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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Public Health 1/2015

Adolescent body weight and health-related quality of life rated by adolescents and parents: the issue of measurement bias

BMC Public Health > Ausgabe 1/2015
Pranav K. Gandhi, Dennis A. Revicki, I-Chan Huang
Wichtige Hinweise

Competing interests

None of the authors of this manuscript has declared any conflict of interest.

Authors’ contributions

All co-authors have significantly contributed to study development. Concept and study design: PKG and ICH; statistical analysis: PKG and ICH; results interpretation: PKG, DAR, and ICH; manuscript development: PKG, DAR, and ICH. All authors read and approved the final manuscript.



Evidence is sparse about whether body weight categories in adolescents are associated with differences in pediatric HRQoL rated by adolescents and parents. Additionally, it is unknown whether HRQoL rated by individuals with different body mass index (BMI) weight categories is psychometrically comparable. This study aimed to assess whether difference in pediatric HRQoL rated by adolescents and their parents was explained by BMI weight status, and to test measurement properties of HRQoL items related to weight categories using differential item functioning (DIF) methodology. DIF refers to the situation when the individuals across subgroups rate an item differently (e.g., item score three by one subgroup and four by another) given the same underlying construct.


A cross-sectional study utilizing a sample of parents (n = 323) and their adolescents aged 15–18 years old (n = 323) who enrolled in Florida’s Medicaid. Adolescent self-reports and parent proxy-reports of the Pediatric Quality of Life Inventory was adopted to measure pediatric HRQoL. We classified body weight categories as normal weight, overweight, and obesity. A Multiple Indicator Multiple Cause (MIMIC) method was used to assess DIF associated with BMI weight status, especially testing the disparity in the parameters of different weight categories (reference: lower weight category) associated with a response to a HRQoL item conditioning on the same underlying HRQoL. DIF analyses were conducted by adolescent self-reports and parent proxy-reports.


Parents reported lower pediatric HRQoL across all domains than adolescents did. Excess body weight (combined overweight and obese) was significantly associated with a greater discrepancy in the rating of emotional and total functioning between adolescents and parents (p < 0.05). DIF associated with BMI weight categories was identified by two items in adolescent self-reports and five items in parent proxy-reports.


Adolescents’ BMI weight categories significantly contribute to a difference in the rating of pediatric HRQoL by adolescents and parents.
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