Determinants of Food Choice and Dietary Change: Implications for Nutrition Education

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 2 © Manyakotic/iStock/ Getty Images Plus/Getty Images © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Determinants of Food Choice and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEDietary OR DISTRIBUTION Change:NOT Implications FOR SALE OR DISTRIBUTION for Nutrition Education © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

OVERVIEW

This chapter provides an ©overview Jones of & the Bartlett numerous Learning, relevant LLC nutrition education.© These Jones influences & Bartlett are Learning, LLC influences on food choiceNOT and dietaryFOR SALE practices. OR DISTRIBUTIONcalled determinants. The chapterNOT also FOR provides SALE a OR DISTRIBUTION Understanding these influences will help nutrition description of the desired competencies for nutrition educators assess the audiences or populations with educators outlined by world’s major professional whom they work and to design appropriate and nutrition education society. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER OUTLINE

77 Determinants of food choice and diet-related 77 Social and environmental determinants behavior: an overview 77 What does all this mean for nutrition educators? © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 77 Food-related determinants: biology and 77 Implications for competencies and skills needed NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION experience by nutrition educators 77 Person-related determinants 77 Chapter summary

LEARNING OBJECTIVES© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION At the end of the chapter, you should be able to: processes in food choices and dietary 77 Describe the research evidence for the behaviors influences of biological predispositions, 77 Appreciate the importance of these individuals’© Jones experience & Bartlett with Learning, food, personal LLC understandings© Jones for &designing Bartlett effective Learning, nutrition LLC factors,NOT and FOR environmental SALE OR factors DISTRIBUTION on human educationNOT FOR SALE OR DISTRIBUTION food choice and dietary behaviors 77 State the competencies needed to be an 77 Understand the key role of intra- and effective nutrition educator interpersonal cultural and psychosocial © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORDeterminants SALE OR DISTRIBUTION of Food Choice and NOT FORWe SALE make ORdecisions DISTRIBUTION about food numerous times a day: when to eat, what to eat, with whom to eat, and how much Diet-Related Behavior: An Overview to eat. Whether the act of eating is a meal or a snack, at You may have known a person like Alicia: She knows a home or at work, the decisions are complex and the influ- lot about nutrition, and,© Jones in particular, & Bartlett she knows Learning, that she LLCences many. Biologically determined© Jones behavioral & Bartlett predisposi Learning,- LLC should eat more fruitsNOT and vegetables.FOR SALE She ORjust can’tDISTRIBUTION seem tions such as liking specificNOT tastes FOR are, of SALE course, OR important DISTRIBUTION to do it. Or Maria, who wants her young daughter to be influences. However, these can be modified by experience healthy but does not know quite what she should do. Or with food as well as by various intrapersonal factors such as Ray, who wants to lose weight and knows what he is sup- our perceptions, attitudes, and cultural expectations, and posed© to Jones do, but & just Bartlett can’t seem Learning, to get to it.LLC Or maybe it interpersonal© Jones factors & such Bartlett as family Learning, and social LLC networks. is you—thereNOT FOR is some SALE eating OR habitDISTRIBUTION you want to change Additionally,NOT environmental FOR SALE factorsOR DISTRIBUTION such as food access, social and cultural practices, or resources either facilitate but don’t. or make it difficult to act on our biological predispositions, Nutrition education is often seen as the process of preferences, or personal imperatives. The influences are so translating the findings of nutrition science to various numerous that they become overwhelming to try to under- © Jones &audiences Bartlett using Learning, methods fromLLC the fields of education and© Jones & Bartlett Learning, LLC stand. Yet, understand we must, if we want to be effective NOT FORcommunication. SALE OR DISTRIBUTION If only the public knew all that we know,NOT FOR SALE OR DISTRIBUTION nutrition educators or communicators. It is very important nutrition educators think, surely they would eat better. for us to understand people, their behaviors, and the vari- Thus, we believe that our task as nutrition educators is ous forces that influence an individual’s or a community’s solely to provide the public with the information needed to decision to eat in a particular way. This chapter simpli- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC eat well. We plan sessions on our government’s food guide fies matters by examining these influences in three cat- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION such as the United States’ MyPlate and food label reading. egories that are commonly used in studying food choice We provide lists of high-fat or high-fiber foods or food or food selection: factors related to food, to the individuals sources for nutrients such as calcium, iron, or vitamins. making the choices, and to the external physical and social We discuss managing food budgets. However, studies show environment—factors related to food, person, and environ- that ©simply Jones communicating & Bartlett Learning,this kind of LLCinformation is ment (Shepherd© Jones 1999). & ThisBartlett chapter Learning, also shows howLLC we can not enough.NOT FOR It is notSALE motivating. OR DISTRIBUTION People often know how use this informationNOT FOR in SALE nutrition OR education. DISTRIBUTION to eat well but do not—just like Alicia, Maria, and Ray. Many factors within each of these categories that This is because eating is about more than health. Eating influence our eating are modifiable. These modifiable is a source of pleasure and is related to many of life’s social influences on our food choices or decisions (as opposed to © Jones &functions. Bartlett Brillat-Savarin Learning, wroteLLC a one hundred page book© Jones non-modifiable & Bartlett onesLearning, such as age LLC or genetics) are explored NOT FORon SALE taste 200 OR years DISTRIBUTION ago in which he noted that, “Taste, suchNOT FORin greater SALE detail OR in DISTRIBUTIONthe sections to follow. We will call these as Nature has given to us, is yet one of our senses . . . that, modifiable influences determinants. all things considered, procures to us the greatest of enjoyment, because: the pleasure of eating is the only one that, taken in moderation,© is Jonesnever followed & Bartlett by fatigue; Learning, it can LLCFood-Related Determinants:© Jones & Bartlett Learning, LLC be combined with allNOT our other FOR pleasures SALE ORand DISTRIBUTIONeven con- NOT FOR SALE OR DISTRIBUTION sole us for their absence . . .” (Brillat-Savarin 1825). Eating Biology and Experience behaviors are acquired over a lifetime and are embedded When asked, most people say their food choices are largely in so many aspects of our lives. Unlike other health-related determined by “taste” (Clark 1998; Kaya 2016, IFIC 2019). behaviors© Jones such as & smoking, Bartlett eating Learning, is not optional. LLC We have By taste,© they Jones mean & flavor, Bartlett which Learning, includes smell LLC and the to eat,NOT and FORany changes SALE we OR make DISTRIBUTION are undertaken with a oral perceptionNOT FOR of food SALE texture OR as well DISTRIBUTION (Small and Prescott great deal of ambivalence. We want to eat to satisfy physi- 2005). Our sensory and emotional responses to the taste, cal hunger and psychological desires and yet also want to smell, sight, and texture of food are a major influence on be healthy, which may require adopting eating patterns food preferences and food choices. What are we born with © Jones &that Bartlett conflict withLearning, these desires. LLC © Jonesand &what Bartlett is learned? Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORBIOLOGICALLY SALE OR DETERMINED DISTRIBUTION BEHAVIORAL NOTSome FOR people SALE cannot OR tasteDISTRIBUTION it and are labeled nontasters, PREDISPOSITIONS others are medium tasters, and still others are supertasters (Tepper 2008; Lipchock et al. 2013). Such differences The Basic Tastes among individuals may be related to differences in being Humans are born with biological© Jones predispositions & Bartlett Learning,toward able LLC to discriminate among different© Jones foods & Bartlettand may con Learning,- LLC liking the sweet taste andNOT rejecting FOR sour SALE and bitter OR DISTRIBUTIONtastes tribute to some of the differencesNOT in FOR liking SALE certain OR foods DISTRIBUTION (Desor, Mahler, and Greene 1977; Mennella and Bobowski (Tepper 2008). 2015; Gravina, Yep, and Khan 2013). The liking of the sweet taste remains throughout life and appears to be uni- Satisfying Hunger versal to all cultures (Drewnowski et al. 2012). The liking © Jones & Bartlett Learning, LLC Many genetic© andJones biological & Bartlett mechanisms Learning, control LLC our of salt seems to develop several months after birth, when NOT FOR SALE OR DISTRIBUTION feelings of hungerNOT andFOR fullness SALE (called OR DISTRIBUTION satiety), ensuring infants have matured somewhat (Mattes 1997; Geerling that people will eat enough to meet their energy needs and Loewy 2008). It has been suggested that these predis- (de Castro 2010). Throughout most of human history, get- positions may have had adaptive value: the liking of the ting enough food was the primary challenge. The human sweet taste because it signals a safe carbohydrate source body developed in an environment where food was scarce © Jonesof calories & Bartlett and the Learning, rejection of LLC bitterness because it may © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOTand FOR high SALElevels of OR physical DISTRIBUTION activity were mandatory for signal potential poisons. survival, leading to various physiological mechanisms that A fifth taste has been identified: umami, a Japanese encourage the body to deposit energy (i.e., fat) and defend word for deliciousness, which is associated with a savory against energy loss (Konner and Eaton 2010; Chakravarthy taste such as the brothiness of soup or the meatiness and Booth 2004; Genne-Bacon 2014; Pontzer et al. 2018). in mushrooms. It seems© to Jones be related & Bartlettto glutamate, Learning, an LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONToday’s environment, however,NOT is different.FOR SALE Researchers OR DISTRIBUTION amino acid, and may capture the taste of protein in food have proposed that the “modern environment has taken (Kurihara 2015). body weight control from an unconscious process to one Preference for fat may also be a basic taste from that requires substantial cognitive effort. In the current recent research ( Gravina, Yep, and Khan 2013; Running environment, people who are not devoting substantial con- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC et al. 2015). Fat is less a flavor than a contributor to tex- scious effort to managing body weight are probably gain- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ture but some genes are thought to be related to the fat ing weight” (Peters et al. 2002). taste (Breslin and Spector 2008; Tucker et al. 2014). It imparts different textures to different foods; it makes Our Preference for Calorie-Dense Foods dairy products such as ice cream seem creamy, meat In addition to these physiological mechanisms, humans juicy and tender, pastries flaky, and cakes moist. Many © Jones & Bartlett Learning, LLC © Jonesseem to & prefer Bartlett the Learning,taste of calorie-dense LLC foods over high-fat foods are those in which fat is paired with sugar NOT FOR SALE OR DISTRIBUTION NOTcalorie-dilute FOR SALE versions OR DISTRIBUTION of the same foods (Birch 1992; (desserts) or salt (potato chips), enhancing their palat- Birch and Fisher 1995). This preference was very adap- ability. Foods containing fat are more varied, rich tast- tive when food, and especially calorie-dense food, was ing, and higher in energy density than nonfat foods and scarce and probably explains the universal liking for hence are more appealing. Additionally, because some © Jones & Bartlett Learning,calorie-dense LLC foods in children© Jones and adults. & Bartlett The finding Learning, LLC taste buds are surrounded by free nerve endings of the NOT FOR SALE OR DISTRIBUTIONthat such foods induce overeatingNOT FOR and obesitySALE inOR ani DISTRIBUTION- trigeminal nerve, people are able to experience the burn mals (Sclafani and Ackroff 2004; Birch and Anzman- from hot peppers and the coolness of menthol (Breslin Frasca 2011a) suggests that this feature is less adaptive and Spector 2008). for humans in today’s environment, where relatively © Jones & Bartlett Learning, LLC cheap, highly© procJonesessed & calorie-dense Bartlett Learning, foods are LLCwidely IndividualNOT Differences: FOR SALE Nontasters OR DISTRIBUTION available (MonteiroNOT FOR et al. SALE 2013). OR DISTRIBUTION and Supertasters Some genetic differences in sensitivity to tastes exist Specific Tastes or Sensory-Specific Satiety between individuals. Research shows that people differ Humans have a built-in biologically determined mecha- © Jonesin their & Bartlett responses Learning, to two bitter LLC compounds called phen- © Jonesnism whereby & Bartlett we get Learning, tired of one LLC taste and move on to NOT FORylthiocarbamide SALE OR (PTC) DISTRIBUTION and 6-n-propylthiouracil (PROP). NOTanother FOR one SALE over ORa short DISTRIBUTION time span, such as while eating

