Improving America's Diet and Health From Recommendations to Action (1991) / Chapter Skim
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3 Determinants of Food Choice and Prospects for Modifying Food Attitudes and Behavior
3 Determinants of Food Choice and Prospects for Modifying Food Attitudes and Behavior
Pages 33-83
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From page 33... ...
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)
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From page 34... ...
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, endowed with sets of sensors that underlie all their subsequent encounters with food.
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From page 35... ...
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.
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From page 36... ...
Birch (1987) , who investigated food acceptance by young children, concluded that "sweetness" and "familiarity" were two characteristics of food that seemed largely to account for children's food choices in the United States.
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From page 37... ...
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. A1though none of these determinants of food selection can be intentionally altered by policymakers, many of them can change over relatively short or long periods.
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From page 38... ...
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.
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From page 39... ...
is an example of a marketing approach that might be used to some advantage in implementing dietary recommendations. The fact that $3.7 billion is spent annually on food advertising (Advertising Age, 1989)
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From page 40... ...
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.
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From page 41... ...
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
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From page 42... ...
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 direction consistent with dietary recommendations.
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From page 43... ...
Based on disappearance data, fresh fruit consumption has increased dramatically in the past two decades. However, food consumption survey data give a somewhat different picture.
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The great growth in the number of fast-service food outlets has had a substantial effect on food consumption patterns (Capps, 1986~. Potato products, cheese, tomatoes, and chicken have benefited from increased consumption away from home.
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From page 47... ...
An emerging consensus that diet is a risk factor for major chronic diseases such as cardiovascular disease, cancer, and hypertension is influencing consumer behavior and the choices available in the marketplace. One useful source of information on consumer attitudes toward nutrition and their food purchasing behaviors is a national survey conducted annually since 1974 by the Food Marketing Institute (FMI)
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From page 48... ...
These data suggest that people who changed their diets did so in accordance with the principles of dietary recommendations. USDA per-capita food consumption data confirm these trends (Putnam, 1989~.
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From page 49... ...
The percentage of people who perceive dietary fats as a risk factor for heart disease rose from 29% in 1983 to 55% in 1988. The mention of cholesterol as a risk factor for heart disease increased similarly.
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From page 50... ...
Two major approaches to behavior change that rely on internal factors are the communication/persuasion model and the social learning model. Some understanding of the findings of basic research on influencing human behavior may help to guard against either overly optimistic or overly pessimistic assessments of the prospects for changing eating habits to promote health.
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From page 51... ...
was often believed to be an important causal determinant of, and prerequisite to, attitude and behavior change, little empirical evidence has accumulated to support this view (McGuire, 1985; Petty and Cacioppo, 19811. Rather, evidence shows that message learning can occur in the absence of attitude change and that people's attitudes may change in the absence of learning the specific information presented.
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From page 52... ...
guides the behavior. Another person hears the same information and responds with the thought that there is no need to be concerned since there is no family history of heart disease.
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From page 53... ...
Links Between Attitudes and Behaviors Once a person's attitude has changed, it is important that one's new attitude rather than the old habits guide behavior. A considerable amount of research has addressed the links between attitudes and behavior, and many situational and dispositional factors have been shown to enhance the consistency between them.
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From page 54... ...
He notes that factors related to motivation, ability, and opportunity will be important in determining the means by which attitudes guide behavior. Thus, for behavioral decisions that are perceived to have serious personal consequences, attitudes are likely to guide behavior by a deliberate process of reflection, but when consequences are perceived to be less serious, spontaneous attitude activation should be more important.
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From page 55... ...
Importantly, from the perspective of the social learning theory, the power of vicariously experienced and self-generated consequences in controlling action is recognized. As in the theory of reasoned action and the health belief model, described above, voluntary behavior in the social learning model is determined by the anticipated consequences of various courses of action (Rosenstock et al., 19881.
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From page 56... ...
Implications of Theoretical Perspectives for Changing Diet for Health Although evidence has shown that it is possible to improve people's knowledge of food and nutrition, this new knowledge does not invariably result in attitude and behavior changes (Axelson et al., 1985~. Information will be successful in producing relatively enduring changes in attitudes and behavior only if people are motivated and able to process the information and if this processing results in favorable cognitive and affective reactions.
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From page 57... ...
Finally, just as some attitudes are thoughtfully based whereas others are not, some behaviors are the product of deliberate reflection on costs and benefits, but others are much more spontaneous. Since implementation of dietary recommendations necessitates longlasting changes in attitudes with behavioral consequences, the central route to persuasion appears to be the preferred influence strategy.
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From page 58... ...
Consistent with social learning theory, various procedures for enhancing self-efficacy such as skills training, self-regulation, and reinforcement may be needed in order to maintain behaviors that reflect a person's new attitudes. COMMUNICATION THROUGH THE MEDIA The two models described in the previous section the communication/persuasion model and the social learning model rely heavily on the media to influence behavior.
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From page 59... ...
This function of the media needs to be marshaled by implementors in communities across the United States. Media attention to dietary recommendations and their implementation is likely to be most effective in improving eating behaviors when the messages can be integrated and coordinated with other community health promotion efforts such as face-to-face
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From page 60... ...
