M (2007) Individual differences in the drive to overeat NutritionBulletin 32 14ndash21

Hill C Llewellyn C H Saxton J Webber L Semmler C Carnell S et al (2008)Adiposity and ldquoeating in the absence of hungerrdquo in children International Journalof Obesity 32(10) 1499ndash1505

145CYY Leung et alAppetite 78 (2014) 139ndash146

Hu L amp Bentler P M (1999) Cutoff criteria for fit indexes in covariance structureanalysis Conventional criteria versus new alternatives Structural EquationModeling 6 1ndash55

Jahnke D L amp Warschburger P A (2012) Familial transmission of eating behaviorsin preschool-aged children Obesity 16(8) 1821ndash1825

Jasinska A J Yasuda M Burant C F Gregor N Khatri S Sweet M et al (2012)Impulsivity and inhibitory control deficits are associated with unhealthy eatingin young adults Appetite 59(3) 738ndash747

Matheny A P Wachs T D Ludwig J L amp Phillips K (1995) Bringing order out ofchaos Psychometric characteristics of the Confusion Hubbub and Order scaleJournal of Applied Developmental Psychology 16 429ndash444

McClelland M M amp Morrison F J (2003) The emergence of learning-related socialskills in preschool children Early Childhood Research Quarterly 18 206ndash224

Mellin A E Neumark-Sztainer D Story M Ireland M amp Resnick M D(2002) Unhealthy behaviors and psychosocial difficulties among overweightadolescents The potential impact of familial factors Journal of Adolescent Health31 145ndash153

Miller A L Lumeng C N Delproposto J Florek B Wendorf K amp Lumeng J C(2013) Obesity-related hormones in low-income preschool-age childrenImplications for school readiness Mind Brain and Education 7(4) 246ndash255

Nederkoorn C Jansen E Mulkens S amp Jansen A (2007) Impulsivity predictstreatment outcome in obese children Behaviour Research and Therapy 45(5)1071ndash1075

OrsquoDougherty M M Story M M amp Stang J J (2006) Observations of parent-childco-shoppers in supermarkets Childrenrsquos involvement in food selections parentalyielding and refusal strategies Journal of Nutrition Education and Behavior 38(3)183ndash188

Olvera N amp Power T G (2010) Brief report Parenting styles and obesity in MexicanAmerican children A longitudinal study Journal of Pediatric Psychology 35243ndash249

Ouwens M A van Strien T amp van Leeuwe J F J (2009) Possible pathways betweendepression emotion and external eating A structural equation model Appetite53 245ndash248

Pieper J R amp Laugero K D (2013) Preschool children with lower executive functionmay be more vulnerable to emotional-based eating in the absence of hungerAppetite 62 103ndash109

Pliner P amp Loewen E R (1997) Temperament and food neophobia in children andtheir mothers Appetite 28 239ndash254

Rhee K E Lumeng J C Appugliese D P Kaciroti N N amp Bradley R H(2006) Parenting styles and overweight status in first grade Pediatrics 117(6)2047ndash2054

Rothbart M K Ahadi S A amp Evans D E (2000) Temperament and personalityOrigins and outcomes Journal of Personality and Social Psychology 78(1)122ndash135

Rothbart M K Ahadi S A Hershey K L amp Fisher P (2001) Investigations oftemperament at 3ndash7 years The Childrenrsquos Behavior Questionnaire ChildDevelopment 72 1394ndash1408

Rothbart M K amp Putnam S (2002) Temperament and socialization In L Pulkinnenamp A Caspi (Eds) Paths to successful development Personality in the life course (pp19ndash45) Cambridge UK New York Cambridge University Press

Seeyave D M Coleman S S Appugliese D D Corwyn R F Bradley R H DavidsonN S et al (2009) Ability to delay gratification at age 4 years and risk ofoverweight at age 11 years Archives of Pediatrics amp Adolescent Medicine 163(4)303ndash308

Shields A amp Cicchetti D (1997) Emotion regulation among school-age childrenThe development and validation of a new criterion Q-sort scale DevelopmentalPsychology 33(6) 906ndash916

Shields A amp Cicchetti D (1998) Reactive aggression among maltreated childrenThe contributions of attention and emotion dysregulation Journal of Clinical ChildPsychology 27(4) 381ndash395

Silveira P P Agranonik M Faras H Portella A K Meaney M J amp Levitan R D(2012) Preliminary evidence for an impulsivity-based thrifty eating phenotypePediatric Research 71(3) 293ndash298

Tan C C amp Holub S C (2011) Childrenrsquos self-regulation in eating Associations withinhibitory control and parentsrsquo feeding behavior Journal of Pediatric Psychology36(3) 340ndash345

Topham G L Hubbs-Tait L Rutledge J M Page M C Kennedy T S Shriver LH et al (2011) Parenting styles parental response to child emotion and familyemotional responsiveness are related to child emotional eating Appetite 56(2)261ndash264

van den Berg L Pieterse K Malik J A Luman M Willems van Dijk K OosterlaanJ et al (2011) Association between impulsivity reward responsiveness and bodymass index in children International Journal of Obesity 35 1301ndash1307

Vollrath M E Stene-Larsen K Tonstad S Rothbart M K amp Hampson S E (2012)Associations between temperament at age 15 years and obesogenic diet at ages3 and 7 years Journal of Developmental amp Behavioral Pediatrics 33(9) 721ndash727

Vollrath M E Tonstad S Rothbart M K amp Hampson S E (2011) Infanttemperament is associated with potentially obesogenic diet at 18 monthsInternational Journal of Pediatric Obesity 6(2ndash2) e408ndashe414

Wardle J Guthrie C A Sanderson S amp Rapoport L (2001) Development of theChildrenrsquos Eating Behavior Questionnaire Journal of Child Psychology andPsychiatry 42(7) 963ndash970

Wardle J J Carnell S S Haworth C A Farooqi I S OrsquoRahilly S S amp Plomin RR (2008) Obesity associated genetic variation in FTO is associated withdiminished satiety Journal of Clinical Endocrinology amp Metabolism 93(9) 3640ndash3643

Wu T Dixon W E Jr Dalton W T III Tudiver F amp Liu X (2011) Joint effects ofchild temperament and maternal sensitivity on the development of childhoodobesity Maternal and Child Health Journal 15 447ndash467

Yeomans M R amp Coughlan E (2009) Mood-induced eating Interactive effects ofrestraint and tendency to overeat Appetite 52(2) 290ndash298

146 CYY Leung et alAppetite 78 (2014) 139ndash146