Click for next page ( 34


The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 33
Determinants of Food Choice and Prospects for Modifying Food Aides and Behavior MANY CHANGES have taken place in the United States during the past century with respect to food selection and attitudes toward diet and health. In this chapter, these changes are reviewed by the committee as are the prospects for future changes in behaviors and attitudes to meet dietary recommendations. The focus is on the general U.S. population rather than specific high-risk groups. Recommendations for changing eating habits are more likely to be adopted if their framers (1) are knowledgeable about the factors known to affect food choices, (2) recognize current trends in food consump- tion and attitudes toward food, (3) base their recommendations on basic theory and research related to changing attitudes and behav- iors, and (4) learn from previous attempts to change diet for health purposes. This chapter is organized to address each of these items in sequence. To select the most appropriate targets of change (e.g., the most critical beliefs or behaviors), one must know the basic determi- nants of food choice and which of these are subject to modification. Likewise, it would not be prudent to recommend specific methods or programs of change without knowledge of basic theory and research on the determinants of behavior change and of the techniques that have already proven successful. For example, it is critical to under- stand why an individual's knowledge alone about the links between diet and health is unlikely to change dietary behavior. It is also important to know what changes are already taking place in the United States and whether these trends are likely to facilitate or hinder implementation of dietary recommendations. 33

OCR for page 33
34 IMPROVING AMERICA'S DIET AND HEALTH This chapter concludes with a critical review of some intervention programs designed explicitly to improve eating patterns. These in- clude programs instituted at the individual, organizational, and com- munity levels. DETERMINANTS OF FOOD CHOICE Why any group of humans eats what it does is considerably more difficult to explain than is the eating behavior of other species. In humans, appetite is not simply a physiological drive toward food but, rather, a complex set of physical, emotional, and cognitive stimuli compounded from events widely separated in time and space. Because humans from birth through childhood depend for their survival on nurturance provided by other members of their species, they are uniquely vulnerable to developing affective relationships with food and feeders. Thus, nourishment for humans almost inevi- tably becomes associated with powerful emotional attachments. These, overlaid with beliefs and feelings that continue to accumulate around food consumption as individuals mature, combine with immediate environmental stimuli to direct food choices. Beneath their socialization, however, humans remain animals, en- dowed with sets of sensors that underlie all their subsequent encoun- ters with food. Taste is one of these. The evidence is overwhelming, for example, that humans are innately programmed to like sweet tastes at birth and even in utero (Montagu, 1962; Weiffenbach, 1977), and there are very tentative indications that they are also born with some sort of attraction to meat, to its fat, or to both (Beauchamp and Moran, 1982; Drewnowski et al., 1985; Farb and Armelagos, 1980; Harris, 19851. Since many poisons are bitter and fruits become sweeter as they ripen toward greater nutritiousness, a taste for sweetness may well have given its possessor a selective advantage. A prefer- ence for fat would also have favored survival under conditions of calorie deprivation. Humans also like salt, although it is not an innately Preferred taste in infancy (Davis, 1928; Steiner, 1977~. J 1 People who change to low- salt foods come to consider formerly acceptable foods too salty. Thus, the preferred level of saltiness appears to be strongly affected by experience. Such is not the case for sweetness, however; preferences for different levels of sweetness appear to be inborn (Desor et al., 1977~. The ability to taste certain isolated flavor chemicals (e.g., phe- nylthiocarbamide) varies with individuals and is genetically controlled. Although there appears to be little genetic control over the liking for particular foods (Fabsitz et al., 1980), early research on food choice

OCR for page 33
DETERMINANTS OF FOOD CHOICE 35 suggested that infants protected from poisonous foods and exposed only to uncombined foods whose indigenous components have been neither concentrated nor diluted with added fat, salt, or sweeteners are able to select fully nutritious diets instinctively (Davis, 1928~. Humans also appear to be born with automatic regulators of energy need (of a complexity not yet deciphered) that are set differently at or before birth (Ravussin et al., 1988; Roberts et al., 1988~. This physiological base on which eating behavior is built appears to explain very little about the food choices people actually make. The experiences of individuals as members of specific families in a particular culture tend almost inevitably to overwhelm many (if not all) the signals coming from what lean Mayer long ago called the "animal within" (Mayer, 1968~. Young babies universally find chili aversive. Yet, as Rozin and Schiller (1980) have demonstrated, this innate aversion to chili, along with the innate preference for sweets, is spontaneously overcome in Mexican children, almost half of whom at age 6 or 7 years will select a spicy hot snack over a sweet one when given a choice. In an earlier classic study, Moskowitz et al. (1975) found that chronic exposure to tamarind among a group of Asian Indians overrode the relative dislike of the sour taste charac- teristic among humans. As indicated by the prevalence of overweight people in the United States, culture can also override in humans the bodyweight-regulating mechanism that operates effectively in all other species (except when they are domesticated). Factors other than physiological ones that affect food choice can all be attributed to either nurture or culture. However, since culture heavily affects the ways in which a society nurtures, even this divi- sion is somewhat artificial. One such factor is early feeding experi- ences, which involve, in addition to tastes and smells, the sounds, sights, textures, and emotions associated with feeders. Thus, they deeply affect infants who are entirely dependent on their feeders for survival. These individual feelings about eating, implanted in infancy, may be difficult to modify. There is evidence that food aversions result- ing from even a single, powerful negative experience with a food can be very long lasting (Garb and Stunkard, 1974~. Therefore, if patterns es- tablished in early infancy need modification, recommendations would need to be directed to food providers, usually parents. There is no direct evidence, however, that food preferences learned in infancy are permanent, but there has been little systematic study of early feeding interactions and their effects on later eating behav- iors. "There are currently no prospective or longitudinal data with human subjects to provide support for Ethel assumption that early food acceptance patterns are . . . reflected in food acceptance patterns

OCR for page 33
36 IMPROVING AMERICA 'S DIET AND HEALTH later in life" (Birch, 1987, p. 127). Nor is it known what makes cer- tain children like certain foods. Davis (1928) found that infants pre- viously unexposed to any food but mother's milk, and protected from outside influences on food choice, expressed a wide range of preferences when they were allowed to choose from a variety of simply prepared, unsalted, unsweetened foods. Birch (1987), who investigated food acceptance by young children, concluded that "sweetness" and "fa- miliarity" were two characteristics of food that seemed largely to account for children's food choices in the United States. In this country, preschoolers are almost unavoidably often exposed to highly sweetened foods; thus, the sweetness factor that drives food acceptability in this and similar cultures may arise in large part from familiarity, as may the preference for spicy hot foods in Mexico. There is evidence that continuous exposure to sweetness sustains the neonate's preference for sweetness (Beauchamp and Moran, 19821. Davis (1934) could not determine whether the initial food choices of infants in her study were random or whether they were based on color, odor, or both. It is known that children's acceptance of food can be influenced by the choices of their eating companions (Birch, 1987~. Since parents or other caretakers normally select the foods to be made available to very young children and their eating compan- ions, adults have a strong influence over children's food choices. In the United States, however, children are exposed from early infancy to adults other than members of their own households who tell them what to eat. Many of these adults are seen on television, advertising edible products consisting largely of sugared cereals, candy, and fast- service foods. A recent study in Quebec indicated that the parents of children who watch child-oriented television that carries commer- cials purchase more brands of breakfast cereal directed specifically toward children than do the parents of children who watch commer- cial-free children's programming (Goldberg and Hartwick, 1990~. Thus, advertising demonstrably influences parents as they select food products for their children. In a study of influences on the food choices of elementary school children and adolescents, Contento and Michela found the two most important variables in both groups to be "parents serve it" and "tastes good" (Contento et al., 1988; Michela and Contento, 1986~. Taste predominated among the adolescents; serving by parents took first place among the younger children. Although the sweetness variable was not examined directly in either study, the same authors found in an earlier investigation that sweetness was a highly salient dimen- sion in children's spontaneous classification of foods into groups (Michela and Contento, 1984~.

