Family Meals Prevent High-Risk Behaviors Among Adolescents

group of person eating indoors

This article reviews the scientific literature on the relationship between family meals and its role in prevention of high risk behaviors, such as teen pregnancy, substance abuse, violence, and others, among adolescents.

Risk behaviors

Adolescence is a period in life with increased susceptibility to high risk behaviors. Adolescence is a time period in life in which many changes take place and is further a transition period from childhood to adulthood. Young people are facing many new opportunities, some of them potentially harmful. These include substance use including alcohol and tobacco use, risky sexual behaviors, suicide, unhealthy eating behaviors, delinquency, and several others.

In my own country, Norway, certain risk behaviors among adolescents have been decreasing during the last decades, such as violence, use of tobacco, marijuana and alcohol (Bakken, 2014). There has further been a reduction in cases of abortion among adolescent women during the last years (Berg-Hansen, 2008). It is important to find good strategies to prevent risk behaviors among adolescents. Public initiatives may represent one type of approach, conducted in schools, after school programs or through other means. A different and more private, yet promising approach seems to involve close relatives and family. Parents naturally serve as role models and are important individuals in the lives of adolescents.

Research suggest that how parents raise their children can explain risk behavior among adolescents (Berg-Olsen, 2008). There are several factors which may influence prevention of risk behaviors and this article sets out to investigate one in particular, the effects of family meals.

Overview and general effects

Family meals are more than just eating together. It provides opportunity for socializing and stimulating manners and good eating habits. Research has suggested that there are several positive effects associated with regular family meals. First of all family meals have been shown to improve the diet quality of adolescents. Larson and colleagues (2007) observed in a 5-year longitudinal study of adolescents that family meal frequency in adolescent years explained increased intake of vegetables and fruits in addition to reduced intake of soft drinks in adult years. In addition adolescents participating more frequently in family meals were found to eat breakfast more regularly as adults. This shows the long lasting influence of behaviors formed during the upbringing.

man in black jacket standing beside woman in gray scarf

Interestingly, Feldman and colleagues (2007) observed in a cross-sectional study of about 4700 adolescents that having the TV set on during family dinners seemed to reduce the intake of vegetables and other healthy foods.

Family meals seem further to be associated with better mental and psychological health. In an association study Eisenberg and colleagues (2004) found that adolescents who rarely participated in family meals had lower grades, increased depression symptoms and suicide involvement. This was also true after adjusting for connectedness between the adolescent and the family. Eisenberg and colleagues (2004) further observed that adolescents who took part in family meals spend more time on homework and reading.

Through analysis of the Longitudinal Survey of Adolescent Health, Musick and Meier (2012) Found that there was a significant positive association between family meals and adolescent well-being. However the effects did not last into adulthood.

Family meals and prevention of disordered eating behaviors

In a study conducted by Neumark-Sztainer and colleagues (2004) they investigated whether family meal frequency and other factors connected to family meals were associated with disordered eating behaviors among adolescents. They observed that adolescents who participated more frequently in family meals (where there was a good atmosphere and family meals had a high priority within the family), were less likely to report disordered eating behaviors. Girls who had 1-2 family meals a week were twice as likely to report disordered eating behaviors compared to girls who had 3-4 family meals a week. The results were weaker after adjusting for family connectedness and other factors, but still significant.

woman in white long sleeve shirt sitting on chair in front of table with foods

A second study conducted again by Neumark-Sztainer and colleagues (2008) followed more than 2500 adolescents for 5 years in order to investigate the relationship between family meals and disordered eating. They found that there exists a protective effect of participating in family meals against disordered eating behaviors. Girls who at baseline reported participating in 5 or more family meals a week had lower prevalence of extreme weight control behaviors 5 years later. This held true even after adjusting for factors such as family connectedness, body mass index and extreme weight control behavior at baseline.

In a large cohort of adolescents Haines and colleagues (2009) followed more than 13000 adolescents. They observed that female adolescents who participated in family dinner most days of the week had reduced risk of reporting binge eating, purging and dieting. The results for boys were similar but lower.

