Classifying foods in contexts: how adults categorize foods for different eating settings.

This project examined adults' food cognitions by applying schema theory to explain how adults categorized foods for different contexts. Qualitative interviews and repeated card sort activities for different eating contexts were conducted to elicit as many food categories as possible from 42 US adults. Participants labeled card sort piles with their own words, providing 991 card sort labels. Qualitative analysis of the labels resulted in the emergence of 12 category types. Personal-experience-based types were specific to the individual (e.g., Preference). Context-based types were related to situational aspects of eating episodes (e.g., Location). Food-based types were related to intrinsic properties of the foods (e.g., Physical characteristics). Different combinations of the 12 category types were used for different eating contexts. Personal-experience and context-based types were used most frequently overall. Some category types were used more frequently for specific contexts (e.g., Convenience for work contexts). Food-based taxonomic category types were used most frequently when no context was defined. Script-oriented categories were more often used in response to specific eating contexts. These findings provide a framework to consider how individuals classify foods in real-life eating contexts. Attention to personal-experience and context-based category types may help improve understanding of relationships between knowledge and food choice behaviors.

Dietary Westernisation: conceptualisation and measurement in Mauritius.

OBJECTIVES: The aims of the study were to provide information that will contribute to conceptualising what is called "dietary Westernisation", and to provide an example of measuring it on an individual level. DESIGN: Food consumption frequency and demographic data on adults in Mauritius were examined in 1988, 1992 and 1998. In 1992, a 24-hour recall was also included. The cross-sectional samples consisted of 1115 (age 25-74 years) Mauritians in 1987/88, 1917 (age 30-74 years) in 1992 and 2239 (age 20-74 years) in 1998. Principal components analysis was carried out on daily consumption frequencies of 10 indicator foods (white rice, white bakery bread, pulses, processed meat, poultry, fresh/frozen fish, butter, margarine, whole milk and skimmed/low-fat milk). Correlations between dietary patterns and selected food consumption frequencies were examined in each survey year. RESULTS: Four dietary patterns were identified as being related to dietary Westernisation. The Traditional dietary pattern was characterised by higher consumption frequencies of Indian breads, salted/smoked fish and sugar-sweetened tea. The Western dietary pattern was characterised by higher consumption frequencies of cakes/pastries, meat and many Western fast foods like burgers, but, surprisingly, also by brown bread, breakfast cereals and salad. The Bread/butter dietary pattern predominantly described more frequent consumption of bread compared with rice. The Margarine/milk dietary pattern was inconsistently related with staple foods. Younger, educated and wealthier Mauritians appeared to adopt Western dietary patterns earlier. CONCLUSIONS: This study suggests that relatively few indicator foods are needed for measuring dietary Westernisation. Dietary Westernisation in a non-Western country may also include shifts towards voluntary consumption of healthier foods.

Religion and body weight.

OBJECTIVES: Relationships between religion and body weight were examined in a US national sample. METHODS: Data from the National Survey of Midlife Development in the United States (MIDUS), collected through telephone and postal questionnaires, were analyzed for 3032 adults aged 25-74. RESULTS: Religious denomination was significantly related to higher body weight in men after accounting for sociodemographic controls. Conservative Protestant men had a 1.1 +/- 0.45 higher body mass index (BMI) than those reporting no religious affiliation. Other religion variables that initially had significant relationships with greater body weight before adjusting for control variables became nonsignificant after smoking was controlled. No significant relationships between religion and body weight were present in women. CONCLUSIONS: Religious denomination was related to body weight in men. Other dimensions of religiosity showing a relationship with higher BMI appeared to be because of the lower rates of smoking among more religious individuals.

Managing healthy eating: definitions, classifications, and strategies.

This study sought to enhance understanding of how people conceptualize and manage healthy eating. An interpretivist approach employed the constant comparative method to analyze 79 open-ended interviews with individuals about food choices and eating behaviors for health-related themes. Participant reports depicted cognitive systems for defining healthy eating, where personal meanings evolved through ongoing exposure to a variety of experiential and informational sources. Participants' definitions of healthy eating clustered around seven themes forrelating food and eating to their personal health. Healthy eating definitions shaped how participants categorized food and eating situations as healthy and unhealthy. Participants described healthy eating strategies that were differentially associated with various healthy eating themes. These findings provide an emic perspective of how a diverse sample of adults conceptualize and manage healthy eating. Exposing the implicit and multiplistic nature of healthy eating conceptions provides information useful to health educators promoting behavior changes.