OCR for page 33
DETERMINANTS OF FOOD CHOICE 37 Examining adolescent food choices more closely, Contento et al. (1988) found that their subjects could be divided into subgroups "with different motivations for food choice irrespective of ethnicity and gender" (p. 2971. Subjects at one extreme were "hedonistic" choos- ing foods even if they could identify those foods as causing heart disease or containing sugar or fat. Subjects at the other extreme were "health oriented" in that they avoided these same foods and ate foods they perceived as "healthful." Although the food choices of peers were reported to be an important influence on the "hedonistic" group and on others, it was not an important factor in all subgroups. The evidence thus suggests that children, some of them even into adoles- cence, are heavily influenced by their parents' choices of food to serve. As they grow older, however, some children choose foods they perceive as healthful or unhealthful; others are more strongly influenced by other social and environmental factors and by taste. Many of the factors known to affect food choice beyond adoles- cence cannot readily be modified by educational or other populationwide interventions. These include individuals' positive or aversive food or eating experiences that may make certain foods especially palatable or nauseatingly unacceptable, as well as simple familiarity, which probably plays an important role in determining food choice in adulthood just as it does among children. But even though education cannot change an individual's historic relationship with certain foods, food likes and dislikes can be modified with further experience; a new and wholesome food, once tried, may become both familiar and liked. Other variables often identified as determining food choices in adults include age, sex, race, place of birth, time of day, season of year, marital status, children's ages, household size, employment status, income, and perhaps less obviously media events affecting the public's perception of the safety or wholesomeness of the food supply. A1- though none of these determinants of food selection can be intention- ally altered by policymakers, many of them can change over relatively short or long periods. For example, women's increasing participa- tion in the work force encourages more frequent eating outside the home. People at different ages or at different stages of their life cycles will also respond differently to messages about food. For example, the population as a whole is aging (DHHS, 1988), and an aging popu- lation is likely to be more aware of and concerned about health and may therefore be more disposed to seek out certain food components (e.g., fiber and calcium) or avoid others (e.g., fat). Much of the research concerned with modifiable determinants of food selection has been conducted either by marketers attempting to determine which appeals will be most effective in selling products or

OCR for page 33
38 IMPROVING AMERICA'S DIET AND HEALTH by researchers interested in the factors that promote overeating. Yankelovich, Skelly and White, Inc. (1985) identified "convenience," "price," "nutrition," "variety," "quality," and "good taste" as the variables that will establish "competitive parameters for those who will serve tomorrow's consumers." Rodin (1980), listing "social and immediate environmental influences on food selection," identified "time of day," "accessibility/availability," "expedience," "variety," "media effects," "conditioned stimuli," and "emotions." Many of the factors on both lists are not directly relevant to the question in this chapter: what factors can be manipulated to affect food choice in a healthful direction? The only common factor on the lists is variety, which often represents to a marketer a way of getting a larger share of the market. In that sense, variety is related to newness, which appears to be an inducement to consumers to at least try a product. Evidence indicates that a monotonous diet leads to de- creased food consumption and the availability of a variety of tasty foods leads to increased calorie intake, even among animals who are normally very good at self-regulation (Sclafani and Springer, 1976~. Humans may have room for a dessert even when they are entirely sati- ated from previous courses. Thus, increased variety is unlikely to be helpful in a situation where overconsumption is part of the problem. Price is often mentioned as influencing food choice, and it has played an important role in at least two major health-related dietary changes: the shift from butter to margarine that began during World War II (Green, 1975) and the shift from red meat to chicken that began in earnest in 1976. Between 1976 and 1987, chicken consump- tion increased by 48% while the average retail price of chicken as a percentage of the price of beef decreased from 40 to 32% (Putnam, 1989~. The importance of price as a factor affecting food choice obvi- ously varies, however, with the proportion of the family budget spent on food. Although increased income does not necessarily lead to an improvement in dietary quality, inadequate funds may limit consump- tion of costly fish and (at certain seasons) certain fresh fruits and vegetables. Many other health-promoting foods (e.g., breads and other grain products, starchy tubers, and dry beans) are relatively cheap, and many less desirable foods (e.g., sweet and salty snacks, rich desserts, and heavily marbled beef) are relatively expensive. Thus, price, combined with appropriate education, is a variable that could in some cases favor adoption of dietary recommendations. Very little is known about how individuals (or populations) ac- quire taste preferences. Familiarity appears to be important among adults as well as among children; however, what tastes good or ap- propriate at a given time to any one person undoubtedly relates to

OCR for page 33
DETERMINANTS OF FOOD CHOICE 39 some of the factors identified by Rodin (1980), for example, "condi- tioned stimuli" (a cocktail with the evening news, popcorn at the movies, hot cocoa at bedtime), "emotions" (candy during times of sadness), or "time of day" (ham and eggs for breakfast). Food pref- erences governed by such factors would be amenable to change if education leads to changed social norms. In discussing factors that affect food choice, a distinction must be made between what is and what is perceived to be reality by the po- tential consumer. In that sense, quality (like nutritiousness or health- fulness) is a belief factor. Quality can mean very different things to different consumers all the way from the fact that a food bears a well-known brand name to the fact that it bears no brand name at all and is purchased fresh from the farmer who produced it. The char- acteristics of foods that groups of people associate with quality can obviously change over time (e.g., among certain groups, marbling in beef has been replaced as a quality factor by beef raised without hormones). Nutritiousness has recently become identifiable as one characteris- tic of a quality product, although no more than 15 years ago, manu- facturers resisted nutritional marketing appeals on the grounds that people were simply not interested (Belasco, 1989~. At present, consumers will, at least some of the time, select food they believe to be nutritious. Perceived nutritiousness, especially in a food already highly desired, is a selling tool. Low calorie is another quality appeal in a culture in which at any given time 33% of women and a smaller percentage of men claim to be dieting (Calorie Control Council, 1989~. The astonishing success of the marketing of diet soft drinks, whose consumption shot up from approximately 1 to 8 gallons per capita between 1954 and 1987 (USDA, 1989), is a clear indicator that identifying a product as diet or low calorie will increase the likelihood that it will be selected by a substantial segment of the population. The selling of the potato as a low-calorie food (Dugas, 1985; Ketchum Communications, 1989) is an example of a marketing approach that might be used to some advan- tage in implementing dietary recommendations. The fact that $3.7 billion is spent annually on food advertising (Advertis- ing Age, 1989) has led to a popular conviction that advertising, especially on television, is a major influence on food choice. Although advertising agencies survive by convincing clients that this is true, the direct effects of the media on food selection are difficult to isolate from all the other promotional factors to which an individual is exposed. Ad- vertising induces people to try new products that might otherwise g unnoticed; it has encouraged the belief that all thirst must be quenched