Family meals in prevention of other risk behaviors

persons left hand on black background

In a 5 year longitudinal study of more than 800 adolescents Eisenberg and colleagues (2008) investigated the effects of family meals on substance use. The results showed that regular family meals may prevent development of substance use such as alcohol, tobacco and marijuana among adolescents. This study was of particular interest. The authors stated that most studies til that time had been of a cross-sectional design, or short term studies. Cross-sectional designs may not help us determine whether family meals are the cause of reduced substance use or if substance use influences participation in family meals. However, the findings in this particular follow up study showed that participating in family meals reduces substance abuse.

In a second and larger correlation study Eisenberg and colleagues (2004) investigated the association between frequency of family meals and several indicators of adolescent health and well being. They found that frequency of family meals had an inverse relationship with substance abuse including tobacco, alcohol and marijuana. The authors concluded that frequently family meals prevent substance use and has a positive effect on the well being of adolescents.

In another study which included almost 100.000 adolescents, Fulkerson and colleagues (2006) also investigated the association between family meal frequency and high risk behaviors. They observed that there was an inverse relationship between family meals and all high risk behaviors which were measured in the study: Substance use, sexual activity, depression/suicide, antisocial behaviors, violence, school problems, binge eating and excessive weight loss. The results remained significant also after adjusting for demographic and family factors.

In a recent study (Hoffmann, & Warnick, 2013) using data from the 1997 National Longitudinal Study of Youth the authors found that frequent participation in family dinners had a protective effect against marijuana use, but not on alcohol and tobacco use.

Data from the National Longitudinal Survey of Youth (1997) were also analyzed and published by Sen (2009). He investigated whether family dinners influenced problem behaviors, including substance abuse, phsyical violence, stealing, gang membership and running away from home. He found that frequent family dinners were negatively associated with the following problem behaviors: substance abuse and running away among females, and drinking, violence, stealing and running away for males.

Fisher and colleagues (2007) investigated whether family meals influenced alcohol use among adolescents through a prospective cohort involving more than 5500 11 to 18 years old adolescents. He found that alcohol initiation was significantly reduced among girls who had family dinners at home every day, compared to girls eating family meals only some days a week (OR 0,66). He concluded that eating family dinner every day can prevent, or more precisely delay alcohol initiation.

no drugs, sign, healthy

As noted earlier in this review, Feldman and colleagues (2007) found that TV viewing during family dinner reduced the positive association between family meals and increased intake of healthy foods. Does keeping the TV on during meals also reduce the preventive effects on substance abuse which we have already observed? Eisenberg and colleagues (2009) set out to investigate this in a cross-sectional study of about 800 adolescents. They found that watching TV during family dinners did not reduce the protective effect on substance abuse.

Conclusions and recommendations

Family meals are associated with positive effects on several health related issues, including improved food quality, improved mental health and wellbeing, and reduced high risk behaviors such as the use of marijuana, tobacco and alcohol. In addition family meals are associated with less violence, stealing and running away from home.

people sitting on chairs in front of table

The positive effects associated with family meals on risk behavior prevention may be linked through several factors. Is it the meal frequency or the context or atmosphere around the meal which causes the positive results? Investigators ask for more research in this area. Due to the somewhat mixed findings in the scientific literature on the preventive effects, it is likely to suggest that there may be other factors involved. Factors related to the home or family environment may play a significant role. From the findings in the reviewed studies connectedness plays a very important role. Lezin and colleagues (2004) stated in their review that parent-child connectedness has a great protective effect against risk behaviors. Thus, parents are recommended to stimulate connectedness with their adolescent children and further facilitate and encourage frequent participation in family meals.


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Allan Fjelmberg, MD, MPH, DipIBLM

As a Norwegian based medical doctor certified in Lifestyle Medicine he currently serves as the medical director of Skogli Health and Rehabilitation Center, Lillehammer. Through consultations, presentations, articles and other public health-related activities, he motivates people to utilize the potential that a healthy lifestyle has both in prevention and treatment of disease.

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