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORproducts SALE are beingOR DISTRIBUTION specially formulated to take advantage of these biological predispositions by manipulating their fat, salt, and sugar content to make them more desirable (Gearhardt et al. 2011; Moss 2013; Hebebrand et al. 2014). © Jones & Bartlett Learning, LLCHowever, as we see in the© nextJones section, & Bartlett these biological Learning, LLC NOT FOR SALE OR DISTRIBUTIONpredispositions can be modifiedNOT FOR and most SALE specific OR preferDISTRIBUTION- ences are actually learned or conditioned—which is good news for nutrition educators because that means we can help people navigate this challenging food environment © Jones & Bartlett Learning, LLC and learn© to Jones like healthful & Bartlett foods. Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION EXPERIENCE WITH FOOD

A combination of fat, salt, and sugar can make foods very attractive to Research suggests that people’s liking for specific foods and eat in large quantities. their food acceptance patterns are largely learned (Birch © Jones &© Photographee.eu/Shutterstock Bartlett Learning, LLC © Jones1999, & 2014; Bartlett Birch andLearning, Anzman-Frasca LLC 2011a; Mennella and NOT FOR SALE OR DISTRIBUTION NOT FORBeauchamp SALE 2004; OR BeauchampDISTRIBUTION and Mennella 2009). Learn- ing, in this context, does not mean cognitive learning but a meal (Rolls 2000). This mechanism is called sensory- rather physiological learning or conditioning arising from specific satiety. Such a mechanism probably had adaptive the positive or negative consequences that people experi- value for humans because it ensures that people eat a vari- © Jones & Bartlett Learning, LLCence physically and emotionally© Jones from & repeatedBartlett exposure Learning, LLC ety of different-tasting foods and thus obtain all the nutri- NOT FOR SALE OR DISTRIBUTIONto a food. NOT FOR SALE OR DISTRIBUTION ents they need from these foods. Studies also reveal that for adults, greater variety stimulates greater intake. Again, Pre- and Postnatal Experience this mechanism might have been very useful in a situation where food was scarce while in today’s food environment, Such learning begins early, even prenatally. Flavors such © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC variety in meals may contribute to overweight. as garlic and alcohol have been detected in mothers’ NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION In summary, these biological predispositions contrib- milk, possibly familiarizing infants with these flavors ute to some degree to preference and to food choices or (Beauchamp and Mennella 2009. In one study, breastfed food selections and behavior, particularly in children, and infants whose mothers were fed carrot juice during preg- are shown in FIGURE 2-1. In today’s food marketplace, food nancy or breastfeeding showed increased acceptance of © Jones & Bartlett Learning, LLC © Jonescarrot & flavorBartlett in their Learning, cereal at weaningLLC (Mennella, Jagnow, NOT FOR SALE OR DISTRIBUTION NOT FORand Beauchamp SALE OR 2001). DISTRIBUTION In another study, infants who were fed a formula made of an unpleasant-tasting, sour and bitter protein (hydrosylate) from birth (from necessity Biologically determined because they did not tolerate milk) drank it well when predispositions: • Taste/pleasure © Jones & Bartlett Learning, LLCtested with the hydrosylate© formulaJones at& 7 Bartlett months, whereasLearning, LLC • Hunger/fullness mechanismsNOT FOR SALE OR DISTRIBUTIONthose fed milk formula rejectedNOT FORit (Mennella, SALE Griffin, OR DISTRIBUTION and • Sweet, sour, salt, bitter, umami Beauchamp 2004). There appear to be sensitive periods • Sensory specific satiety during which early experience has more impact on flavor • Genetics learning (Trabulsi and Mennella 2012). © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION LearningNOT from FOR the PhysiologicalSALE OR DISTRIBUTION Consequences of Eating: Preferences and Aversions Preferences/dislikes: Food choice and How humans feel physiologically after eating a food can Taste and affective factors diet-related behaviors have a powerful impact on food preferences. If eating is © Jones &FIGURE Bartlett 2-1 Our Learning, biologically determined LLC behavioral predispositions© Jonesfollowed & Bartlett by negative Learning, effects, such LLC as a feeling of nausea, a NOT FORinfluence SALE food OR choices DISTRIBUTION and dietary behaviors. NOT FORconditioned SALE aversionOR DISTRIBUTION follows. Conditioned aversions can