OCR for page 33
40 IMPROVING AMERICA'S DIET AND HEALTH from a bottle not from the water tap; it can lead consumers to switch from one brand of soda or tuna to another; and the repeated picturing on television of highly palatable food may induce snacking (Falciglia and Gussow, 1980~. Of all the factors affecting food selection, two availability of foods and knowledge of and beliefs about foods and health are perhaps the most powerful of those amenable to modification. Availability is a much less obvious concept than it seems, incorporating such notions as convenience and technological progress. Real availability-the presence of enough varied food to eat is not an issue in the United States, where variety and quantity abound. However, the sheer number of choices does sometimes constrain availability, since food stores tend to feature the products that sell fastest, so that, for example, refined flour products have been more readily available than those made of whole grains. Nevertheless, certain desirable products such as lower-fat meat and a greater vari- ety of fresh fruits and vegetables are now becoming increasingly avail- able (Duewer, 1989; Greene, 1988~. Perceived availability is a different sort of factor. It changes over time among different groups with different skills and expectations. For many people, a food is now considered to be available only when it can be acquired in a few minutes or is ready to eat at any time of the day or night at a nearby location. This definition of availability restricts many people's food choices; for example, what is available for immediate consumption in many settings may be limited to a variety of bottled liquids and a collection of small packaged snacks. Increasingly, especially in urban areas, there are specialty shops that sell foods with highly concentrated energy components premium ice cream and freshly baked cookies, for example. With regard to these prepacked or proportioned street foods, it is usually more "ex- pedient" (to use Rodin's word) to eat the whole thing the whole cookie (however enormous), the whole package of crackers or nuts, or the whole bottle of beer or soda regardless of actual appetite, since that is what is available. Because snacks and fast-service foods of all kinds are ubiquitous, they are seen as choices, even though they provide a limited variety and less control over fat, sodium, and sugar intake than people might want. Convenience a term applied to something that promises to save work or time-is a subset of availability. To someone who feels time-constrained, a food that requires extended preparation is not perceived as available. To someone without cooking skills, a raw chicken is not available. Technology's impact on food choices results partly from its ability to continually redefine perceived availability.

OCR for page 33
DETERMINANTS OF FOOD CHOICE 41 Microwave ovens, for example, lead to increased availability, and thus consumption, of microwavable snacks (Erickson, 1989~. Thus, instant heating makes hot snack foods more available. Cultural availability is important, because one's culture determines what constitutes food; all cultures reject some edible parts of their envi- ronments. In the United States, dogs, cats, and horses are seldom eaten, although they are readily available, and Americans do not think of hunting birds and squirrels in parks. In many cultures, milk is considered to be an inappropriate food for adults, and in many others, bread is not spread with butter or margarine as it is in the United States. Because this country is relatively young and culturally diverse, it has no traditional national cuisine no foods that most of its citizens have eaten for generations. Regional foods (e.g., baked beans and brown bread or grits and red-eye gravy) have tended to be displaced by the cuisine offered at franchise restaurants. This lack of a long-standing, strong food tradition may prove to be an advantage to those attempting to produce dietary changes directed toward health. Cultural factors determine not only what but also when, where, how much, and how quickly food is to be eaten. Since the U.S. population has traditionally bolted its food (Fletcher, 1899), fast-service food is nothing really new. People in the United States also spend more time alone than people in many other countries do (Szalai, 1972) and they often eat alone in cars, at their desks, by the refrigerator, or close to vending machines (Lantis, 19621. Foods are increasingly available in quantities designed to be eaten alone, which means that any attempt to alter eating patterns must be directed at different population segments, not merely at adults, since they are no longer the "gatekeepers" identified by Lewin (1943~. Efforts to affect eating patterns need to be attentive to these ambiguous cultural messages since what will be eaten is so often dependent on where, when, and how quickly it is to be eaten. 1 1 ~ . . . . As documented later in this chapter, consumers have become more concerned about the relationship between diet and health and report that they are trying to change their diets accordingly. This interest is confirmed by the increasing emphasis on healthfulness as an important food marketing tool. During the past few decades, there have been substantial changes in overall food consumption patterns (Putnam, 1989~. Survey data show a widespread verbal commitment to eating for health, but consumption data show that declining consumption of beef, eggs, butter, whole milk, and other traditional contributors of saturated fat and cholesterol has been countered somewhat by a rising consumption of cheese, premium ice cream, and other rich sources of saturated fat (Popkin et al., 1989; Putnam, 1989~. In providing con

OCR for page 33
42 IMPROVING AMERICA 'S DIET AND HEALTH sumers with information that will allow or induce them to act on their stated health concerns, attention will need to be paid to helping them place the confusing bits of information they encounter into a coherent overall picture of the association of diet with health. CHANGES IN FOOD SELECTION It is evident from the preceding discussion that learning why people eat what they do is a complicated undertaking. Finding out exactly what individuals eat is only marginally easier (see, for example, NRC, 1989 and Woteki, 1986). It is possible, however, to obtain reasonably good data on overall changes in the U.S. food supply over time. These are useful for tracking trends in food demand and can be examined to learn whether food consumption patterns are changing in a direc- tion consistent with dietary recommendations. Changes in foods available to the public from 1909 to the present can be identified by examining U.S. Department of Agriculture (USDA) data on the disappearance of foods into wholesale and retail markets. The amounts of foods available to the public in a given year are estimated by subtracting data on exports, year-end inventories, and nonfood uses from data on total production, imports, and inventories at the beginning of the year. These quantities are larger than those actually consumed, since they do not include losses from processing, marketing, and home use (NRC, 1989; Putnam, 19891. USDA has also surveyed food use of households and dietary intakes and patterns of individuals in the Nationwide Food Consumption Surveys (NFCS) and the Continuing Surveys of Food Intake by Individuals (CSFII). Since the overall pattern of changes in both the NFCS and CSFII are generally consistent with the patterns shown in the disappearance data (Popkin et al., 1989), only the latter are presented here. 1 1 Table 3-1 presents the quantities of food available for consumption per person from periods extending from 1909 to 1987 (the latest data available when this report was prepared). Since data on some foods, especially processed vegetables and fruits, were not collected in the earlier years, comparisons of the consumption of these products over time are difficult to make. Changes from 1909 to 1987 Since the first settlers arrived in a New World that was teeming with game, meat has had a dominant position in the diets of its in- habitants. Although beef consumption in 1987 was the lowest since the 1960s, it remained approximately 40 to 50% higher than that dur

OCR for page 33
DETERMINANTS OF FOOD CHOICE 43 ing World War II and the preceding years back to 1909. Much of the apparent decrease noted in 1987 may be misleading, however, since retail cuts were much more closely trimmed of fat in that year than they were in the past (Putnam, 1989~. Thus, past disappearance data probably included some weight that was trimmed before consumption. Although year-to-year fluctuations in pork consumption have often been quite high, the long-term average weight of pork available per person has varied little during the past eight decades. The-most remarkable change has occurred in poultry consumption, which now averages 78 lb per person nearly five times higher than pre-World War II levels. This increased intake of poultry and a much smaller increase in fish consumption have more than made up for the decrease in beef, veal, and lamb. The annual consumption of total red meat, poultry, and fish in 1987 was not only the highest ever in the United States but it also exceeded that of the traditional leaders Australia and New Zealand. Consumption of dairy products peaked in 1945. Per-capita consumption decreased until the 1960s and 1970s, when consumption of low-fat milk, cheese, and frozen dairy products such as ice cream began to increase. Low-fat milk (1 to 2% fat, skim, buttermilk, and some flavored milk) consumption almost doubled between 1971 and 1987, when consumption of low-fat milk overtook that of whole milk. Egg consumption has decreased to 67% of its World War II high, but is only 15% less than its prewar level and has remained fairly constant in the 1980s. Although butter and margarine use combined has changed relatively little since the 1940s, margarine use has increased at the expense of butter. Consumption of fats and oils has steadily increased, reaching a point in 1987 that was approximately 50% higher than that recorded in the period from 1909 to 1913. Per-capita use of salad and cooking oils has increased markedly in the past two decades. Data on average vegetable consumption are less clear than those for other food groups because the sources of these data have changed. For example, current data are no longer available on several veg- etables. Putnam (1989) reported, however, that per-capita consump- tion of nine major fresh vegetables asparagus, broccoli, carrots, cau- liflower, celery, corn, lettuce, onions, and tomatoes reached a record high in 1987. In the past decade, per-capita consumption of frozen vegetables has increased while consumption of canned vegetables has decreased. Based on disappearance data, fresh fruit consump- tion has increased dramatically in the past two decades. However, food consumption survey data give a somewhat different picture. According to USDA, consumption of fruits and vegetables among women ages 19 to 50 actually declined by an average of 7% between

