Linda L. Knol

Determinants of Food Label Use Differ by Sex

Although the Nutrition Facts label has been a requirement on food packages for more than 20 years, few studies have conducted comprehensive assessments of food label use. The purpose of this study was to assess the demographic and psychosocial correlates of food label use using a comprehensive approach. A sample of 1,382 males and females (n=573 and n=809, respectively) aged 19 to 70 years was drawn from the 2005-2006 National Health and Nutrition Examination Survey. The food label Check and Use subscales are the sums of multiple questions on frequency of checking and using each separate component on a Nutrition Facts label. Multiple linear regression was used to assess differences in predictors of Check and Use. Determinants of food label use differed by sex. Women check and use food label components more often and thoroughly than men. Older adults and adults with good diet-quality perception were significant predictors of food label use for both men and women. Race was a significant predictor for men only. Mexican-American and other Hispanic groups check (P=0.03) and use (P=0.01) the food label more frequently than non-Hispanic white men. Men who do not receive Supplemental Nutrition Assistance Program benefits also check (P<0.01) and use (P=0.01) food labels more frequently than those who receive assistance. The findings of this study could be used to improve nutrition education efforts. It may be beneficial to target men and women separately, as food label use determinants are different.

College Students Must Overcome Barriers to Use Calorie Labels in Fast-Food Restaurants

OBJECTIVE To explore predictors of intention of college students to use calorie labels on fast-food menus and differences in calories ordered after viewing calorie information. DESIGN Quasi-experimental design. Participants selected a meal from a menu without calorie labels, selected a meal from the same menu with calorie labels, and completed a survey that assessed demographics, dietary habits, Theory of Planned Behavior constructs, and potential barriers to use of calorie labeling. SETTING A southern university. PARTICIPANTS Undergraduate university students (n = 97). MAIN OUTCOME MEASURES Predictors of intention to use calorie labels and whether calories selected from the nonlabeled menu differed from the labeled menu. ANALYSIS Confirmatory factor analysis, exploratory factor analysis, multiple regression, and paired t tests. RESULTS Participants ordered significantly fewer calories (P = .02) when selecting from the labeled menu vs the menu without labels. Attitudes (P = .006), subjective norms (P < .001), and perceived behavioral control (P = .01) predicted intention to use calorie information but did not predict a difference in the calories ordered. Hunger (P = .03) and cost (P = .04) were barriers to using the calorie information. CONCLUSIONS AND IMPLICATIONS If students can overcome barriers, calorie labeling could provide information that college students need to select lower-calorie items at fast-food restaurants.

Food Insecurity, Self-rated Health, and Obesity among College Students

ABSTRACT Background: The prevalence of food insecurity among college students ranges from 14% to 59%. Most of the research to date has examined the determinants of food insecurity. Purpose: The purpose of this study was to examine the relationships between food insecurity and self-rated health and obesity among college students living off campus. Methods: An online survey was sent to students 19 years of age or older. Food security status was measured using the Adult Food Security Survey Module. Health status, height, and weight were self-reported. Two logistic regression analyses assessed the associations between food insecurity and the 2 dependent variables, health status and overweight/obesity. Results: A sample of 351 students provided valid responses to the questions used in these analyses. Food insecurity was not associated with obesity. Food insecure students had significantly higher rates of fair/poor health when compared to their food secure counterparts (odds ratio [OR] = 2.1, 95% confidence interval [CI], 1.1, 4.3). Discussion: Food insecurity is related to self-rated fair/poor health but not overweight/obesity in college students living off campus. Translation to Health Education Practice: Health Educators on college campuses should be cognizant of financial conditions that may place students at risk for food insecurity.

College Students' Intentions to Use Calorie Information on a Restaurant Menu: Application of the Theory of Planned Behavior

Background: Obesity continues to be an epidemic in the United States and is associated with multiple chronic diseases. Greater numbers of people eat in restaurants and select high calorie foods. Labeling laws require calorie information on menus in some restaurants. Purpose: The purpose of this study was to determine the predictors of intention to use calorie labels among college students using constructs of the Theory of Planned Behavior (TPB). Methods: College students selected a meal from a menu without calories and from the same menu with calorie information, and completed a survey that addressed TPB constructs. Regression analysis was used to determine predictors of intention to use labels and calorie changes of meals ordered. Results: Students (n = 100) ordered significantly fewer calories with posted calorie information. Intention was significantly correlated with attitudes, subjective norms, and perceived behavioral control. Discussion: The TPB may help explain factors involved in the intention to use posted calorie information on a restaurant menu. Results support the inclusion of the calorie statements on these menus. Translation to Health Education Practice: Education efforts should include constructs of the TPB. When planning, implementing and evaluating programs, utilizing strategies to influence attitudes, subjective norms and perceived behavioral control is suggested.

