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9 Directions for Research As INDICATED throughout this report, continued research is es- sential to establish a better base of knowledge for designing effective and efficient implementation strategies and for assessing their costs and benefits. The committee identified six principal areas of research in which more activity is required to achieve these goals. They are not ranked in any order of priority. In the committee's judgment, successful implementation requires that research in all six areas be conducted simultaneously, as is currently the case. In fact, there is considerable overlap between the research areas because each is broad in scope and complex to investigate. Research in each of the areas identified below tends to be con- ducted by different types of experts in a wide variety of settings, including nutrition scientists in laboratories; public health specialists in communities; food policy analysts working for governments, voluntary agencies, and consumer advocacy groups; and economists and other social scientists in schools of higher education. Resources to increase research in these areas will need to come from a wide variety of sources, including governments, the private sector, foundations, vol- untary agencies, and academia. 1. Improve methods to characterize what people actually eat, especially over long periods during which dietary patterns change. The difficulty in assessing dietary intakes is a major impediment in studying the effects of diet on health and on assessing the effects of initiatives to improve eating habits. There are weaknesses in all current assessment methods (e.g., those based on food disappear 210

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DIRECTIONS FOR RESEARCH 211 ance, household food inventories, and individual diet histories) (see review in the Diet and Health report [NRC, 1989, Chapter 2~. More comprehensive data collection and timely reporting of results are required to learn more about what people eat and how eating habits vary in relation to such factors as geographical location, life-style, ethnicity, and socioeconomic status. High priority should be given to improving methods for collecting and assessing data on dietary patterns, including the intakes of specific foods and the dietary con- stituents of foods (e.g., macro- and microconstituents that affect the risk of chronic diseases). 2. Increase understanding of the existing and potential determinants of dietary change and how this knowledge can be used to promote more health- ful eating behaviors. As noted in Chapter 3, much more needs to be learned about the behaviors and motivations of people who have improved their diets compared with the behaviors and motivations of those who have not and how dietary change is most effectively induced. Research in this area would include basic and applied studies to lead to better under- standing of the obstacles to, and opportunities for, dietary change. In addition, very little is known about the influence of major life- style factors (e.g., moving out of the parents' home, getting married, having children, and working in a demanding job) on dietary changes. Studies should also be conducted to learn more about taste prefer- ences and how dietary change is influenced by the media (especially television), growing older, and genetic and cultural factors. Further- more, the extent to which environmental factors affect dietary change require investigation. These factors include proximity of grocery stores of various sizes to shoppers, transportation facilities, food costs, low- income-neighborhood shopping strategies, and security of shopping areas. Learning more about why, how, and when during the course of a lifetime people began to adopt more healthful diets would provide a better understanding of the factors that lead to long-term dietary change (Achterberg and Trenkner, 1990; Sims, 1987; Sims and Light, 1980~. Major efforts have been undertaken to educate and motivate people to practice healthy behaviors such as quitting smoking or refraining from taking up the habit, fastening seat belts in the car, and not driving after drinking alcoholic beverages. Research should be con- ducted to determine how the lessons learned from these initiatives can be applied to the task of improving U.S. dietary patterns. 3. Continue research to develop new food products and modify both the production and processing of existing products to help consumers more easily meet dietary recommendations.

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212 IMPROVING AMERICA'S DIET AND HEALTH By applying the results of research conducted at government, in- dustry, and academic facilities, various segments of the food indus- try have been able to develop nutritionally desirable foods that help consumers to more easily meet dietary recommendations (see Chap- ter 6~. This research should continue, especially in the areas of flavor, texture, nutrient content and retention, preservation, and safety. Perhaps the food industry could respond to trends (or anticipate them) even more readily if more research were conducted to track consumer attitudes and knowledge about food and nutrition issues and about their food selection and preparation practices. Research should also be con- ducted to identify alternative uses of foods or food constituents (e.g., butterfat) that should be limited in a healthful diet. 4. Review and improve government and private-sector policies that di- rectly and indirectly affect the availability of particularfoods and the promotion of healthful dietary patterns. As noted throughout this report, government policies and private- sector practices substantially influence consumer food demands and dietary patterns often in complex and subtle ways. Systematic and comprehensive studies should be conducted to determine precisely how and at what critical points the policies and practices are so influential. Studies should include comprehensive reviews of public laws and regulations and private-sector activities pertaining to food and nutrition. For example, there is a need to reconcile government activities in these areas at the federal, state, and local levels. Results could be used to improve policies and practices so that they encourage accep- tance and practice of dietary recommendations. 5. Determine how implementors of dietary recommendations at all levels (e.g., supermarket managers, physicians, and high school health teachers) can more effectively teach the basis of the recommendations and motivate people to follow them. Success in implementing dietary recommendations can be achieved only by teaching their basis and application to people with different levels of interest in improving their diets, different capacities for un- derstanding the recommendations themselves, and different tenden- cies to become either informed, confused, or overwhelmed by the proliferation of information and promotions encouraging consumption of particular food products. Continued research is required to develop educational strategies that motivate and empower people to select and consume healthful diets that are nutritionally adequate and meet dietary recommendations. 6. Investigate the costs and benefits of implementing dietary recommen- dations as proposed by this committee and by others.

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DIRECTIONS FOR RESEARCH 213 As described in Chapter 2, scarce financial and human resources should be used efficiently to accomplish the goals of implementation at the lowest costs. The committee discovered that it could not pro- vide estimates of the costs and benefits of its recommendations primari- ly because of the lack of quantification of the effects of past initiatives to improve dietary practices. In order to make cost-benefit calcula- tions, the following types of systematic documentation are needed: (1) the amount, length, and frequency of exposure to food and nutrition messages; (2) descriptions of the channels through which the messages are provided; and (3) the effects of the messages in terms of knowledge, attitude, and behavioral changes of recipients. Continued research to determine effective and efficient means to evaluate initiatives to imple- ment dietary recommendations is important. In addition, all initia- tives to Improve dietary pattems should include a comprehensive evaluation component and sufficient resources to carry it out; the descriptions and results of these evaluations should be made publicly available. REFERENCES Achterberg, C., and L.L. Trenkner. 1990. Developing a working philosophy of nutri- tion education. J. Nutr. Educ. 22:189-193. NRC (National Research Council). 1989. Diet and Health: Implications for Reducing Chronic Disease Risk. Report of the Committee on Diet and Health, Food and Nutrition Board, Commission on Life Sciences. National Academy Press, Washington, D.C. 749 pp Sims, L.S. 1987. Nutrition education research: reaching toward the leading edge. J. Am. Diet. Assoc. 87:S10-S18. Sims, L.S., and L. Light. 1980. Directions for Nutrition Education Research: The Penn State Conferences: A Proceeding. Pennsylvania State University, University Park, Pa. 108 pp.

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