OCR for page 33
DETERMINANTS OF FOOD CHOICE TABLE 3-3 Sources of Health Communications 73 Network Level Extended social networks Peer groups Families Organization Level Work sites Restaurants Grocery stores Food producers and processors Institutional food providers Schools Mass media organizations Health-care organizations Public health organizations Government organizations Community Level Integrates network and organization levels, leading to change in public opinion, social norms, legislation, food production, and the social environment live and lasting change. This conclusion is based on the studies showing transitory effects in small groups, and on school or work- site programs conducted in isolation from broad, reinforcing community influences. The committee's review of these studies supports the common sense notion that change is more readily achieved if nutri- tion change programs include all three levels of communication. It is clear from the studies discussed above that well-designed nu- trition education programs are successful in a variety of settings and for a variety of people. Study results also demonstrate that unimagina- tive, information-only programs are not successful. The imagination of the learners must be captured; they must feel that the messages are personally relevant and that a stepwise course of action that avoids too much personal discomfort will yield tangible benefits (Bandura, 1986; Crouch et al., 1986; Killen et al., 1988; Meyer and Henderson, 1974~. Success requires both an adequate quantity and mix of effective instructional components. Appreciable changes in eating patterns have been maintained for 6 to 12 months in schools, work sites, and

OCR for page 33
74 IMPROVING AMERICA'S DIET AND HEALTH adult groups after approximately 7 to 15 hours of instruction given over a few months (Crouch et al., 1986; Killen et al., 1988; King et al., 1988; Meyer and Henderson, 1974). In addition, many people have improved their eating habits appreciably after being exposed to mul- tifactor, comprehensive, community-based programs that included prolonged and intermittent exposure to approximately 2 hours of nutrition education per year for approximately 2 to 4 years (Farquhar et al., 1977, 1990). Ingredients for success in both selected and general populations seem to require approximately equal proportions of (1) alerting, inform- ing, and changing attitudes; (2) step-by-step active learning of self- directed behavior change methods; and (3) prevention of recidivism. Key elements of the first category include transmission of knowledge concerning diet-disease links and the provision of evidence of their relevance to the individual so that personal attitudes are changed. The learner must also gain knowledge of high-risk dietary patterns and of his or her own eating patterns. To accomplish this, the individual must learn monitoring methods, gain confidence from early successes, identify internal and external barriers to change, learn how to resist social pressures to change, and practice new skills in restaurant menu selection, label reading, food shopping, and food preparation and tasting. This effort is assisted by continued social support and main- tenance incentives provided by others. SUMMARY The factors affecting food choices are numerous and complex. Some, such as inherent taste preferences and demographic trends, can be controlled little or not at all. Others more subject to modification include social norms, attitudes, skills, and availability of health-pro- moting foods. Over the past several decades, there have been important changes in food consumption patterns. Some of these changes are consistent with dietary recommendations (e.g., an increase in fish and vegetable consumption), but others are not (e.g., an increase in the consumption of high-fat ice cream). Similarly, recent changes in consumer attitudes and beliefs provide cause for both optimism and concern. Although there is a general trend toward recognition of the role of diet in disease prevention, surveys indicate that people are sometimes confused about which foods and food components are health-promoting and which are not. Nevertheless, a review of current theory and practice with respect to attitude and behavior changes suggests that modification of food preferences and eating patterns is possible, but will require more

OCR for page 33
DETERMINANTS OF FOOD CHOICE 75 than simply providing information to the population. People will need to be motivated to accept the information, see its personal relevance to them, integrate it into existing belief structures, acquire new skills and self-perceptior~s, and learn how to apply newly acquired atti- tudes to appropriate actions and to prevent recidivism. Various studies conducted within schools, at work sites, and in communities have indicated that intervention programs based on the communication/ persuasion model and the social learning model can be effective in producing substantial reductions in risk factors for diet-related diseases, particularly when they involve several components that reinforce each other arid include the mass media. It seems very reasonable to infer from these studies that new national programs that implement favorable regulatory and food supply changes will enhance the impact of com- prehensive education on the public's dietary patterns. REFERENCES Advertising Age. 1989. National ad spending by category. Advertising Age 60:8. Ajzen, I. 1989. Attitudes, Personality, and Behavior. Wadsworth, Florence, Ky. 150 PP Ajzen, I., and M. Fishbein. 1980. Understanding Attitudes and Predicting Social Behavior. Prentice-Hall, Englewood Cliffs, N.J. 278 pp. Arntzenius, A.C., D. Kromhout, J.D. Barth, J.H.C. Reiber, A.V.G. Bruschke, B. Buts, C.M. van Gent, N. Kempen-Voogd, S. Strikwerda, and E.A. van der Velde. 1985. Diet, lipoproteins, and the progression of coronary atherosclerosis: the Leiden Intervention Trial. N. Engl. J. Med. 312:805-811. Atkin, C.K. 1979. Research evidence on mass mediated health communication campaigns. Pp. 655-668 in D. Nimmo, ed. Communication Yearbook 3. Transaction Books, New Brunswick, N.J. Axelson, M.L., T.L. Federline, and D. Brinberg. 1985. A meta-analysis of food- and nutrition-related research. J. Nutr. Educ. 17:51-54. Bandura, A. 1977. Social Learning Theory. Prentice-Hall, Englewood Cliffs, N.J. 247 PP Bandura, A. 1982. Self-efficacy mechanism in human agency. Am. Psychol. 37:122- 147. Bandura, A. 1986. Social Foundations of Thought and Action: a Social Cognitive Theory. Prentice-Hall, Englewood Cliffs, N.J. 617 pp. Beauchamp, G.K., and M. Moran. 1982. Dietary experience and sweet taste preference in human infants. Appetite 3:139-152. Belasco, W.J. 1989. Appetite for Change: How the Counterculture Took on the Food Industry, 1966-1988. Pantheon Books, New York. 311 pp. Best, J.A. 1989. Intervention perspectives on school health promotion research. Health Educ. Q. 16:299-306. Best, J.A., S.J. Thomson, S.M. Santi, E.A. Smith, and K.S. Brown. 1988. Preventing cigarette smoking among school children. Annul Rev. Public Health 9:161-201. Birch, L.L. 1987. The acquisition of food acceptance patterns in children. Pp. 107-130 in R.A. Boakes, D.A. Popplewell, and M.J. Burton, eds. Eating Habits: Food, Physi- ology, and Learned Behavior. John Wiley & Sons, Chichester, Great Britain.