Managing values in personal food systems.

People in post-industrial societies are faced with many food products and diverse eating situations that can make food-choice decisions complex. This study examined the ways that people managed values in making food choices in various contexts. An analysis of 86 semi-structured, in-depth qualitative interviews from a diverse population of urban adults living in upstate New York revealed that all participants used a personal food system, which was a dynamic set of processes constructed to enact food choices. Within these personal food systems people managed the five main food-related values of taste, health, cost, time and social relationships, and other less prominent values of symbolism, ethics, variety, safety, waste and quality. The salience of these values varied among the participants as well as across the eating situations that confronted each participant. Participants used three main processes in their personal food systems: (i) categorizing foods and eating situations; (ii) prioritizing conflicting values for specific eating situations; and (iii) balancing prioritizations across personally defined time frames. Understanding the personal food systems people use to help them make food choices can be useful for developing theories about eating behavior and communicating health messages related to food and eating.

Sample extensiveness in qualitative nutrition education research.

OBJECTIVE: Extensiveness represents the amount of information gathered in qualitative research. This study examined sample extensiveness in qualitative nutrition education research. DESIGN: Retrospective analysis was performed on articles published in the Journal of Nutrition Education (JNE) from 1969 to 1999 (Volumes 1 to 31). SUBJECTS: Content analysis was used to code articles and the studies they reported as units of analysis. OUTCOME MEASURES: Articles were coded to determine whether they included one or more studies using qualitative research and, if so, the types of qualitative studies performed, the sample extensiveness of each study, and mention of sample extensiveness limitations in the article. STATISTICAL ANALYSES: The statistics used were univariate (counts, percentages, means, medians, modes, ranges) and bivariate (chi-square, correlations). RESULTS: Of the published JNE articles, 71 (8%) used qualitative methods, and most (85%) qualitative articles were published in the 1990s. Some (19%) of these articles reported using multiple qualitative methods. The 30 studies using individual interviews interviewed an average of 45 people (range 15-155). The 38 studies using group interviews averaged 15 groups (range 1-180) and 141 people (range 9-900). Ten studies used observation/fieldwork, and eight used other types of qualitative research, with mixed [corrected] patterns of sample extensiveness in those studies. Few articles made specific statements about limitations based on sample extensiveness. IMPLICATIONS: Sample extensiveness in qualitative research in JNE varied considerably. Future qualitative research would benefit from more explicit attention to sample extensiveness.

The 9th annual multidisciplinary conference on food choice

The Food Choice theme includes research on cognitive, cultural, economic, interpersonal, physiological or sensory determinants of food and drink selection and its consequences for health and other benefits to consumers Copyright 2000 Academic Press.

Acculturation and health in Korean Americans.

Despite increasing research on the relationships between acculturation and health, it is unclear whether (1) ethnic group variation occurs in acculturation-health relationships, (2) acculturation components vary differently in relationship to health, (3) biculturalism has beneficial effects on health and (4) multidimensional health relationships occur with acculturation. This study examined the Korean American ethnic group, considering how acculturation was related with five dimensions of health: smoking, physical activity, fat intake, body weight, and reported health. Pretested questionnaires were mailed to a national sample with Korean American surnames, and 55% of the deliverable sample responded, producing 356 usable questionnaires. Acculturation was measured using a two-culture matrix model and Gordon's theoretical work, and showed three distinct groups (acculturated, bicultural and traditional) and four components (American structural, American cultural, Korean structural and Korean cultural). Bicultural men were least likely to smoke, while acculturated and bicultural women were more likely to smoke than traditional women. Korean structural and cultural components were related to men's smoking. Higher acculturation was related to light physical activity, but not to vigorous physical activity. Fat intake did not differ by acculturation status. Higher acculturation was associated with higher body weight and better self-reported health only in men. Higher American cultural component scores were associated with better self-reported health in men. Among Korean Americans, acculturation components varied in their relationships with health, beneficial effects of being bicultural on health were not found, and acculturation-health relationships were multidimensional. Overall, ethnic group variation in health occurred, with Korean Americans similar to some ethnic groups but different than others. Future health research and practice can benefit by acknowledging the complexity of acculturation and its multidimensional effects on health.