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORbe quite SALE powerful. OR DISTRIBUTION A one-time experience of illness fol- NOT FOR SALE OR DISTRIBUTION lowing eating a food can turn us off that food for decades. On the other hand, liking for foods usually develops more slowly through a process of learned or conditioned preference, whereby repeated© eating Jones of a & food, Bartlett or familiarity, Learning, LLC © Jones & Bartlett Learning, LLC is followed by pleasant consequencesNOT FOR suchSALE as aOR feeling DISTRIBUTION of NOT FOR SALE OR DISTRIBUTION fullness or satiety. Conditioning of food preferences continues throughout our lives, but early experience with food and eating is especially© crucial Jones in &the Bartlett development Learning, of eating LLC patterns, © Jones & Bartlett Learning, LLC in terms NOTof both FOR the kindsSALE of OR food DISTRIBUTION we come to like and NOT FOR SALE OR DISTRIBUTION the amount we eat. Indeed, one study found that the food preferences of children 2–3 years old persisted into adolescence and early adulthood, confirming the importance Neophobia often occurs during early childhood. © A3pfamily/Shutterstock © Jonesof these & Bartlett early experiences Learning, with LLC food (Nicklaus et al. 2004). © Jones & Bartlett Learning, LLC NOT FORExperience SALE with OR food DISTRIBUTION influences the development of eating NOT FOR SALE OR DISTRIBUTION patterns of children and adults in several ways. Picky or fussy eating is somewhat different—it is the rejection of a large proportion of familiar (as well as new Exposure to New Foods or novel) foods, tending to result in a diet that is lower in Humans, like other omnivores,© Jones experience & Bartlett the “omnivore’s Learning, variety LLC (Dovey et al. 2008). This© Jones quality &tends Bartlett to persist, Learning, LLC dilemma”: we need to seekNOT variety FOR in SALE our diets OR to DISTRIBUTION meet even into adulthood and mayNOT have aFOR genetic SALE component. OR DISTRIBUTION nutritional requirements, but ingesting new substances Here, even more frequent food exposures may be necessary can be potentially dangerous (Rozin 1988). This dilemma for acceptance to occur, presenting a challenge to parents can be resolved through familiarity and conditioning. and nutrition educators alike. Research© Jones has shown & Bartlett that repeated Learning, opportunities LLC to In sum, ©with Jones repeated & Bartlett consumption, Learning, preference LLC for taste newNOT foods FOR is the SALE key to ORdeveloping DISTRIBUTION preferences for initially novelNOT foods FOR tends SALE to increase. OR DISTRIBUTION Thus, if children these foods, often requiring 6–12 or more exposures are exposed to many high-sugar, high-fat, and high-salt (Savage, Fisher, and Birch 2007; Anzman-Frasca et al. 2012), foods at home, at school, and in other settings, these foods and probably through a “learned safety” mechanism. That will become more familiar and will become preferred over © Jonesis, when & Bartlett eating a Learning,food is not followedLLC by negative conse- © Jonesthose that & remainBartlett relatively Learning, unfamiliar, LLC such as vegetables NOT FORquences, SALE the child OR learnsDISTRIBUTION it is safe to eat and increased food NOTor wholeFOR grainsSALE (Birch OR DISTRIBUTIONand Anzman-Frasca 2011a). acceptance results. Once the foods are familiar, the preferences tend to persist (Skinner et al. 2002). Additionally, Influence of Experience with Food on the Basic Tastes tasting or actual ingestion has been found to be necessary— Biologically determined behavioral propensities can be not just looking at or smelling the food (Savage et al. 2007). © Jones & Bartlett Learning,modified LLC by experience in adults© Jones as well &(Pliner, Bartlett Pelchat, Learning, LLC NOT FOR SALE OR DISTRIBUTIONand Grabski 1993; Pelchat andNOT Pliner FOR 1995). SALE For example, OR DISTRIBUTION Neophobia and Picky/Fussy Eating those who eat lower-salt diets come to like them more Although food neophobia, or fear of new foods, is mini- (Mattes 1997). The dislike for bitterness can be overcome, mal in infants, it increases through early childhood so that as shown by the study described earlier where infants, 2- to 5-year-olds,© Jones like & other Bartlett young Learning,omnivores, demonstrate LLC with experience,© Jones comfortably & Bartlett consumed Learning, the bitter LLC pro- neophobiaNOT (Birch FOR 1999; SALE Dovey ORet al. DISTRIBUTION2008). This would have tein hydrosylateNOT and FOR by the SALE fact that OR people DISTRIBUTION come to like adaptive value because infants are fed by adults, whereas a variety of bitter tastes, such as coffee, dark chocolate, toddlers are beginning to explore their world and have not or bitter vegetables such as broccoli. Sour tastes, such as learned yet what is safe to eat and what is not. However, vinegar and grapefruit, can also be acquired. Likewise, © Jonesneophobia & Bartlett can be Learning, reduced by LLC repeated opportunities to © Jonesthe liking & Bartlettfor dietary Learning, fat can be modified.LLC Studies have NOT FORsample SALE new foods OR (DoveyDISTRIBUTION et al. 2008). NOTfound FOR that SALE those ORwho DISTRIBUTION switched from a high-fat diet to

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORnaturally SALE ORlow-fat DISTRIBUTION foods such as grains and vegetablesNOT FORpreschool SALE children OR DISTRIBUTION who, at snack time, observed other (Mattes 1993) or to reduced-fat foods (Ledikwe et al. children eating and liking vegetables that they did not 2007) came to like the fat taste less. Maintaining these like, increased their liking and intake (Birch 1999). changed preferences involved continuing to eat these new foods. © Jones & Bartlett Learning, LLCFood Parenting Practices© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONParents create a home environmentNOT FOR thatSALE plays OR a critical DISTRIBUTION Learning What Fullness Means: role in shaping children’s food preferences, eating behav- Conditioned Satiety iors, and energy intake (Savage, Fisher, and Birch 2007; Research shows that, surprisingly, in both young chil- Frankel et al. 2012). Children learn what, when, and how dren ©and Jones adults, & feeling Bartlett full, orLearning, satiety, is alsoLLC influenced much to eat© Jonesbased on & the Bartlett transmission Learning, of cultural LLC and fam- by associativeNOT FOR conditioning SALE OR or learningDISTRIBUTION (Birch et al. 1987; ily beliefs,NOT attitudes, FOR and SALE practices. OR ParentingDISTRIBUTION practices are Birch and Fisher 1995). The ability of our bodies to learn specific parental actions or behaviors that are designed to about how full familiar foods can make us feel may explain influence children’s eating behaviors and nourishment. how it is that we end meals most often before we have Parents shape children’s eating behaviors by the foods they © Jones &yet Bartlett experienced Learning, the physiological LLC cues that signal satiety.© Jones make & availableBartlett to Learning,children (as food LLC providers), by their own NOT FORThus, SALE as aOR result DISTRIBUTION of repeatedly consuming familiar foods,NOT FOReating SALE styles OR(as role DISTRIBUTION models), how they discipline their people’s bodies recognize the “filling” and the “fattening” children around food issues, the policies they set, and their quality of familiar foods and normally make adjustments actual child feeding practices. These feeding practices may in what they eat in anticipation of the end of the meal be carried out not only by parents but also by family and (Stunkard 1975). This© is Jonessupported & byBartlett the repeated Learning, obser- LLCother caregivers, and these© practices Jones can & Bartlettencourage Learning, health- LLC vations that portion sizeNOT is FORinfluenced SALE by ORoutside DISTRIBUTION events, ful eating or modify and interfereNOT FOR with theSALE child’s OR ability DISTRIBUTION to such as serving size, size of plate, and so forth (Fisher and respond to food appropriately. We use the term “parents” Kjal 2008; DiSantis et al. 2013). to refer to all those who care for the child. These practices may be seen as falling into three gen- LEARNING© Jones FROM & Bartlett SOCIAL-AFFECTIVE Learning, LLCCONTEXT: eral categories:© Jones structure, & Bartlett by which Learning, we mean LLC parents’ SOCIALNOT CONDITIONING FOR SALE OR DISTRIBUTION organizationNOT of FOR children’s SALE environment OR DISTRIBUTION (Grolnik and The emotional context, called the social-affective context, Pomerantz 2009); control, by which we mean [parents’ of eating also has a powerful impact on food preferences behaviors of controlling what children eat; and support for and on the regulation of how much people eat. Food is autonomy, by which we mean nurturing children’s sense of © Jones &eaten Bartlett many timesLearning, a day in LLC many different contexts, pro© -Joneschoice & Bartlettand capacity Learning, for self-direction LLC (Vaughn et al. 2016; NOT FORviding SALE opportunities OR DISTRIBUTION for individuals’ emotional responsesNOT FORO’Connor SALE et ORal. 2017). DISTRIBUTION Some of the specific practices in to the social context of eating to become associated with each category will be described below. the specific foods being eaten. This is particularly true of children. Structure © Jones & Bartlett Learning, LLCParents or Families as Providers© Jones of Food:& Bartlett Exposure Learning, and LLC Social Modeling NOT FOR SALE OR DISTRIBUTIONaccessibility The types NOTof foods FOR and SALE beverages OR parents DISTRIBUTION Children learn about food not only from the direct expe- make readily available in the home will affect what chil- rience of eating but also from observing the behaviors dren eat and drink. Parents can shape their children’s food of peers and adults (Birch 1999). Familiar adults have preferences by frequently exposing them to healthy foods been© found Jones to be& Bartlettmore effective Learning, models LLCthan unfamil- at home ©and Jones making & thoseBartlett foods Learning, more easily LLC accessible. iar ones,NOT and FOR having SALE the ORadults DISTRIBUTION themselves eat the same Putting fruitsNOT andFOR vegetables SALE OR in a DISTRIBUTION place where the child foods is more effective than when adults offer the foods can easily reach them (e.g., in a bowl on the table or on a without eating the foods themselves (Harper and Sanders lower shelf in the refrigerator) and preparing them into 1975; Addessi et al. 2005). Food preferences also increase sizes that are easy to eat (e.g., fruit cut into bite-size pieces) © Jones &when Bartlett adults offerLearning, the foods LLC in a friendly way (Birch 1999).© Jones may & increase Bartlett the child’sLearning, intake LLCof these foods (Baranowski, NOT FORChildren SALE ORare also DISTRIBUTION influenced by their peers. In one study,NOT FORCullen, SALE and Baranowski OR DISTRIBUTION 1999).