OCR for page 33
76 IMPROVING AMERICA'S DIET AND HEALTH Blackburn, H., R. Luepker, F.G. Kline, N. Bracht, R. Carlaw, D. Jacobs, M. Mittelmark, L. Stauffer, and H.L. Taylor. 1984. The Minnesota Heart Health Program: a re- search and demonstration project in cardiovascular disease prevention. Pp. 1171- 1178 in J.D. Matarazzo, S.M. Weiss, J.A. Herd, N.E. Miller, and S.M. Weiss, eds. Behavioral Health: A Handbook of Health Enhancement and Disease Prevention. John Wiley & Sons, New York. Blair, S.N., P.V. Piserchia, C.S. Wilbur, and J.H. Crowder.1986. A public health intervention model for work-site health promotion: impact on exercise and physical fitness in a health promotion plan after 24 months. J. Am. Med. Assoc. 255:921-926. Bogart, L. 1967. Strategy in Advertising. Harcourt, Brace, & World, New York. 336 PP Bruno, R., C. Arnold, L. Jacobson, M. Winick, and E. Wynder. 1983. Randomized controlled trial of a nonpharmacologic cholesterol reduction program at the worksite. Prev. Med. 12:523-532. Burros, M. January 6, 1988. What Americans really eat: nutrition can wait. New York Times. C1, C6. Calorie Control Council. 1989. 1989 National Survey. Conducted by Booth Research Services for the Calorie Control Council, Atlanta, Ga. Various pagings. Capps, O., Jr. 1986. Changes in domestic demand for food: impacts on Southern agriculture. South. J. Agric. Econ. 18:25-36. Carmody, T.P., S.G. Fey, D.K. Pierce, W.E. Connor, and J.D. Matarazzo. 1982. Behav- ioral treatment of hyperlipidemia: techniques, results, and future directions. J. Behav. Med. 5:91-96. Carmody, T.P., J. Istvan, J.D. Matarazzo, S.L. Connor, and W.E. Connor. 1986. Applica- tions of social learning theory in the promotion of heart-healthy diets: the Family Heart Study intervention model. Health Educ. Res. 1:13-27. Chaiken, S. 1987. The heuristic model of persuasion. Pp. 3-39 in M.P. Zanna, J.M. Olson, and C.P. Herman, eds. Social Influence: the Ontario Symposium. Vol. 5. Lawrence Erlbaum Associates, Hillsdale, N.J. Chaiken, S., and C. Stangor. 1987. Attitudes and attitude change. Annul Rev. Psychol. 38:575-630. Cialdini, R.B., R.E. Petty, and J.T. Cacioppo. 1981. Attitude and attitude change. Annul Rev. Psychol. 32:357-404. Contento, I.R., J.L. Michela, and C.J. Goldberg. 1988. Food choice among adolescents: population segmentation by motivations. J. Nutr. Educ. 20:289-298. Cooper, J., and R.T. Croyle. 1984. Attitudes and attitude change. Annul Rev. Psychol. v 35:395-426. Crouch, M., J.F. Sallis, J.W. Farquhar, W.L. Haskell, N.M. Ellsworth, A.B. King, and T. Rogers. 1986. Personal and mediated health counseling for sustained dietary reduction of hypercholesterolemia. Prev. Med. 15:282-291. Davis, C.M. 1928. Self selection of diet by newly weaned infants: an experimental study. Am. J. Dis. Child. 36:651-679. Davis, C.M. 1934. Studies in the self-selection of diet by young children. J. Am. Dent. Assoc. 21:636-640. Desor, J.A., O. Maller, and L.S. Greene. 1977. Preference for sweet in humans: infants, children, and adults. Pp. 161-172 in J.M. Weiffenbach, ed. Taste and Development: the Genesis of Sweet Preference. DHEW Publ. No. (NIH) 77-1068. National Insti- tutes of Health, Public Health Service, U.S. Department of Health, Education, and Welfare, Bethesda, Md. DHHS (U.S. Department of Health and Human Services). 1988. The Surgeon General's Report on Nutrition and Health. DHHS (PHS) Publ. No. 88-50210. Public Health

OCR for page 33
DETERMINANTS OF FOOD CHOICE 77 Service, U.S. Department of Health and Human Services. U.$. Government Print- ing Office, Washington, D.C. 727 pp. Drewnowski, A., J.D. Brunzell, K. Sande, P.H. Iverius, and M.R.C. Greenwood. 1985. Sweet tooth reconsidered: taste responsiveness in human obesity. Physiol. Behav. 35:617-622. Duewer, L.A. 1989. Changes in the beef and pork industries. Natl. Food Rev. 12(1):5-8. Dugas, C. 1985. Countermarketing: "bad" foods fight back. Ad Forum 6:18-22. Egger, G., W. Fitzgerald, G. Frape, A. Monaem, P. Rubinstein, C. Tyler, and B. McKay. 1983. Results of a large scale media antismoking campaign in Australia: North Coast "Quit For Life" programme. Br. Med. J. 287:1125-1128. Ehnholm, C., J.K. Huttunen, P. Pietinen, U. Leino, M. Mutanen, E. Kostiainen, J. Pikkarainen, R. Dougherty, J. Iacono, and P. Puska. 1982. Effect of diet on serum lipoproteins in a population with a high risk of coronary heart disease. N. Engl. J. Med. 307:850- 855. Ellison, R.C., A.L. Capper, R.J. Goldberg, J.C. Witschi, and F.J. Stare. 1989. Changing school food services to promote cardiovascular health. Health Educ. Q. 16:171-180. Elmore, J., C.B. Taylor, and J.A. Flora. 1982. Self-help nutrition kit with a nutrition booklet. Internal formative research report prepared for the Stanford Heart Dis- ease Prevention Program. Stanford, Calif. Erickson, J.L. 1989. Simplot bites back in micro snack war. Advertising Age 60:4. Fabsitz, R., M. Feinleib, and Z. Hrubec. 1980. Weight changes in adult twins. Acta Genet. Med. Gemellol. 29:273-279. Falciglia, G.A., and J.D. Gussow. 1980. Television commercials and eating behavior of obese and normal-weight women. J. Nutr. Educ. 12:196-199. Farb, P., and G. Armelagos. 1980. Consuming Passions: the Anthropology of Eating. Houghton Mifflin, Boston. 279 pp. Farquhar, J.W., N. Maccoby, P.D. Wood, J.K. Alexander, H. Breitrose, B.W. Brown, Jr., W.L. Haskell, A.L. McAlister, A.J. Meyer, J.D. Nash, and M.P. Stern. 1977. Com- mun~ty education for cardiovascular health. Lancet 1:1192-1195. Farquhar, J.W., N. Maccoby, and P.D. Wood. 1985a. Education and communication studies. Pp. 207-221 in W.W. Holland, R. Detels, and G. Knox, eds. Oxford Text- book of Public Health. Vol. 3. Investigative Methods in Public Health. Oxford University Press, London. Farquhar, J.W., S.P. Fortmann, N. Maccoby, W.L. Haskell, P.T. Williams, J.A. Flora, C.B. Taylor, B.W. Brown, Jr., D.S. Solomon, and S.B. Hulley. 1985b. The Stanford Five-City Project: design and methods. Am. J. Epidemiol. 122:323-334. Farquhar, J.W., S.P. Fortmann, J.A. Flora, C.B. Taylor, W.L. Haskell, P.T. Williams, N. Maccoby, and P.D. Wood. 1990. Effects of communitywide education on cardiovas- cular disease risk factors. J. Am. Med. Assoc. 264:359-365. Fazio, R.H. 1990. Multiple processes by which attitudes guide behavior: the MODE model as an integrative framework. Pp. 75-109 in M. Zanna, ed. Advances in Experimental Social Psychology. Academic Press, New York. Fazio, R.H., and M.P. Zanna. 1981. Direct experience and attitude-behavior consis- tency. Adv. Exp. Soc. Psychol. 14:161-202. Fletcher, H. 1899. Nature's Food Filter or What and When To Swallow. Herbert S. Stone & Company, Chicago. 29 pp. FMI (Food Marketing Institute). 1989. Trends: Consumer Attitudes & the Supermar- ket, 1989. Conducted for Food Marketing Institute by Opinion Research Corpora- tion. The Research Department, Food Marketing Institute, Washington, D.C. 65 pp. FMI (Food Marketing Institute). 1990. Trends: Consumer Attitudes & the Supermar- ket, 1990. Conducted for Food Marketing Institute by Opinion Research Corpora