Acculturation and dietary practices among Korean Americans.

OBJECTIVE: Examine variation in dietary practices and nutritional intakes of Korean Americans at different acculturation levels. DESIGN: Cross-sectional mail survey. SUBJECTS/SETTING: US national sample of 348 Korean Americans (46% of the Korean American sample to whom questionnaires were delivered). STATISTICAL ANALYSIS PERFORMED: Analysis of variance, Pearson correlation, Spearman rank correlation, chi 2 test, and multiple regression analysis. RESULTS: Korean Americans who were more acculturated consumed more American food and less Korean food. American foods such as oranges, low-fat milk, bagels, tomatoes, and bread were consumed regularly by Korean Americans; Korean foods such as rice, kimchi, garlic, green onions, and Korean soup were also consumed regularly. American foods were adopted the most at breakfast and the least at dinner. Bicultural people regularly incorporated more different types of foods into their diet. Despite significant differences in dietary practices, dietary quality did not vary by acculturation status. APPLICATION/CONCLUSIONS: Acculturation was influential in the dietary patterns of Korean Americans. Specific information about Korean diet related to acculturation status can be used by dietitians who work with Korean Americans. Dietitians can benefit from gathering and applying specific information about Korean diets and diets of other ethnic groups; they also need to recognize the changing nature of dietary patterns as acculturation occurs.

Dating people with anorexia nervosa and bulimia nervosa: attitudes and beliefs of university students.

Attitudes and beliefs about dating people with eating disorders were investigated in men and women using a questionnaire administered to 752 university students. Students believed that people with anorexia nervosa and bulimia nervosa had a difficult time dating, dates would involve conflict, and dating would be a negative experience. Students were more comfortable in casual interactions than more serious dating activities with people with anorexia nervosa and bulimia nervosa. Men were somewhat comfortable dating people with anorexia nervosa or bulimia nervosa, but less so for obesity. Most students believed dating people with anorexia nervosa and bulimia nervosa would not be a positive experience, and men stigmatized people with eating disorders differently than did women.

A conceptual model of the food and nutrition system.

The food system is a widely used concept, but few systematic frameworks model the full scope and structure of the food and nutrition system. Bibliographic searches, a modified Delphi technique, focus groups and interviews with experts on the topic were conducted to identify existing models of agriculture, food, nutrition, health and environmental systems. These models were examined, classified and synthesized into an integrated conceptual model of the food and nutrition system. Few existing models broadly described the system and most focused on one disciplinary perspective or one segment of the system. Four major types of models were identified: food chains, food cycles, food webs and food contexts. The integrated model developed here included three subsystems (producer, consumer, nutrition) and nine stages (production, processing, distribution, acquisition, preparation, consumption, digestion, transport, metabolism). The integrated model considers the processes and transformations that occur within the system and relationships between the system and other systems in the biophysical and social environments. The integrated conceptual model of the food and nutrition system presents food and nutrition activities as part of a larger context and identifies linkages among the many disciplines that deal with the food and nutrition system.

Parity-associated weight gain and its modification by sociodemographic and behavioral factors: a prospective analysis in US women.