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORParents SALE and Families OR DISTRIBUTION as Providers of Food: Portion Sizes NOTSocial FOR Context: SALE MealOR DISTRIBUTION and Snack Routines Routines While very young children seem to be able to adjust their include where meals are served, whether family members intakes to some extent over time (Cecil et al. 2005), recent are present, and whether there are distractions (such as the studies show that portion sizes influence the amount eaten TV) during meals. There is evidence that children who eat by children as young as 2 years© Jones of age & (FisherBartlett et al.Learning, 2007; with LLC their families consume more© Jones healthy & foods Bartlett and nutri Learning,- LLC Birch, Savage, and Fisher NOT2015). FORMany SALEparents ORapparently DISTRIBUTION ents. Children and adolescentsNOT who FOR have companionshipSALE OR DISTRIBUTION are not concerned about portion sizes for their children, at mealtimes eat better (Stankek et al. 1990; Neumark- assuming children will select appropriate sizes (Croker, Sztainer et al. 2003) and these eating patterns persist over Sweetman, and Cooke 2009). Yet, many studies of meals time (Larson et al. 2007). Adolescents who watch television with energy-dense© Jones foods & Bartlett show that Learning, the larger theLLC portion during meals ©are Jones more likely & Bartlett to eat poorer Learning, quality diets LLC and size, the moreNOT consumed FOR SALE (Fisher OR and DISTRIBUTION Kjal 2008; Fisher et have a higherNOT weight FOR status SALE (Vik et OR al. 2013). DISTRIBUTION al. 2007). Indeed, when children are allowed to serve them- Interviews with parents suggest that they use a variety selves, they tend to eat more (Savage et al. 2012). Thus, of practical strategies to encourage their children to eat parents need to learn more about age-appropriate serving healthfully (Carnell et al. 2011; Blisset 2011; O’Connor et al. © Jonessizes & and Bartlett offer these Learning, to children. LLC The good news is that © Jones2010). These & Bartlett include presentingLearning, foods LLC in an attractive way; NOT FORserving SALE vegetables OR asDISTRIBUTION a soup or first course at the beginning NOTverbal FOR encouragement; SALE OR DISTRIBUTION making eating healthful foods fun; of a meal (Spill et al. 2010, 2011) or placing large amounts use of teachable moments, involving the child; and flex- of fruits and vegetables on the dinner plate also increases ible responses to individual differences shown by children. consumption of these items (Mathias et al. 2012).

Parental Role Modeling ©Parents Jones can & indirectly Bartlett influence Learning, Control LLC © Jones & Bartlett Learning, LLC their children’s eating habitsNOT by FOR modeling SALE good OR eatingDISTRIBUTION Pressure to Eat Healthful Food NOTand Restricting FOR SALE Access OR to Less DISTRIBUTION behaviors. Evidence suggests that parents who eat fruits Healthful Food Pressuring children to eat healthful foods and vegetables and other healthy foods have children who and restricting less healthful foods are behaviors widely eat more healthfully (Blissett 2011; O’Connor et al. 2010). practiced by parents (Savage et al. 2007; O’Connor et al. Unfortunately,© Jones modeling & Bartlett of negative Learning, behaviors LLC can have 2010; Carnell© et Jones al. 2011). & TheBartlett relationship Learning, of these LLC prac- an equallyNOT strong FOR but oppositeSALE OR effect DISTRIBUTION and has been associ- tices by parentsNOT and FOR caregivers SALE to OR children’s DISTRIBUTION preferences ated with the development of emotional eating, excessive and intakes are quite complex (Blisset 2011; Vaughn 2016). snacking, and body dissatisfaction (Brown and Ogden Some research suggests the excessive use of pressure to eat 2004). These may include eating when bored or angry, specific—usually healthy—foods is associated with lower © Joneseating & Bartlettwhen watching Learning, TV or read LLCing, or consistently eat- © Jonesintakes and& Bartlett more negative Learning, comments LLC about those pressured NOT FORing second SALE helpings OR DISTRIBUTION (Gattshall et al. 2008) Thus, parents NOTfoods. FOR Here SALE the parent OR isDISTRIBUTION forceful or demanding in order to and caregivers who offer healthful foods in appropriate push the child to eat food that is served during a meal or portion sizes and enjoy the foods themselves are likely to snack even if the child is not hungry. Likewise, high levels of facilitate healthful eating in their children. restriction or coercive control of children’s access or intake of specific foods, usually those that are most tasty because of Parental Policies and Rules© JonesThe policies & Bartlett or rules Learning,parents LLC © Jones & Bartlett Learning, LLC their high sugar, fat, and/or salt content, may increase pref- set for their children are NOTalso important. FOR SALE These OR apply DISTRIBUTION to NOT FOR SALE OR DISTRIBUTION erence for, and consumption of, these items (Savage et al. what types of food are encouraged or limited (e.g., children 2007; Vaughn 2016; O’Connor 2017). should be encouraged to taste new foods whenever possible [Gattshall et al. 2008]); when certain foods can be eaten Rewards The use of rewards is another very com- (e.g., snacks© Jones after school); & Bartlett and where Learning, foods and LLCsnacks can mon but controversial© Jones practice& Bartlett of parents Learning, (Ventura LLC and be eaten NOT(e.g., children FOR SALE can be ORencouraged DISTRIBUTION to eat at a table Birch 2008). NOTThere FORis concern SALE that OR rewards DISTRIBUTION might reduce and/or should not eat in their bedrooms). Parents make reasoned action and intrinsic motivation. There is evi- known the guidelines or boundaries of how much and what dence that non-food tangible rewards (e.g., stickers) or kind of foods to eat and the timing or routine of meals. non-tangible rewards (praise) can be highly effective in © JonesHow & these Bartlett rules are Learning, communicated LLC to the child and applied © Jonesencouraging & Bartlett children Learning, to taste new LLC or initially moderately NOT FORis crucial SALE and ORwill likelyDISTRIBUTION reflect the parents’ feeding style. NOTdisliked FOR foods SALE such OR as vegetablesDISTRIBUTION sufficiently often so that

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORchildren SALE become OR DISTRIBUTION familiar with the foods and benefit fromNOT FORChild SALE Involvement OR DISTRIBUTION The parent acknowledges that the the familiarity effect (Cooke et al. 2011b). child is an independent individual and takes the child’s For example, some studies found that exposure plus preferences into consideration by actively involving the rewards increased the liking and intake for the targeted child during meal planning, grocery shopping, and meal vegetables (Wardle et© al. Jones 2003; Remington & Bartlett et al.Learning, 2012). In LLCpreparation with the goal© of Jones motivating & Bartlett more nutritious Learning, LLC a peer-modeling plusNOT reward-based FOR SALE intervention, OR DISTRIBUTION chil- intake. This includes lettingNOT the childFOR serve SALE him- OR or herselfDISTRIBUTION dren aged 4–11 years watched video adventures of heroic and decide how much food he or she eats, letting the child cartoon characters eating fruits and vegetables and were choose fruits and vegetables at the store, or making the food given rewards for tasting the fruits and vegetables that the interesting in terms of seasoning or method of preparation. cartoon models ate. Liking for both fruits and vegetables © Jones & Bartlett Learning, LLC Reasoning© and Jones Education & Bartlett Parents Learning, can help children LLC learn increased significantly, as did consumption, both imme- NOT FOR SALE OR DISTRIBUTION decision-makingNOT FOR skills SALE by using OR mealtime DISTRIBUTION to discuss the diately after the intervention and at a 4-month follow-up, foods’ nutritional qualities as well as the benefits of eating after gradual withdrawal of the rewards (Horne et al. 2004, healthful foods or the consequences of eating unhealthy 2011). Social rewards (praise) can be more effective than ones. Parents use explanations to persuade the child to eat tangible rewards (Cooke et al. 2011a). Incentives offered in © Jones & Bartlett Learning, LLC © Joneshealthfully. & Bartlett The reasoningLearning, can LLC become more complex as the school context have also increased intake of fruits and NOT FOR SALE OR DISTRIBUTION NOT FORthe children SALE getOR older. DISTRIBUTION vegetables (Hendy, Williams, and Camise 2005). These findings suggest that judicious use of rewards can facili- Parental Feeding Styles tate healthy eating by getting children to at least try new, Parents influence their children’s eating not only by their or initially disliked foods,© Jones and hence & Bartlett become familiar Learning, with LLC © Jones & Bartlett Learning, LLC them (Cooke et al. 2011a). practices but also by their feeding styles. By parenting feed- NOT FOR SALE OR DISTRIBUTIONing styles, we mean the attitudesNOT FORand beliefs SALE of parentsOR DISTRIBUTION that create the socio-emotional climate in which parenting Autonomy Support practices are conducted (Rhee 2008; Blisset 2011). Paren- Autonomy support involves helping children to develop a tal feeding styles vary on the dimensions of responsive- sense of ownership, or endorsement of, the healthful eating © Jones & Bartlett Learning, LLC ness to the© childJones (warmth & Bartlett and nurturance) Learning, versus LLC control patterns that the parent is encouraging and the capacity to NOT FOR SALE OR DISTRIBUTION (expectationsNOT and FOR demands) SALE [HughesOR DISTRIBUTION et al. 2005; Blissett make their own decisions (Vaughn et al. 2016; O’Connor 2011]). The authoritarian feeding style involves high expec- et al. 2017). To achieve this, the parent can encourage tations or involvement with the child and encourages eating healthful eating, provide sufficient structure within which using highly controlling behaviors or strict rules, threats, the child can be involved in making choices, involve the © Jones & Bartlett Learning, LLC © Jonesor bribes, & Bartlett with little Learning, regard for LLC the child’s needs (cold and child in food-related activities and engage in conversations NOT FOR SALE OR DISTRIBUTION NOT FORunresponsive SALE ORto the DISTRIBUTION child). The authoritative style is not with the child about the reasons for the rules and boundar- only typified by high expectations or involvement with the ies, and provide appropriate nutrition education. child’s diet and eating behavior with a clear set of boundar- Encouragement to Eat Healthful Food and Guided ies but also by high warmth and sensitivity to child needs. It Choices This approach© Jones involves & theBartlett parent Learning,prompting LLCinvolves actively encouraging© Jones eating through & Bartlett non-dire Learning,ctive LLC the child to eat healthfulNOT food FOR without SALE being OR overly DISTRIBUTION force- and supportive behaviors,NOT such as FOR reasoning SALE with OR the DISTRIBUTION child ful or coercive. For example, a parent might encourage, or explaining why it is important to eat vegetables. By with warmth, the child to choose from or eat foods that contrast, the permissive parenting styles are characterized are good for him or her, or ask the child to try at least one by lack of structure and allowing children to make many bite of© Jonesnew foods, & Bartlettwhich may Learning, be effective LLC in increasing decisions© for Jones themselves & Bartlett and setting Learning, few rules LLC or bound- intakeNOT and FORpreference SALE (Blisset OR DISTRIBUTION 2011). Again, in terms of aries. ThereNOT are FOR two types,SALE one OR where DISTRIBUTION parents are overly setting boundaries and limiting choice, a middle ground indulgent (expressing warmth and responsiveness to child of mealtime rules and limits on unhealthy snacks seems to needs) and another where parents are uninvolved/neglectful be effective. This is a discrete parental practice and repre- (lacking warmth and responsiveness and indifferent to © Jones &sents Bartlett a balance Learning, in sharing ofLLC control and decision-making© Jones child’s & Bartlettneeds). Parental Learning, feeding LLC styles can have long-term NOT FORbetween SALE parentOR DISTRIBUTION and child. NOT FORconsequences SALE OR (Berge DISTRIBUTION et al. 2010; Fuemmeler et al. 2012).