OCR for page 33
78 IMPROVING AMERICA'S DIET AND HEALTH lion. The Research Department, Food Marketing Institute, Washington, D.C. 70 PP Fortmann, S.P., P.T. Williams, S.B. Hulley, W.L Haskell, and J.W. Farquhar. 1981. Ef- fect of health education on dietary behavior: the Stanford Three Community Study. Am. J. Clin. Nutr. 34:2030-2038. Freimuth, V.S. 1990. The chronically uninformed: closing the knowledge gap in health. Pp. 171-186 in E.B. Ray and L. Donohew, eds. Communication and Health: Systems and Applications. Lawrence Erlbaum Associates, Hillsdale, N.J. Freimuth, V.S., and W. Mettger. 1990. Is there a hard-to-reach audience? Public Health Rep. 105:232-238. Freimuth, V.S., S.L. Hammond, and J.A. Stein. 1988. Health advertising: prevention for profit. Am. J. Public Health 78:557-561. Garb, J.L., and A.J. Stunkard. 1974. Taste aversions in man. Am. J. Psychiatr. 131:1204- 1207. Glanz, K. 1985. Nutrition education for risk factor reduction and patient education: a review. Prev. Med. 14:721-752. Glanz, K., and R.M. Mullis. 1988. Environmental interventions to promote healthy eating: a review of models, programs, and evidence. Health Educ. Q. 15:395-415. Glanz, K., and T. Seewald-Klein. 1986. Nutrition at the worksite: an overview. J. Nutr. Educ. 18:S1-S12. Goldberg, M.E., and J. Hartwick. 1990. The effects of advertiser reputation and extremity of advertising claim on product evaluation. J. Consumer Res. 17:185-192. Green, L.W. 1975. Diffusion and adoption of innovations related to cardiovascular risk behavior in the public. Pp. 84-108 in A.J. Enelow and J.B. Henderson, eds. Applying Behavioral Science to Cardiovascular Risk: Proceedings of a Conference. American Heart Association, Dallas, Tex. Greene, C. 1988. A new look for supermarket produce sections. Natl. Food Rev. 11(4):1-5. Gutzwiller, F., B. Nater, and J. Martin. 1985. Community-based primary prevention of cardiovascular disease in Switzerland: methods and results of the National Research Program (NRP 1A). Prev. Med. 14:482-491. Harris, M. 1985. Good To Eat: Riddles of Food and Culture. Simon and Schuster, New York. 289 pp. Hewitt, L.E., and H.T. Blaine. 1984. Prevention through mass media communication. Pp. 281-326 in P.M. Miller and T.D. Nirenberg, eds. Prevention of Alcohol Abuse. Plenum Press, New York. Hjermann, I., K.V. Byre, I. Holme, and P. Leren. 1981. Effect of diet and smoking intervention on the incidence of coronary heart disease. Lancet 2:1303-1310. Janz, N.K., and M.H. Becker. 1984. The Health Belief Model: a decade later. Health Educ. Q. 11:1-47. Ketchum Communications. 1989. The Potato Board: How To Give a Greatly Misunderstood Food a Fresh Perception. Ketchum Communications, San Francisco, Calif. 1 p. Killen, J.D. 1985. Prevention of adolescent tobacco smoking: the social pressure resis- tance training approach. J. Child. Psychol. Psychiatr. 26:7-15. Killen, J.D., M.J. Telch, T.N. Robinson, N. Maccoby, C.B. Taylor, and J.W. Farquhar. 1988. Cardiovascular disease risk reduction for tenth graders: a multiple-factor school-based approach. J. Am. Med. Assoc. 260:1728-1733. King, A.C., J.A. Flora, S.P. Fortmann, and C.B. Taylor. 1987. Smokers' challenge: immediate and long-term findings of a community smoking cessation contest. Am. J. Public Health 77:1340-1341. King, A.C., K.E. Saylor, S. Foster, J.D. Killen, M.J. Telch, J.W. Farquhar, and J.A. Flora.

OCR for page 33
DETERMINANTS OF FOOD CHOICE 79 1988. Promoting dietary change in adolescents: a school-based approach for modi- fying and maintaining healthful behavior. Am. J. Prev. Med. 4:68-74. King, A.C., B. Frey-Hewitt, D.M. Dreon, and P.D. Wood. 1989. Diet vs. exercise in weight maintenance. Arch. Intern. Med. 149:2741-2746. Kinsey, J. 1983. Working wives and the marginal propensity to consume food away from home. Am. J. Agric. Econ. 65:10-19. Klesges, R.C., M.M. Vasey, and R.E. Glasgow. 1986. A worksite smoking modification competition: potential for public health impact. Am. J. Public Health 76:198-200. Kotler, P., and G. Zaltmann. 1971. Social marketing: an approach to planned social change. J. Market. 35:3-12. Kreuter, M.W., G.M. Christenson, and R. Davis. 1984. School health education re- search: future issues and challenges. J. School Health 54:27-32. Lantis, M. 1962. The child consumer: cultural. J. Home Econ. 54:570-579. Lasater, T., D. Abrams, L. Artz, P. Beaudin, L. Cabrera, J. Elder, A. Ferreira, P. Knisley, G. Peterson, A. Rodrigues, P. Rosenberg, R. Snow, and R. Carleton. 1984. Lay volunteer delivery of a community-based cardiovascular risk factor change program: the Pawtucket Experiment. Pp. 1166-1170 in J.D. Matarazzo, S.M. Weiss, J.A. Herd, N.E. Miller, and S.M. Weiss, eds. Behavioral Health: A Handbook of Health En- hancement and Disease Prevention. John Wiley & Sons, New York. Lefebvre, R.C., and J.A. Flora. 1988. Social marketing and public health intervention. Health Educ. Q. 15:299-315. Levy, A.S., and R.C. Stokes. 1987. Effects of a health promotion advertising campaign on sales of ready-to-eat cereals. Public Health Rep. 102:398-403. Levy, A.S., N. Ostrove, T. Guthrie, and J.T. Heimbach. 1988. Recent Trends and Beliefs about Diet/Disease Relationships: Results of the 1979-1988 FDA Health and Diet Surveys. Presented at FDA/USDA Food Editors Conference: December 1-2, 1988. Division of Consumer Studies, Center for Food Safety and Applied Nutrition, Food and Drug Administration, U.S. Department of Health and Human Services, Washington, D.C. Lewin, K. 1943. Forces behind food habits and methods of change. Pp. 35-65 in The Problem of Changing Food Habits. Report of the Committee on Food Habits 1941- 1943. Bulletin of the National Research Council, No. 108. National Academy of Sciences, Washington, D.C. Light, L., J. Tenney, B. Portnoy, L. Kessler, A.B. Rodgers, B. Patterson, O. Mathews, E. Katz, J.E. Blair, S.K. Evans, and E. Tuckermanty. 1989. Eat for Health: a nutrition and cancer control supermarket intervention. Public Health Rep. 104:443-450. Maccoby, N., J.W. Farquhar, P.D. Wood, and J. Alexander. 1977. Reducing the risk of cardiovascular disease: effects of a community-based campaign on knowledge and behavior. J. Community Health 3:100-114. Manoff, R.K. 1985. Social Marketing: New Imperative for Public Health. Praeger, New York. 293 pp. Marshall, J.F. 1971. Topics and networks in intra-village communication. Pp. 160-166 in S. Polgar, ed. Culture and Population: a Collection of Current Studies. Schenkman Publishing, Cambridge, Mass. Mayer, J. 1968. Overweight: Causes, Cost, and Control. Prentice-Hall, Englewood Cliffs, N.J. 213 pp. McGuire, W.J. 1964. Inducing resistance to persuasion: some contemporary approaches. Adv. Exp. Soc. Psychol. 1:191-229. McGuire, W.J. 1985. Attitudes and attitude change. Pp. 233-346 in G. Lindzey and E. Aronson, eds. Handbook of Social Psychology, 3rd ed. Vol. II. Random FIouse, New York.