OBJECTIVE: To examine how the relationship between parity increase and weight gain is modified by sociodemographic and behavioral factors. DESIGN: Prospective longitudinal data from the first National Health and Nutrition Examination Survey (NHANES I, 1971-75) and its follow-up of those aged 25 y and older, the NHANES I Epidemiologic Follow-up Survey (NHEFS, 1982-84). SUBJECTS: The analytical sample was nationally representative of the United States and included 2952 white or African-American non-pregnant women aged 25-45 y at baseline, who were re-measured approximately 10 y later. MEASUREMENTS: Statistical interactions in multiple linear and logistic regression models were examined to identify how eight sociodemographic and three behavioral factors modified the effect of parity increase on body weight change and risk of substantial weight gain. RESULTS: Factors that increased parity-associated weight gain included being African-American, living in a rural area, not working outside the home, having fewer children, lower income and lower education, and being unmarried. Among white women, being younger and having higher body weight at baseline increased parity-associated weight gain, while among African-American women, being older and having lower body weight increased parity-associated weight gain. African-American smokers gained less weight with an increase in parity, while the interactions between smoking and physical activity with parity-associated weight gain in whites were complex. CONCLUSION: The effects of sociodemographic and behavioral factors on parity-associated weight gain varied by race and parity change, with the most consistent findings being that unmarried and unemployed white women had greater parity-associated weight gain, while both white and African-American women who smoked, had higher education, or higher parity had lower parity-associated weight gain. This information may contribute to better targeting and more effective interventions to prevent postpartum weight retention.

Nutrition beliefs, attitudes, and resource use of high school wrestling coaches.

Beliefs, attitudes, and nutrition resource use among high school wrestling coaches were measured for weight loss, weight class, dehydration, training diet, and eating disorders. Most coaches (82%) considered themselves very knowledgeable about wrestling but less informed about sport nutrition, weight loss, and vitamin supplements. They used a variety of nutrition resources, but only 36% had attended nutrition workshops. Almost all coaches were interested in learning more about specific nutrition topics. More experienced coaches attended nutrition workshops and felt more informed about weight loss and sport nutrition. The mean percentage of correct responses to questions about weight loss was 64%, training diets 59%, dehydration 57%, body composition 52%, and eating disorders 80%; the mean score for healthy attitudes about weight loss was 69%, training diets 34%, dehydration 29%, body composition 70%, and eating disorders 69%. These results can be used to develop training seminars and educational materials to promote greater knowledge and healthy attitudes among wrestling coaches.

Parity-associated body weight: modification by sociodemographic and behavioral factors.

This research examines the association between parity and body weight and how this relationship is modified by sociodemographic and behavioral factors. Using multiple linear regression analysis, the study assessed the relationship between parity and relative body weight (as Body Mass Index, BMI) and how this relationship interacts with seven sociodemographic and seven behavioral factors in a national sample of 5,707 women from the Second National Health and Nutritional Examination (NHANES II) survey. After adjusting for sociodemographic factors, the amount of weight associated with parity averaged about 0.5 kg per child. However, parity-associated weight differed by sociodemographic and behavioral factors, and was much larger in some subgroups. Among 18-45 year olds, the amount of weight associated with parity was greater in blacks than in whites, less in employed than unemployed white women but greater in employed than unemployed black women, less in smokers than nonsmokers, less in those with a high level of recreational exercise, and differed with the level of nonrecreational physical activity depending on race. Among 46-74 year olds, the amount of weight associated with parity was greater in married than unmarried women, and less in those who were active outside of recreation versus those who were less active. These results suggest that sociodemographic and behavioral variables modify the relationship between parity and body weight, and provide insight for identifying women who are at risk for having greater BMI with higher parity. This information may be applicable to the targeting and design of interventions to prevent postpartum weight retention.

Acculturation, socioeconomic status, and obesity in Mexican Americans, Cuban Americans, and Puerto Ricans.

OBJECTIVES: This study examined the relationship between acculturation and obesity in United States (US) Hispanics, controlling for socioeconomic status (SES). METHODS: The sample included 3141 Mexican American, 828 Cuban American, and 1211 Puerto Rican adults 18-74 y of age in the 1982-84 Hispanic Health and Nutrition Examination Survey (HHANES). Acculturation was measured by language preference and generation; SES by income and education; and obesity by body mass index (BMI). RESULTS: Mean and standard deviations of BMI (kg/m2) were 25.9 +/- 4.4, 26.0 +/- 4.2, and 25.5 +/- 4.3 in men of Mexican American, Cuban American, and Puerto Rican origin, respectively. For women, the corresponding values were 26.6 +/- 5.8, 25.9 +/- 5.0, and 26.2 +/- 5.9. Linear regression models of BMI which included acculturation, income, education, and other covariates were carried out. Income and education were not associated consistently with BMI. Acculturation, but only among Mexican Americans, was associated with BMI. Specifically, greater preference for English was associated with reduced BMI among women (P < 0.01). Also, men and women of the second (P < 0.001 in both sexes) and third (P < 0.01 in men P < 0.001 in women) generation had greater BMIs. Relative to the first generation, the increase in BMI units was 1.15 +/- 0.34 in men and 1.76 +/- 0.39 in women in the second generation and 0.83 +/- 0.31 in men and 1.83 +/- 0.37 in women of the third generation. CONCLUSIONS: BMI was not associated with SES, an unexpected finding since the relationship is generally negative in women from developed countries. The relationship between BMI and acculturation was weak and conditional. BMI in Mexican Americans appeared to be somewhat more sensitive to the process of acculturation than among Cubans or Puerto Ricans.