9781284169010_CH02_Contento.indd 39 2019-12-16 7:09 PM 40 Chapter 2 Determinants of Food Choice and Dietary Change: Implications for Nutrition Education

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORThere SALE has ORbeen DISTRIBUTION considerable concern that the authori- NOThas FOR proposed SALE a “division OR DISTRIBUTION of responsibility,” where parents tarian, or controlling feeding style, may be detrimental to take on the responsibility of what, when, and where, and child healthful eating. Indeed, it has been negatively associ- the child takes on how much and whether. That is, parents ated with parents offering, and children eating, vegetables should decide what foods are served for meals and snacks, (Patrick et al. 2005). However,© Jones the relationship & Bartlett with Learning, child when LLC they are served, and where© Jones they will& Bartlett be eaten. Learning, In LLC weight is mixed. Some studiesNOT haveFOR found SALE an associationOR DISTRIBUTION turn, children should be responsibleNOT FOR for how SALE much OR to eatDISTRIBUTION with higher weights of children (Faith et al. 2004; Rhee 2008; during a snack or meal and whether to eat what is offered. Ventura and Birch 2008), and others found that authoritar- It has been useful to guide child-feeding practices (Loth ian parents are equally likely to have normal weight chil- et al. 2018). The authoritative approach is also the basis of dren as overweight© Jones children & Bartlett (Robinson Learning, et al. 2001; LLC Pai and books on what© hasJones been described& Bartlett as theLearning, French approach LLC ContentoNOT 2014). FOR On the SALE other hand, OR DISTRIBUTIONthe authoritative feed- to bringing upNOT children, FOR SALEincluding OR in DISTRIBUTION relation to food, ing style, where there are clear boundaries and the child is where it is applied not only in families but also in daycare encouraged to eat healthful foods, but where the child is settings and even schools (Druckerman 2012). also given some choice about eating options, all in a warm Social and Environmental Influences © Jonesemotional & Bartlett atmosphere, Learning, has been LLC shown to be associated © Jones & Bartlett Learning, LLC on Parenting Styles and Practices NOT FORwith increasedSALE OR consumption DISTRIBUTION of dairy and vegetables and NOT FOR SALE OR DISTRIBUTION decreased consumption of sweet drinks (Patrick et al. 2005; Parents and caregivers want to do the best for their chil- O’Connor et al. 2010; van der Horst et al. 2007). dren. Yet they live in the context of communities, social The permissive parental feeding styles (both indulgent structures and environments that may shape their paren- and uninvolved) appear to be the most problematic. They tal feeding practices and styles (Patrick et al. 2013). Social © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC are related negatively to children’s intake of fruits and veg- and cultural influences such as parenting norms can shape NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION etables (Blisset 2011) and nutrition-rich foods such as 100% parents’ own parenting style and practices. For example, juice, fruit, vegetables, and dairy foods (Hoerr et al. 2009). permissive parenting seems to be on the rise. Parents might Permissive styles, in particular the indulgent style, are also consider permissive parenting to be the socially accepted most associated with higher levels of overweight children style if they see other parents, whether friends or people in several© cultural Jones groups & Bartlett (Rhee 2008; Learning, Hughes LLCet al. 2008; in the media,© using Jones that &style Bartlett when interacting Learning, with LLC chil- Pai and ContentoNOT FOR 2014). SALE Permissive OR DISTRIBUTION styles have become dren. Also, children’sNOT FOR expectations SALE OR about DISTRIBUTION how their par- more common. One extensive, in-depth qualitative study ents should interact with them might be influenced by found that parents stocked the house and refrigerator with how friends’ parents behave with regard to setting rules individual sized snacks and meals, and children ate what- or encouraging healthy choices. © Jonesever & they Bartlett wanted Learning, whenever they LLC wanted (Ochs and Beck © JonesThe & environment Bartlett Learning, also presents LLC challenges to parents’ NOT FOR2013). SALE In reality, OR parents DISTRIBUTION use a mixture of styles (although NOTwell-intentioned FOR SALE efforts OR DISTRIBUTION to encourage healthy eating behav- one or another style may dominate) and parenting styles iors in their children. With schools near stores full of sug- and practices are closely interconnected (O’Connor et al. ary drinks and high-sugar, high-fat food items at low cost, 2010; Carnell et al. 2011). children may eat less healthful snacks after school, making Clearly, neither too much© Jones nor too &little Bartlett control isLearning, effec- children LLC less enthusiastic about© Jones a healthy & dinner.Bartlett Given Learning, LLC tive. Encouragement to eatNOT healthy FOR foods SALE is desirable, OR DISTRIBUTION as that parents have to see to otherNOT aspects FOR of theirSALE children’s OR DISTRIBUTION are clear boundaries. It is the emotional tone and the lives such as homework and school activities, parents often way these practices are carried out that is the issue. The feel that they can’t fight every battle and so rules about eat- authoritative style seems to work best. It is typified by set- ing often get set aside. ting boundaries© Jones and & using Bartlett non-controlling Learning, practices LLC that There are© also Jones time constraints:& Bartlett Today’s Learning, parents LLC work encourageNOT healthful FOR eating SALE but OR do notDISTRIBUTION force consumption, longer hoursNOT and mostFOR often SALE both OR parents DISTRIBUTION work outside accompanied by moderately restrictive practices about eat- the home. Many families consist of only one parent. Get- ing less healthful foods and snacks, all in a climate of emo- ting food on the table quickly becomes a priority and it is tional warmth and sensitivity to the child (Blisset 2011; often hard to practice an authoritative parental feeding © JonesO’Connor & Bartlett et al. 2010).Learning, This authoritative LLC approach is the © Jonesstyle under & Bartlett these circumstances. Learning, Additionally, LLC given lim- NOT FORbasis ofSALE a popular OR child DISTRIBUTION feeding book by Satter (2000), who NOTited FOR time, SALE parents OR often DISTRIBUTION say that they want quality time

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORwith SALE their OR children DISTRIBUTION and they perceive that limiting junkNOT FORGiven SALE that energy-dense, OR DISTRIBUTION high-fat, high-sugar foods are foods and setting boundaries will lead to arguments and widely available in the environment, they tend to be used interfere with quality. And finally, parenting practices and as rewards, are most often offered in positive social con- child behavior are bi-directional—children also influence texts such as celebrations and holidays, are liked by other their parents’ practices.© Jones & Bartlett Learning, LLCfamily members, satisfy ©biological Jones predispositions,& Bartlett Learning, and LLC NOT FOR SALE OR DISTRIBUTIONproduce positive feelings NOTof being FOR full, SALE it is not OR surprising DISTRIBUTION that they become highly preferred by adults and children alike. On the other hand, fewer opportunities are provided for people to learn to like whole grains, fruits, and © Jones & Bartlett Learning, LLC vegetables© inJones similar & social Bartlett contexts. Learning, When such LLC oppor- NOT FOR SALE OR DISTRIBUTION tunities areNOT provided, FOR SALE children OR can DISTRIBUTION develop a liking for healthy foods such as vegetables (Anzman-Frasca et al. 2012). Practices that encourage healthful eating include making healthful foods available and easily accessible, © Jones & Bartlett Learning, LLC © Jonesoffering & Bartlett encouragement Learning, to try LLC them, setting boundaries NOT FOR SALE OR DISTRIBUTION NOT FORbut providing SALE OR choices DISTRIBUTION among them, and using strategies designed to facilitate acceptance but that are not exces- sively firm and controlling. SUMMARY OF THE INFLUENCE OF INDIVIDUAL EXPERIENCE WITH ©FOOD Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Person-Related Determinants Biologically determinedNOT behavioral FOR SALE propensities, OR DISTRIBUTION physi- NOT FOR SALE OR DISTRIBUTION ological mechanisms, and social conditioning through Biology and personal experiences with food are not the experience with food all influence people’s sensory expe- only influences on individuals’ food intake. Children rience of food and food preferences. These influences are tend to eat the foods they like and reject the foods they do summarized© Jones in &FIGURE Bartlett 2-2. WhileLearning, these LLCinfluences are not like in© Jonesterms of &taste, Bartlett smell, Learning,or texture. However, LLC as mostNOT prominent FOR in SALE children, OR they DISTRIBUTION apply to adults as well. individualsNOT become FOR older, SALE they OR also DISTRIBUTION develop perceptions,