OCR for page 33
80 IMPROVING AMERICA'S DIET AND HEALTH McGuire, W.J. 1989. Theoretical foundations of campaigns. Pp. 39-42 in R.E. Rice and C.K. Atkin, eds. Public Communication Campaigns, 2nd ed. Sage, Newbury Park, Calif. McGuire, W.J., and D. Papageorgis. 1961. The relative efficacy of various types of prior belief-defense in producing immunity against persuasion. J. Abnorm. Soc. Psychol. 62:327-337. Meyer, A.J., and J.B. Henderson. 1974. Multiple risk factor reduction in the preven- tion of cardiovascular disease. Prev. Med. 3:225-236. Meyer, A.J., N. Maccoby, and J.W. Farquhar. 1977. The role of opinion leadership in a cardiovascular health education campaign. Pp. 579-591 in B.D. Ruben, ed. Commu- nication Yearbook 1. Transaction Books, New Brunswick, N.J. Michela, J.L., and I.R. Contento. 1984. Spontaneous classification of foods by elemen- tary school-aged children. Health Educ. Q. 11:57-76. Michela, J.L., and I.R. Contento. 1986. Cognitive, motivational, social, and environ- mental influences on children's food choices. Health Psychol. 5:209-230. Miller, N., E. Wagner, and P. Rogers. 1988. Worksite-based multifactorial risk inter- vention trial. J. Am. Coll. Cardiol. 11:207A. Montagu, M.F.A. 1962. Prenatal Influences. Charles C Thomas, Springfield, Ill. 614 pp. Moskowitz, H.W., H.L. Jacobs, and S.D. Sharma. 1975. Cross-cultural differences in simple taste preferences. Science 190:1217-1218. Mothner, I. 1987. Our national food fight. We're eating lots of fruits and veggies, but more fats, snacks and sweets, too. Am. Health 6:48-49. MRFIT Research Group. 1982. Multiple Risk Factor Intervention Trial: risk factor changes and mortality results. J. Am. Med. Assoc. 248:1465-1477. Mullis, R.M., and P. Pirie. 1988. Lean meats make the grade a collaborative nutri- tion intervention program. J. Am. Diet. Assoc. 88:191-195. Mullis, R.M., M.K. Hunt, M. Foster, L. Hachfeld, D. Lansing, P. Snyder, and P. Pirie. 1987. The Shop Smart for Your Heart grocery program. J. Nutr. Educ. 19:225-228. Nader, P.R., J.F. Sallis, J. Rupp, C. Atkins, T. Patterson, and I. Abramson. 1986. San Diego family health project: reaching families through the schools. J. School Health 56:227-231. Nickens, H.W. 1990. Commentary: health promotion and disease prevention among minorities. Health Affairs 9:133-143. 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, Washing- ton, D.C. 749 pp. Perry, C.L., R.V. Luepker, D.M. Murray, M.D. Hearn, A. Halper, B. Dudovitz, M.C. Maile, and M. Smyth. 1989. Parent involvement with children's health promotion: a one year follow-up of the Minnesota home team. Health Educ. Q. 16:171-180. Petty, R.E., and J.T. Cacioppo. 1981. Attitudes and Persuasion: Classic and Contem- porary Approaches. W.C. Brown, Dubuque, Iowa. 314 pp. Petty, R.E., and J.T. Cacioppo. 1984. Motivational factors in consumer response to advertisements. Pp. 418-454 in R.G. Geen, W.W. Beatty, and R.M. Arkin, eds. Human Motivation: Physiological, Behavioral, and Social Approaches. Allyn and Bacon, New York. Petty, R.E., and J.T. Cacioppo. 1986. Communication and Persuasion: Central and Peripheral Routes to Attitude Change. Springer-Verlag, New York. 262 pp. Popkin, B.M., P.S. Haines, and K.C. Reidy. 1989. Food consumption trends of US women: patterns and determinants between 1977 and 1985. Am. J. Clin. Nutr. 49:1307-1319.

OCR for page 33
DETERMINANTS OF FOOD CHOICE 81 Progressive Grocer. 1986. The cream also rises. Record growth for the ice cream business is being fueled by two new scoops: superpremiums and frozen novelties. Progressive Grocer 65:115. Puska, P. 1985. Effectiveness of nutrition intervention strategies. Pp. 39-46 in E.M.E. van den Berg, W. Bosman, and B.C. Breedveld, eds. Nutrition in Europe: Proceed- ings of the Fourth European Nutrition Conference. Voorlichtingsbureau voor de Voeding, The Hague, The Netherlands. Puska, P., K. Koskela, A. McAlister, U. Pallonen, E. Vartiainen, and K. Homan. 1979. A comprehensive television smoking cessation program in Finland. Int. J. Health Educ. Suppl. 22:1-28. Puska, P., J. Tuomilehto, J. Salonen, A. Nissinen, J. Virtamo, S. Bjorkqvist, K. Koskela, L. Neittaanmaki, L. Takalo, T.E. Kottke, J. Maki, P. Sipila, and P. Varvikko. 1981. Community Control of Cardiovascular Diseases: the North Karelia Project. World Health Organization, Copenhagen, Denmark. 351 pp. Puska, P., K. Koskela, A. McAlister, H. Mayranen, A. Smolander, S. Moisio, L. Viri, V. Korpelainen, and E.M. Rogers. 1986. Use of lay opinion leaders to promote diffu- sion of health innovations in a commurrity programme: lessons learned from the North Karelia project. Bull. W.H.O. 64:437-446. Putnam, J.J. 1989. Food Consumption, Prices, and Expenditures, 1966-87. Statistical Bulletin No. 773. Economic Research Service, U.S. Department of Agriculture, Washington, D.C. 111 pp. Ravussin, E., S. Lillioja, W.C. Knowler, L. Christin, D. Freymond, W.G. Abbott, V. Boyce, B.V. Howard, and C. Bogardus. 1988. Reduced rate of energy expenditure as a risk factor for body-weight gain. N. Engl. J. Med. 318:467-472. Roberts, D.F., and N. Maccoby. 1985. Effects of mass communication. Pp. 539-598 in G. Lindzey and E. Aronson, eds. Handbook of Social Psychology, 3rd ed. Vol. II. Random House, New York. Roberts, S.B., J. Savage, W.A. Coward, B. Chew, and A. Lucas. 1988. Energy expendi- ture and intake in infants born to lean and overweight mothers. N. Engl. J. Med. 318:461-466. Rodin, J. 1980. Social and immediate environmental influences on food selection. Int. J. Obesity 4:364-370. Rogers, E.M. 1983. Diffusion of Innovations, 3rd ed. Free Press, New York. 453 pp. Rootman, I. 1985. Using health promotion to reduce alcohol problems. Pp. 57-81 in M. Grant, ed. Alcohol Policies. WHO Regional Publications, European Series No. 18. World Health Organization, Copenhagen, Denmark. Rosenstock, I.M. 1974. Historical origins of the Health Belief Model. Health Educ. Monogr. 2:328-335. Rosenstock, I.M., V.J. Strecher, and M.H. Becker. 1988. Social learning theory and the Health Belief Model. Health Educ. Q. 15:175-183. Rossouw, J.E., P.L. Jooste, J.P. Kotze, and P.C.J. Jordaan. 1981. The control of hyper- tension in two communities: an interim evaluation. S. Afr. Med. J. 60:208-212. Rozin, P., and D. Schiller. 1980. The nature and acquisition of a preference of chili pepper by humans. Motiv. Emotion 4:77-101. Sallis, J.F., R.D. Hill, S.P. Fortmann, and J.A. Flora. 1986. Health behavior change at the worksite: cardiovascular risk reduction. Prog. Behav. Modif. 20:161-197. Schoenborn, C.A., and B.H. Cohen. 1986. Trends in Smoking, Alcohol Consumption and Other Health Practices Among U.S. Adults, 1977 and 1983. NCHS Advance Data from Vital & Health Statistics, No. 118. National Center for Health Statistics, Public Health Service, U.S. Department of Health and Human Services, Hyattsville, Md. 13 pp.

