Parental norms and attitudes in Relation to Children’s sugar consumption − A mediation analysis of the “Are You Too Sweet?” intervention study

• Parental awareness of children’s intake of sugar-rich foods and drinks is targetable. • Parental norms for occasions for child provision might mediate child sugar intake. • Mediation analysis can be used to evaluate health-promoting strategies. Parental influence on children’s dietary behaviour makes parents an obvious target for prevention strategies with nutritional foci. Mediation analysis is considered a valuable tool for understanding the underlying mechanisms of influence in intervention studies aimed at implementing behaviour change strategies. The present study used data from the multi-component cluster-randomised intervention “Are You Too Sweet?” with 153 Danish children (5–7 years) to explore mediating effects and role of parental determinants on added sugar intake in children. A pre-and post-intervention questionnaire evaluated parental knowledge, practices, self-efficacy, norms, and attitudes. Children’s dietary intake was estimated from a seven-day dietary record. Associations between children’s added sugar intake and parental responses and changes in responses following the intervention were evaluated using linear mixed models. Exploring potential behaviour change pathways of the intervention was done using mediation analyses. Children’s reduction in added sugar consumption was partly mediated by changes in parental norms and attitudes regarding limiting sugar-rich foods and drinks to special occasions. Parental knowledge of guidelines on the intake of sugar-rich discretionary foods and drinks increased as an intervention effect but did not demonstrate a mediating effect. No significant changes or mediating effects were found in parental self-efficacy or practices. The findings highlight parental norms and attitudes regarding restricting sugar-rich foods and drinks to special occasions as modifiable and a mediator for reducing added sugar intake in the “Are You Too Sweet?” intervention study. Trial registration: Retrospectively registered at ISRCTN: ISRCTN10409779.