Food choice: a conceptual model of the process.

Interviews examining the food choice process were conducted with 29 adults, primarily individuals making grocery store food choice decisions, who were sampled for their diversity. These people were asked about how they chose foods when shopping and in other settings, and what influenced their choices. Verbatim transcripts of the interviews were analysed using qualitative methods that included constant comparison, concept mapping, and case summaries, and a conceptual food choice process model was developed. Data from the interviews are presented to illustrate the structure of this conceptual model. People's life course experiences affected major influences on food choice that included ideals, personal factors, resources, social contexts and the food context. These influences informed the development of personal systems for making food choices that incorporated value negotiations and behavioral strategies. Value negotiations weighed sensory perceptions, monetary considerations, health and nutrition beliefs and concerns, convenience, social relationships and quality of food choice decisions. Strategies employed to simplify the food choice process developed over time. The conceptual food choice process model represents the rich and complex bases of food practices, and provides a theoretical framework for research and practice in nutrition.

The relationship between body weight and mortality: a quantitative analysis of combined information from existing studies.

OBJECTIVE: To estimate the relationship between body mass index (BMI, kg/m2) and all-cause mortality with information from the published scientific literature. DESIGN: Meta-analysis using a hierarchical, mixed model. The analysis included random effects for information sources and fixed effects for factors that may modify the BMI-mortality relationship such as smoking, control for disease, and country of origin, which allowed combining information from diverse studies. MAIN OUTCOME MEASURES: Predicted probability of death over a given duration of follow-up plotted by BMI for sex-age cohorts of white race. RESULTS: An extensive search identified nineteen prospective cohort studies that met inclusion criteria. A U-shaped relationship between BMI and mortality was demonstrated for 50-year-old men followed for 30 years. Mortality risk increased with low and high BMI (< 23 or > 28) in groups of non-smokers without evidence of disease upon study entry. Limited information from studies of women indicated that, with 10 year follow-up, there was little relationship between BMI and mortality for (1) non-smokers and for (2) mixtures of smokers and non-smokers. CONCLUSION: This quantitative analysis of existing studies revealed increased mortality at moderately low BMI for white men comparable to that observed at extreme overweight, which does not appear to be due to smoking or existing disease. Attention to the health risks of underweight is needed, and body weight recommendations for optimum longevity need to be considered in light of these risks.

Ten-year changes in the obesity, abdominal adiposity, and serum lipoprotein cholesterol measures of Western Samoan men.

Previously reported associations between abdominal adiposity and coronary heart disease (CHD) may be mediated through serum lipids. In the present longitudinal study, 43 Western Samoan men who participated in a 1982 study were recontacted for a second determination of anthropometric and serum lipoprotein cholesterol levels. The men showed dramatic increases in weight (mean change +/- SD: 10.5 +/- 8.8 kg), abdominal circumference (10.0 +/- 7.6 cm), total cholesterol (49.5 +/- 26.4 mg/dl), and non-HDL cholesterol (53.1 +/- 26.6 mg/dl). A new indicator was used to estimate changes in abdominal adiposity: the residual from the regression of change in the abdominal circumference on change in body weight (the AR). The AR was significantly correlated with changes in total (r = 0.38) and non-HDL cholesterol (r = 0.39). Changes in HDL cholesterol were correlated with changes in weight only (r = -0.37). These bivariate relations remained significant in multiple linear regression analyses. These longitudinal results are the first to suggest changes in abdominal adiposity are related to changes in total and non-HDL cholesterol levels.