OCR for page 33
82 IMPROVING AMERICA'S DIET AND HEALTH Sclafani, A., and D. Springer. 1976. Dietary obesity in adult rats: similarities to hypo- thalamic and human obesity syndromes. Physiol. Behav. 17:461-471. Senauer, B. 1986. Economics and nutrition. Pp. 46-57 in What Is America Eating? Proceedings of a Symposium. Food and Nutrition Board, Commission on Life Sciences. National Academy Press, Washington, D.C. Sheppard, B.H., J. Hartwick, and P.R. Warshaw. 1988. The theory of reasoned action: a meta-arralysis of past research with recommendations for modifications and future research. J. Consumer Res. 15:325-343. Sherman, S.J. 1987. Cognitive processes in the formation, change, and expression of attitudes. Pp. 75-106 in M.P. Zanna, J.M. Olson, and C.P. Herman, eds. Social Influence: the Ontario Symposium. Vol. 5. Lawrence Erlbaum Associates, Hillsdale, N.J. Smallwood, D., and J. Blaylock. 1981. Impact of Household Size and Income on Food Spending Patterns. Technical Bulletin No. 1650. National Economics Division, Economics and Statistics Service, U.S. Department of Agriculture, Washington, D.C. 22 pp. Smith, K. 1990. Alar: One Year Later. A Media Analysis of a Hypothetical Health Risk. American Council on Science and Health, New York. 10 pp. Staats, A.W., and C.K. Staats. 1958. Attitudes established by classical conditioning. J. Abnorm. Soc. Psychol. 57:37-40. Steiner, J.E. 1977. Facial expressions of the neonate infant indicating the hedonics of food-related chemical stimuli. Pp. 173-190 in J.M. Weiffenbach, ed. Taste and Development: the Genesis of the Sweet Preference. DHEW Publ. No. (NIH) 77- 1068. National Institutes of Health, Public Health Service, U.S. Department of Health, Education, and Welfare, Bethesda, Md. Stone, E. 1985. School-based health research funded by the National Heart, Lung, and Blood Institute. J. School Health 55:168-174. Stone, E.J., C.L. Perry, and R.V. Leupker. 1989. Synthesis of cardiovascular behavioral research for youth health promotion. Health Educ. Q. 16:155-169. Strong, E.K. 1925. The Psychology of Selling and Advertising. McGraw-Hill, New York. 468 pp. Stunkard, A.J., M.R.J. Felix, and R.Y. Cohen. 1985. Mobilizing a community to promote health: the Pennsylvania County Health Improvement Program (CHIP). Pp. 143-190 in J.C. Rosen and L.J. Solomon, eds. Prevention in Health Psychology. University Press of New England, Hanover. Supermarket Business. 1986. 39th Annual Consumer Expenditures Study. Americans as artifacts: examining today's shoppers through their spending habits. Supermarket Business. September, pp. 69, 88. Szalai, A. 1972. The Use of Time: Daily Activities of Urban and Suburban Populations in Twelve Countries. Mouton Press, The Hague, The Netherlands. 868 pp. Telch, M.J., J.D. Killen, A.L. McAlister, C.L. Perry, and N. Maccoby. 1982. Long-term follow-up of a pilot project on smoking prevention with adolescents. J. Behav. Med. 5:1-8. Tuomilehto, J., J. Geboers, J.T. Salonen, A. Nissinen, K. Kuulasmaa, and P. Puska. 1986. Decline in cardiovascular mortality in North Karelia and other parts of Fin- land. Br. Med. J. 293:1068-1071. U.S. Department of Commerce. 1983. Statistical Abstract of the United States, 1982-83, 103rd ed. Bureau of the Census, U.S. Department of Commerce. U.S. Government Printing Office, Washington, D.C. 1042 pp. USDA (U.S. Department of Agriculture). 1953. Consumption of Food in the United States, 1902-1952. Agriculture Handbook No. 62. Bureau of Agricultural Econom- ics, U.S. Department of Agriculture, Washington, D.C. 249 pp.

OCR for page 33
DETERMINANTS OF FOOD CHOICE 83 USDA (U.S. Department of Agriculture). 1985. Nationwide Food Consumption Sur- vey Continuing Survey of Food Intakes by Individuals: Women 19-50 Years and Their Children 1-5 Years, 1 Day, 1985. Report No. 85-1. Nutrition Monitoring Division, Human Nutrition Information Service, U.S. Department of Agriculture, Washington, D.C. 102 pp. USDA (U.S. Department of Agriculture). 1989. Table on production and per capita consumption of soft drinks and soft drinks by flavor. Economic Research Service, U.S. Department of Agriculture, Washington, D.C. 2 pp. Weiffenbach,J.M. 1977. Sensory mechanisms in the newborn's tongue. Pp. 205-213 in J.M. Weiffenbach, ed. Taste and Development: the Genesis of the Sweet Preference. DHEW Publ. No. (NIH) 77-1068. National Institutes of Health, Public Health Service, U.S. Department of Health, Education, and Welfare, Bethesda, Md. White, S.L., and S.K. Maloney. 1990. Promoting healthy diets and active lives to heard-to-reach groups: market research study. Public Health Rep. 105:224-231. WHO (World Health Organization). 1986. Community Prevention and Control of Cardiovascular Diseases. Technical Report Series No. 732. Report of a WHO Expert Committee. World Health Organization, Geneva, Switzerland. 62 pp. Wilbur, C.S. 1983. The Johnson & Johnson Program. Prev. Med. 12:672-681. Wilhelmsen, L., G. Berglund, D. Elmfeldt, G. Tibblin, H. Wedel, K. Pennert, A. Vedin, C. Wilhelmsson, and L. Werko. 1986. The multifactor primary prevention trial in Goteborg, Sweden. Eur. Heart J. 7:279-288. Woteki, C.E. 1986. Methods for surveying food habits: how do we know what Americans are eating? Clin. Nutr. 5:9-16. Yankelovich, Skelly and White, Inc. 1985. Consumer Climate for Meat Products. Prepared for the American Meat Institute, Washington, D.C., and the National Live Stock and Meat Board, Chicago, Ill.