Experience with food: Associative conditioning © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOTPhy FORsiological SALE OR DISTRIBUTION conditioning: Biologically determined • Familiarity: predispositions: learned safety • Taste/pleasure • Conditioned food • Hunger/fullness mechanisms preferences; Aversions © Jones• Sw eet,& Bartlettsour, salt, bit teLearning,r, umami • LLCConditioned satiety © Jones & Bartlett Learning, LLC • Sensory specific satiety NOT FOR• Genetics SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Social conditioning: • Social affective context • Parenting practices and styles © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Preferences/dislikes: Food choice and Taste and affective factors diet-related behaviors © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONFIGURE 2-2 Our experiences withNOT food influence FOR SALE our food choicesOR DISTRIBUTION and dietary behaviors.

9781284169010_CH02_Contento.indd 41 2019-12-16 7:09 PM 42 Chapter 2 Determinants of Food Choice and Dietary Change: Implications for Nutrition Education

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Person-relatedNOT FOR SALE OR DISTRIBUTION determinants: Intra-person Experience with food: Factors: Associative conditioning Motivational © Jones & Bartlett Learning, LLC • Beliefs about © Jones & Bartlett Learning, LLC Physiological benefits, barriers NOT FOR SALE ORconditioning: DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Attitudes Biologically determined • Familiarity: • Values predispositions: learned safety • Taste/pleasure • Conditioned food • Social and cultural • Hunger/fullness mechanisms preferences norms, roles • Sweet, sour, salt, bitter, umami • Conditioned satiety • Self-efficacy © Jones &• Sensor Bartletty specific Learning, satiety LLC © Jones & Bartlett Learning, LLC Facilitating • Genetics NOT FOR SALE OR DISTRIBUTIONSocial conditioning: • Knowledge/skillsNOT FOR SALE OR DISTRIBUTION • Social affective • Self regulation context skills • Parenting practices Inter-person factors: © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Family practices and NOT FOR SALE OR DISTRIBUTION socialNOT netwo FORrks SALE OR DISTRIBUTION

Pre©ferences/dislikes: Jones & BartlettBeliefs, Learning, attitudes, norms,LLC Food choice© Jonesand & Bartlett Learning, LLC Taste and affective factors knowledge, and skills diet-related behaviors NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION FIGURE 2-3 Intra- and interpersonal factors influence food choices and dietary behaviors.

expectations,© Jones and feelings & Bartlett about foods. Learning, These perceptions, LLC will be fattening© Jones or, in &contrast, Bartlett good Learning, for our complex LLC - attitudes, beliefs, values, emotions, and personal mean- NOT FOR SALE OR DISTRIBUTION ion. Our foodNOT choices FOR may SALE be determined OR DISTRIBUTION by the personal ings are all powerful motivators of food choice and dietary meanings we give to certain foods or practices, such as behavior, as are individuals’ interactions with others in chicken soup when we are ill or chocolate when we feel their social environment. Additionally, people’s knowl- self-indulgent. Our food- and nutrition-related behaviors edge and skills and their confidence to use these in cont ext are also determined by our attitudes toward them—for © Jonesare also& Bartlett important, Learning, particularly LLC when they want to make © Jonesexample, & ourBartlett attitudes Learning, toward breastfeeding LLC or certain NOT FORchanges SALE in their OR eatingDISTRIBUTION patterns or dietary behaviors. NOTfood FOR safety SALE practices. OR DISTRIBUTION These influences, generally referred to as determinants, are Our identity in relation to food may also influence explored below and are shown in FIGURE 2-3. They oper- our behaviors. For example, some teenagers may see ate whether people are purchasing groceries at the store, themselves as health conscious, but many others may choosing food when eating© out,Jones or making & Bartlett food at Learning, home. see themselves LLC as part of the© junk-food-eating Jones & Bartlett set. Learning,We LLC NOT FOR SALE OR DISTRIBUTIONmay see that there are healthNOT benefits FOR to SALE eating OR more DISTRIBUTION INTRAPERSONAL DETERMINANTS healthfully but may consider the barriers, such as high cost or the effort required to prepare the foods in health- Motivating Determinants: Perceptions, ful ways, just too great to take action. Or perhaps we Beliefs, ©and Jones Attitudes & Bartlett Learning, LLC lack confidence© Jones in preparing & Bartlett foods in Learning, ways that are LLC tasty Our foodNOT choices FOR and SALE dietary OR practices DISTRIBUTION are powerfully and healthful.NOT Or again,FOR weSALE may haveOR DISTRIBUTIONspecific culturally influenced by a variety of personal factors, such as our related health beliefs that influence what we eat. For exam- beliefs about what we will get from these choices. We want ple, the concepts of balance and moderation are common our foods to be tasty, convenient, affordable, filling, famil- among many cultures. Some individuals may come from © Jonesiar, or& comforting.Bartlett Learning, We may also LLC be motivated by how the © Jonescultures & where Bartlett foods Learning,are described LLC as having hot and cold NOT FORfood willSALE contribute OR DISTRIBUTION to how we look, such as whether it NOTqualities FOR andSALE must OR be DISTRIBUTIONeaten in such a way as to balance

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORcold SALE and hotOR body DISTRIBUTION conditions. These cultural beliefs canNOT FORexpectations, SALE ORor emotions, DISTRIBUTION and together these filters deter- have a major influence on food choices. mine what actions we will take. For example, we may pro- We come to value some aspects of food over others. cess the idea of eating more fruits and vegetables in terms In the United States, the major values in choosing foods of taste, convenience, expected benefits, perceived barriers, are taste, cost convenience,© Jones (Food & Bartlett Marketing Learning, Institute LLCor what our friends and relatives© Jones do, in & addition Bartlett to ourLearning, con- LLC 2012; IFIC 2019). In Europe,NOT FOR the major SALE values OR are DISTRIBUTION quality, cerns about getting cancer.NOT Consequently, FOR SALE our OR decisions DISTRIBUTION nutritional value, price, and family/communal preferences about whether to eat more fruits and vegetables to reduce (Rozin et al. 2011). cancer risk are based on our beliefs and knowledge about Our food choices may also reflect larger, more global expected consequences (of eating fruits and vegetables), values,© Jonessuch as &sense Bartlett of accomplishment, Learning, LLC pleasure and our motivations© Jones and & values Bartlett about Learning, desired consequences LLC enjoymentNOT FORin life, SALE independent OR DISTRIBUTION and creative thought, (reduced NOTrisk of FOR cancer), SALE and ourOR personal DISTRIBUTION meanings and power or social status, concern for the welfare of all peo- values (with respect to developing cancer). ple and nature, safety and security, and so forth (Rokeach 1973; Schwartz 1992). These more global values may exert Balancing Motivations and Trade-Offs © Jones &their Bartlett influence Learning, on dietary LLC choices by influencing ©the Jones In the & Bartlettfood choice Learning, process, most LLC times, we will also need NOT FORmore SALE immediate OR DISTRIBUTION values such as desired outcomes fromNOT FORto make SALE trade-offs OR DISTRIBUTIONamong various determinants or reasons these practices (Botonowski and Konstadonos, 2010; for food choice, such as trade-offs among health consid- Arbit et al. 2017). erations, taste, time to prepare food, family norms, and Food rejections are also highly influenced by psycho- cultural expectations. For example, the primary family logical processes, based on both previous experience and © Jones & Bartlett Learning, LLCfood preparer who works© full Jones time outside & Bartlett the home Learning, and LLC beliefs. Rozin and Fallon (1987) place the motivations for NOT FOR SALE OR DISTRIBUTIONhas very little time may decideNOT that FOR the SALEuse of convenience OR DISTRIBUTION rejecting foods into three main categories: (1) sensory- foods in preparing meals means that at least the family affective beliefs (e.g., the food will smell or taste bad) that can eat dinner together. People may also trade off between lead to distaste; (2) anticipated consequences or beliefs items within a meal or between meals. For example, indi- about the possible harmful outcomes of eating certain viduals may choose an item for its fillingness (e.g., a donut) © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC foods (e.g., vomiting, disease, social disapproval), lead- but then balance it with something perceived as more NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ing to danger; and (3) ideation or ideas about the origin healthful (e.g., orange juice). Individuals may prepare or or nature of foods, leading to disgust (e.g., eating insects). choose a “healthy” dinner to balance what they consider Knowledge regarding all these numerous person- to have been a less-than-healthful lunch (Contento et al. related factors is crucial for nutrition educators so that we 2006). © Jones &can Bartlett better understand Learning, and LLCassist our audiences to eat more© Jones & Bartlett Learning, LLC NOT FORhealthfully. SALE OR Indeed, DISTRIBUTION the next three chapters are devotedNOT to FORSocial, SALE Cultural, OR DISTRIBUTIONand Religious Norms the findings from the field of psychology to help us under- Humans are social creatures. We all live in a social and stand these person-related influences on eating behav- cultural context and experience society-wide social norms ior and how we can use such understandings in nutrition and cultural expectations, which can be extraordinarily education. © Jones & Bartlett Learning, LLCpowerful. We feel compelled© Jones to subscribe & Bartlett to these Learning, norms LLC NOT FOR SALE OR DISTRIBUTIONand expectations to varyingNOT degrees. FOR For SALE example, OR teenag DISTRIBUTION- The Process of Choosing Foods ers may feel pressure to eat less-nutritious fast food items Our food choices are based on an interaction of our in a choice situation with peers (e.g., after school), or indi- thoughts and feelings with what we experience in the envi- viduals may experience family members’ expectations that ronment.© Jones For example, & Bartlett we may Learning, see a news storyLLC on the role they will© eat Jones in a certain & Bartlett way. Whether Learning, to breastfeed LLC may of fruitsNOT and FOR vegetables SALE in ORreducing DISTRIBUTION cancer risk, or a friend be influencedNOT very FOR much SALE by the OR desires DISTRIBUTION of a woman’s family of ours develops colon cancer (external stimuli). We pro- or her husband’s family, depending on the culture. Being cess such environmental stimuli or external events both “large” has positive value in some societies. In the United cognitively and emotionally. These stimuli are filtered States, there is a saying: “you can never be too rich or too © Jones &through Bartlett a host Learning, of internal LLC personal reactions of the kind© Jones thin,” & especiallyBartlett Learning,when it comes LLC to women. But in some NOT FORlisted SALE previously, OR DISTRIBUTION such as our perceptions, beliefs, values,NOT FORsocieties, SALE “people OR shareDISTRIBUTION goods, so no one is too rich, and