Development and Feasibility of a Childhood Obesity Prevention Program for Rural Families: Application of the Social Cognitive Theory

Background: Effective childhood obesity prevention programs for preschool children are limited in number and focus on changes in the child care environment rather than the home environment. Purpose: The purpose of this project was to develop and test the feasibility of a home environment obesity prevention program that incorporates mindful eating strategies and social cognitive theory (SCT) constructs. Home Sweet Home (HSH) is specifically designed for rural parents and grandparents of preschool-age children. Methods: HSH was developed using community-based participatory research practices and constructs from SCT. Three community-based education sessions were delivered. Pre- and postintervention data were collected from 47 grandparents and mothers. Results: Three of the 4 selected behavioral outcomes improved between pre- and postintervention. The number of hours engaged in sedentary behaviors and intake of “red light” foods decreased and 3 of 4 mindful eating scores increased. Graduates of the program were able to decrease the number of red light foods available in their homes. Discussion: Improvements in mindful eating and several key behaviors were observed after a 3-week mindful eating/home environment intervention. Translation to Health Education Practice: Health Educators should incorporate mindful eating strategies and use SCT when designing childhood obesity prevention programs.

The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale: A New Measurement Instrument for Prenatal Breastfeeding Self-efficacy

Background: Breastfeeding self-efficacy and breastfeeding intention are two modifiable factors that influence rates of breastfeeding initiation. Research Aims: (1) To develop a scale to measure prenatal breastfeeding self-efficacy, and (2) test its psychometric properties by determining the internal consistency and reliability, and (3) assess the relationships between prenatal breastfeeding self-efficacy and breastfeeding intention. Methods: Cross-sectional prospective one-group survey design was used. A convenience sample of pregnant patients attending an obstetrics and gynecology clinic (N=124) completed a survey at the recruitment site that assessed demographics, breastfeeding intention, and breastfeeding self-efficacy theory constructs. Retest surveys (n=14) were taken home and returned to the researcher by mail after completion. Results: Cronbach’s alpha for the 39-item scale was .98 (test) and .97 (retest) with an item-to-total correlation range of .54 to .78. A four-factor solution for the scale was retained. Test-retest indicated each factor was significant and highly correlated: Individual Processes (.88, p < .001), Interpersonal Processes (.893, p < .001), Professional Advice (.919, p < .001), and Social Support (.880, p < .001). Overall prenatal breastfeeding self-efficacy score was highly correlated (.610,p <.001) with breastfeeding intention scores. Conclusions: The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale is a valid and reliable measure of a prenatal women’s self-efficacy in preparation to breastfeed. Measuring the level of self-efficacy could alert prenatal women and health professionals to individual skill sets.

Physical Activity and Healthful Eating in Middle Schools

Greaney et al. describe the problems of overweight and obesity, the efforts made to address this problem in school systems, and a rapid assessment procedure to determine the feasibility of implementing an interdisciplinary curriculum in a school setting. Regarding the last item, they discuss the need for researchers and practitioners to work together to develop multiple interventions that are collaborative, flexible, and effective. The current epidemic of inactivity and poor diet, along with the associated epidemic of obesity, is driven by multiple factors (societal, technological, industrial, commercial, financial), and each of these factors must be considered when dealing with the obesity problem. The Healthy Choices Collaborative Intervention used by Greaney et al. is designed to address these factors. It includes before- and after-school activities to expand school physical education, messages to dissuade youths from pursuing sedentary activities, including television viewing, and nutrition education to increase fruit and vegetable consumption. Community program implementation is more likely to be successful when community leaders are involved. Greaney et al. present the perceptions of key leaders who were previously involved in a school-based nutrition and physical activity program and who shared their perceptions regarding what is needed to facilitate the implementation and sustainability of the Healthy Choices Collaborative Intervention. Many ideas were presented by participants regarding critical elements needed for this program to be successful, including possessing resources, having a visible leader, and achieving buy-in from teachers, administrators, students, food-service personnel, parents, and the community at large. Greaney et al. discuss valuable information for program planners. When designing obesity interventions for youths, program planners are advised to consider characteristics of the priority population. The authors demonstrate that middle school youths as a group require specific attention and intervention. Nutrient needs, eating patterns, and physical activity patterns change markedly during the middle school years. For example, most children maintain adequate milk intake until about 9 years of age. After age 9, milk intake should generally be increased to meet nutrient needs, but most children do not do so. This problem is especially pronounced in preteen girls. As children age and begin to have more influence over their food intake decisions, the nutritional quality of their diets declines. Age transitions in food consumption patterns need to be addressed in the development of school-based obesity prevention programs so that appropriate behavioral targets for nutrition education can be written into the curriculum. Thus, nutrition education between middle and elementary school should vary based on higher nutrient needs and changes in behavioral mediators such as greater freedom of choice. The Teens Eating for Energy and Nutrition at School (TEENS) study revealed that positive intervention results were limited with middle school students. Investigators suggested that future research consider the use of more controlled efficacy studies in working with this age group. They also suggested that efforts to reach this group include use of peer leaders, more intensive teacher training, ongoing formative assessment, and the testing of more powerful environmental change intervention strategies. (1) In examining the target group issue, planners also need to consider that adolescent girls tend to be less active and less responsive to specific treatments than their male counterparts. (2) To reach middle school girls, interventions that provide desirable role models for diet and activity are suggested. One study demonstrated positive body mass index changes among middle school girls who received computer-based feedback combined with parental support. (3) Tailored interventions are suggested for specific age and sex. …