Dissemination of information through printed brochures and pamphlets is not likely to be very effective with groups that tend to be infrequent readers and have poor reading skills. REVIEW OF EVIDENCE ON CHANGING DIET TO BENEFIT HEALTH Because of the many complexities involved, public policy initiated to modify diet to benefit health should call for the use of the communication/persuasion and social learning models.
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From page 61... ...
Although there is an extensive literature on efforts to produce dietary change for the purpose of weight reduction, there are fewer studies of educational interventions designed to produce qualitative dietary change, i.e., changes in the types of foods consumed; and only some of these describe precisely the type and amount of education provided. This section reviews more than 50 studies reported in the past two decades that have evaluated the effectiveness of nutrition education in producing qualitative dietary changes in either special subgroups or the general population.
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From page 62... ...
Programs that provide not only the information needed to change knowledge and attitudes but also instruction in methods of monitoring change and guidance on how to achieve gradual incremental change in dietary habits have been successful, for example, in lowering blood cholesterol levels (Arntzenius et al., 1985; Bruno et al., 1983; Carmody et al., 1986; Glanz, 1985; Hjermann et al., 1981; Meyer and Henderson, 1974; MRFIT Research Group, 1982; Puska, 1985; Wilhelmsen et al., 1986~. Educational programs relying largely on self-help printed instructions that include the social learning features mentioned above have also been successful in lowering cholesterol levels by dietary means for adult participants identified as being at high risk for cardiovascular disease (Crouch et al., 1986~.
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From page 63... ...
if they felt personally involved by virtue of completing a lengthy survey in which they identified their personal cardiovascular disease-risk status (Meyer et al., 1977~. Given this evidence for the spontaneous creation of opinion leaders as a function of the degree of exposure to health education and of perceived personal relevance, one can see why a popularly conceived and implemented health communication program applied to any part of a system (such as a school, a work site, or a community)
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From page 64... ...
Special attention was paid to making the information personally relevant (fostering the central route of attitude change) and to providing guided practice in menu planning, identifying highrisk foods, countering nutrition myths, and resisting peer pressures (following the guidelines of social learning theory)
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From page 65... ...
Methods common to successful smoking prevention and diet change programs incorporate elements of attitude change research (e.g., enhancing personal relevance and use of McGuire's inoculation methods) and elements of Bandura's social learning theory (e.g., increasing self-confidence and mastery of skills through stepwise guided practice in new behaviors)
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From page 66... ...
One study has shown considerable reductions in blood cholesterol levels and in self-reported saturated fat intake among adults in widely dispersed work sites (Miller et al., 19881. This study
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From page 67... ...
The communities were three semirural towns in northern California (economies centered largely around agriculture and related business) with populations of approximately 15,000 each, in which random samples of 500 people from each town were surveyed to determine their knowledge of cardiovascular disease and risk factor levels (smoking rates, body weight, blood cholesterol, and blood pressure)
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From page 68... ...
Greater changes in dietary patterns and blood cholesterol levels were observed in those who received classroom instruction in addition to the mass media exposure (Farquhar et al., 1977; Fortmann et al., 1981; Maccoby et al., 1977~. These findings reinforce the conclusion that behavior change is more likely in people given evidence of personal relevance.
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From page 69... ...
, no changes in blood cholesterol levels were observed, but 6 and 9% decreases in smoking rates, respectively, were reported. The reasons for the smaller sizes of these decreases compared with those of the Stanford and Finnish studies are unclear, but it appears that the campaigns were not as extensive nor were the campaigns based on the communication/persuasion and social learning models.
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From page 70... ...
Since the kit was successful in changing eating behaviors, the investigators then used the kit in the field in the subsequent Stanford Five-City Project (Elmore et al., 1982~. The kit contained six lessons based on successive steps, beginning with a personal nutrition risk appraisal and then moving to specific shifts toward health-promoting food choices.
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From page 71... ...
of this annual education was devoted to nutrition instruction designed principally to achieve attitude and behavior change. That experience suggests that if only 10% of the total exposure is devoted to face-to-face communication, the changes in diet observed (i.e., a greater than 20% reduction in saturated fat intake)
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From page 72... ...
The adoption and continued application of new technologies (such as use of principles of attitude change and social learning theory and the use of multiple channels of education) requires support from an organized structure of agencies and groups.
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From page 73... ...
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
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From page 74... ...
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
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From page 75... ...
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 comprehensive education on the public's dietary patterns.
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From page 76... ...
1986. Applications of social learning theory in the promotion of heart-healthy diets: the Family Heart Study intervention model.
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From page 77... ...
1990. Effects of communitywide education on cardiovascular disease risk factors.
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1985. Nutrition education for risk factor reduction and patient education: a review.
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1984. Lay volunteer delivery of a community-based cardiovascular risk factor change program: the Pawtucket Experiment.
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1974. Multiple risk factor reduction in the prevention of cardiovascular disease.
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1988. Social learning theory and the Health Belief Model.
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From page 82... ...
1989. Synthesis of cardiovascular behavioral research for youth health promotion.
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From page 83... ...
1985. Nationwide Food Consumption Survey Continuing Survey of Food Intakes by Individuals: Women 19-50 Years and Their Children 1-5 Years, 1 Day, 1985.
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