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORfriends SALE share ORfood, DISTRIBUTION so no one is too thin” (Sobo 1997). NOTamong FOR individuals SALE OR (Israel DISTRIBUTION and Rounds 1987). These net- Indeed, weight gain, good appetite, and large stature are works involve family, peers, coworkers, and those in com- signs of good health, good social relations, generosity, and munities and various organizations to which we belong many friends. Conversely, weight loss, a small appetite, and and influence what we eat (Wang et al. 2011). For exam- thinness are considered signs© Jones of poor & health, Bartlett poor Learning, social ple, LLC in one study, food choices© were Jones 94% &similar Bartlett between Learning, LLC relations, lack of friends, andNOT meanness FOR SALE (the person OR did DISTRIBUTION not spouses, 76–87% similar betweenNOT adolescentsFOR SALE and OR their DISTRIBUTION share food when the person had it and so now the person parents and 19% similar between adolescents and their has no friends to share food with him or her) (Rittenbaugh peers (Feunekes et al. 1998). Food choices and eating pat- 1982; Sobo 1997). terns are also influenced by the need to negotiate with Our perceptions© Jones & of Bartlett our status Learning, and roles in LLC our com- others in the© family Jones about & Bartlett what to buy Learning, or eat (Connors LLC munities NOTare also FOR important. SALE ORThe DISTRIBUTIONfood choices and eat- et al. 2001; ContentoNOT FOR et al. SALE 2006, Larsen OR DISTRIBUTION et al. 2015). Rela- ing patterns of celebrities create social expectations for us tionships with peers and those with whom we work also all. What others in our community think are appropriate have an impact on our day-to-day choices (Devine et al. foods to eat in various situations may also create social 2003). © Jonespressures. & Bartlett Thus, ourLearning, choice of LLCfoods may be heavily influ- © JonesIndeed, & Bartlett eating contexts Learning, and the LLC management of social NOT FORenced SALE by our perceptionsOR DISTRIBUTION of the social and cultural expec- NOTrelationships FOR SALE in these OR numerous DISTRIBUTION contexts play a major role tations of those around us. in what people eat (Furst el al. 1996). For example, if a mother thinks it would be good for the whole family to Facilitating Determinants: Knowledge and Skills reduce or eliminate sweetened beverages at meals, she may find resistance from her family who think of this as a meal People’s nutrition literacy© or Jones food-related & Bartlett knowledge Learning, and LLC © Jones & Bartlett Learning, LLC ritual or cultural tradition. Or the teenage daughter who skills also influence what NOTthey eat. FOR For example,SALE OR a national DISTRIBUTION NOT FOR SALE OR DISTRIBUTION has decided to become a vegetarian may have special food survey found that about one-third of individuals thought requests and the family needs to decide whether to accom- that the recommended number of servings of fruit and modate the requests. vegetables per day was two or three, and only about 20% In addition to the impact of needing to manage social thought it was five (National Cancer Institute 2007). Many © Jones & Bartlett Learning, LLC relationships© within Jones social & Bartlett networks, Learning, social support LLC for consumers have difficulty judging the amounts of fat and NOT FOR SALE OR DISTRIBUTION healthy eatingNOT is also FOR important, SALE especially OR DISTRIBUTION for those with number of calories in many common foods and in their long-term health conditions such as hypertension or dia- own diets or knowing what an appropriate serving size betes where following special eating patterns has to be should be (Brug et al. 1997; Chandon and Wansink 2007). maintained indefinitely (Rosland et al. 2008). They may not be familiar with the recommendations of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC national dietary guidelines or how to apply the guide- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION lines to choosing healthful diets. Health claims on product labels are hard to evaluate and the symbols used by Social and Environmental different companies to indicate food ingredients in the Determinants package, such as fiber or sugar, are hard to decode. They © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC are confused about how to achieve a healthy weight. In Social and environmental factors are powerful influences NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION particular, given so much misinformation from a wide on food choice and nutrition-related behaviors and must be variety of sources, particularly online and in the lay press, considered by nutrition educators in planning programs. they often have misguided eating patterns. Then of course, lack of skills in preparing healthful foods also influences FOOD ENVIRONMENT what individuals© Jones eat. & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Foods availableNOT in anyFOR region SALE were OR traditionally DISTRIBUTION a product of its geography and ecology, history, and cultural tradi- INTERPERSONAL DETERMINANTS tions and they still generally form a basis of its staple foods. Within societies, we all participate in a network of social However, there has been considerable globalization of the © Jonesrelationships, & Bartlett the Learning, extensiveness LLC and density of which vary © Jonesfood system, & Bartlett including Learning, technological LLC advancement in the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORprocessing SALE OR of foods,DISTRIBUTION affecting food availability, accessiNOT- FORfoods. SALE However, OR some DISTRIBUTION 57% of the food products are now bility, convenience, and quality. The traditional foods in the ultra-processed category in the United States with often sit alongside the global. Nutrition educators need to rapid increases in many other countries (Martinez Steele be aware of these forces as they work with many diverse et al. 2017; Mont eiro et al. 2013). These are often of low populations. © Jones & Bartlett Learning, LLCquality, being high in fat,© salt, Jones and sugar & Bartlett and often Learning, lack- LLC NOT FOR SALE OR DISTRIBUTIONing in desirable nutrientsNOT and may FOR have SALE a high OR ecological DISTRIBUTION Food Availability, Accessibility, and Quality footprint to produce and market. Food availability may be described as the physical presence of sufficient quantities of food that are present in Markets the food© Jones system through& Bartlett domestic Learning, production LLC or imports, Studies have© Jones shown that& Bartlett the availability Learning, of more LLC healthful includingNOT food FOR aid. SALE Food accessibilityOR DISTRIBUTION refers to the access options inNOT neighborhood FOR SALE grocery OR stores, DISTRIBUTION such as fruits and by individuals to adequate resources for acquiring vegetables or low-fat milk, is correlated with these foods appropriate foods for a nutritious diet. Accessibility also being more available in homes, which, in turn, is related is dependent on where sources of food are physically to a higher quality of people’s food choices and intakes © Jones &located. Bartlett Supermarkets, Learning, where LLC a wide range of foods© is Jones (Morland, & Bartlett Wing, Learning, and Diez Roux LLC 2002; Powell et al. 2007; NOT FORavailable, SALE OR may DISTRIBUTION require transportation to reach, limitingNOT FORBoone-Heinonen SALE OR etDISTRIBUTION al. 2011). Thus, what is available in the the accessibility of food for many people, such as older community influences what is purchased and consumed. people who are no longer able to drive or lower-income Many neighborhoods with low resources and people of people without cars. The types of foods that are readily color have fewer supermarket chains that have a wider available in the local ©grocery Jones stores, & Bartlett small corner Learning, stores, LLCrange of foods with higher© Jones quality &and Bartlett cheaper Learning, prices. LLC and restaurants withinNOT a given FOR community SALE OR depend DISTRIBUTION on These are often termed “foodNOT deserts” FOR SALEto describe OR the DISTRIBUTION lack potential profits, consumer demand, and adequate stor- of healthy foods at affordable prices in neighborhoods (Ver age and refrigeration facilities. The foods served or prod- Ploeg et al. 2009; United States Department of Agriculture ucts stocked thus tend to be those that sell well, which [USDA] 2017). Just as important, and maybe more so, is are not always the most nutritious. Farmers’ markets pro- © Jones & Bartlett Learning, LLC the notion© ofJones “food swamps”& Bartlett or the Learning, overabundance LLC of fast vide fresh, local foods but may require transportation to NOT FOR SALE OR DISTRIBUTION food andNOT less healthy FOR SALEfoods in OR neighborhoods DISTRIBUTION (Rose et al. reach and are often only seasonal. Hence, some foods 2009; Boone-Heinonen et al. 2011; Cooksey-Stowers et al. that are very important for health, such as fruits and 2017). Certainly, youth report this as a major temptation to vegetables, may not be readily accessible or are available eat high-calorie food products and beverages and a barrier only at a higher cost. Food convenience may be thought to healthful eating (Mallya et al. 2012, Burgermaster et al. © Jones &of Bartlettas more immediate Learning, accessibility—whether LLC the food© Jones & Bartlett Learning, LLC 2018, Koch et al. 2019). NOT FORrequires SALE littleOR DISTRIBUTIONor no cooking and is packaged in a conNOT- FOR SALE OR DISTRIBUTION venient way, and whether it can be stored for some time Workplaces, Schools, and Homes without spoilage. Food quality has many meanings, such as the characteristics of food that is acceptable to con- Foods available at or near workplaces also tend to be those sumers. This includes© suchJones external & Bartlett factors Learning,as appear- LLCthat are convenient, low in© cost, Jones and popular. & Bartlett In the Learning, United LLC ance, texture, and flavorNOT andFOR internal SALE factors OR DISTRIBUTION such as States, the National SchoolNOT Lunch FOR Program SALE provides OR DISTRIBUTIONmeals safety. It can also refer to whether the foods were pro- that conform to federal guidelines that specify nutritional duced in an environmentally sustainable manner and are standards. Participation in the program declines with age wholesome (Gussow 2006). Availability and accessibility so that by high school, two-thirds of students obtain their of such© Jonesfoods influences & Bartlett the qualityLearning, and healthfulness LLC of lunch from© Jones other sources. & Bartlett The majority Learning, of foods LLC in these the overallNOT FOR diet. InSALE high-income OR DISTRIBUTION countries and increas- other venuesNOT have FOR been SALE found OR to DISTRIBUTIONbe high-fat and high- ingly in many others, foods and processed food prod- sugar items, including snack chips, candy, and soft drinks. ucts are available in an ever-widening array of choices. In some countries, commercial vendors provide meals for Technology has improved the packaging and distribution purchase at school. What is available around school envi- © Jones &and Bartlett thus the cleanliness,Learning, safety, LLC and convenience of many© Jones ronments & Bartlett may also Learning, affect the dietary LLC behaviors of children NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR(Briefel SALE et al. 2009; OR DISTRIBUTIONSmith et al. 2013; Williams et al. 2014). NOT FOR SALE OR DISTRIBUTION Within the home, accessibility means that clean and safe water is easy to reach, a vegetable is not just available in the refrigerator but is already cut up and ready to eat, or fruit has been washed and© is Jonessitting on & a Bartletttable, ready Learning, to eat. LLC © Jones & Bartlett Learning, LLC The limited accessibility ofNOT healthful, FOR convenientSALE OR foods DISTRIBUTION in NOT FOR SALE OR DISTRIBUTION many settings may narrow good choices and make it difficult to eat healthfully.

Social and© Jones Cultural & EnvironmentBartlett Learning, LLC © Jones & Bartlett Learning, LLC Social environmentsNOT FOR SALEand cultural OR DISTRIBUTION contexts are no less NOT FOR SALE OR DISTRIBUTION important than the physical environment. Social influences and cultural practices all influence food choice and Most eating occurs in social settings. dietary behavior (Rozin 1996). © Monkey Business Images/Shutterstock. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORSocial SALE Settings OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Most eating occurs in the presence of other people. The different practices. For example, for those from the Amer- effect can be positive or negative in terms of healthful eat- ican South, a home-style meal may be chicken-fried steak, ing, in part because family and friends serve as models mashed potatoes, corn bread, and bacon- and onion-laden as well as sources of peer© pressure. Jones For & Bartlettexample, Learning,there is green LLC beans, with pie for dessert,© Jones whereas & thoseBartlett who Learning,live LLC evidence that eating withNOT others FOR can leadSALE to eating OR DISTRIBUTION more in Texas may expect to eat barbecueNOT FOR or Tex-MexSALE OR foods DISTRIBUTION food compared with eating alone, especially when the oth- that are hot and spicy. Those who have immigrated from ers are familiar people (de Castro 2000; Salvy et al. 2009). different countries from around the world maintain some Spending more time at a meal, eating with others also of their cultural practices in varying degrees, chief among increases© intake. Jones Eating & Bartlett with others Learning, can result inLLC pressure them traditions© Jones that influence & Bartlett eating Learning, patterns. Religious LLC to eat higher-fatNOT FOR foods. SALE On the OR other DISTRIBUTION hand, eating with practices alsoNOT influence FOR what SALE is eaten. OR DISTRIBUTION others can also result in pressure to try new foods that Cultural rules often specify which foods are con- are healthy (MacIntosh 1996). Parents’ own eating pat- sidered acceptable and preferable, and the amount and terns likely influence those of their children (Patrick and combination of various categories of foods that are appro- © JonesNicklas, & Bartlett 2005; Contento Learning, et al. 2006), LLC and it has been shown © Jonespriate for & various Bartlett occasions. Learning, The cultural LLC practices of family and friends, especially at times of special celebrations NOT FORthat children SALE ORand adolescentsDISTRIBUTION who eat with their families NOT FOR SALE OR DISTRIBUTION most days each week have better-quality diets than those and holidays, provide occasions to eat culturally or ethni- who eat with their families less frequently (Gillman et al. cally determined foods and reinforce the importance of 2000; Berge et al. 2013). these foods. If dietary recommendations based on health © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Cultural Practices and FamilyNOT of FOROrigin SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Culture has been described as the knowledge, traditions, beliefs, values, and behavioral patterns that are developed, learned, shared, and transmitted by members of a group. It is a worldview© Jones that & a Bartlett group shares, Learning, and hence, LLC it influ- © Jones & Bartlett Learning, LLC ences perceptionsNOT FOR about SALE food OR and DISTRIBUTIONhealth. Cultural prac- NOT FOR SALE OR DISTRIBUTION tices and family of origin have an important impact on food choices and eating practices, even in modern, mul- tiethnic societies where many different types of cuisine This child was asked to draw a picture of her family eating their © Jonesare available& Bartlett (Satia-Abouta Learning, et al. LLC 2002; Kittler et al. 2017). © Jonesfavorite meal & Bartletttogether. Learning, LLC NOT FORThose SALE from differentOR DISTRIBUTION regions of the country may have NOTCourtesy FOR of CookingSALE with OR Kids. DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORconsiderations SALE OR DISTRIBUTIONconflict with family, cultural, and religiousNOT FOR(USDA SALE 2018). OR Compared DISTRIBUTION with other economic variables, traditions, individuals who want to make dietary changes income has the strongest marginal impact (i.e., additional may find themselves having to think about and integrate effect) on dietary behavior: those with higher incomes eat their cultural expectations with their concern about their a higher-quality diet (Macino, Lin, and Ballenger 2004). personal health. All of© these Jones considerations & Bartlett influence Learning, indi- LLCOther material resources ©also Jones influence & Bartlettdiet—those Learning, below LLC viduals’ willingness andNOT ability FOR to SALEmake changes OR DISTRIBUTION in their certain poverty levels in manyNOT countriesFOR SALE qualify OR for DISTRIBUTION gov- diets. These beliefs and practices must be carefully under- ernment assistance—such as free or reduced-price meals stood so that nutrition educators can become culturally for children at school, food coupons in some form, or competent and can design culturally sensitive nutrition direct cash aid (U.S. Department of Labor 2012). These education© Jones programs. & Bartlett Learning, LLC may improve© Jones the quality & Bartlett of diets. Learning, LLC NOT FOR SALE OR DISTRIBUTION In thisNOT context, FOR statistics SALE ORshow DISTRIBUTION that about 12.3% of Social Structures and Policy American households are food insecure, meaning that Society has been described as a group of people interact- they have limited or uncertain availability of nutrition- ing in a common territory who have shared institutions, ally adequate and safe foods or limited or uncertain abil- © Jones &characteristic Bartlett Learning, relationships, LLC and a common culture. The© Jones ity to & acquire Bartlett acceptable Learning, foods LLCin socially acceptable ways. NOT FORorganizations SALE OR toDISTRIBUTION which we belong within a society can haveNOT FORWithin SALE this category, OR DISTRIBUTION about 4.9% are very food insecure a profound effect on our eating patterns. Some are volun- (USDA 2016). tary organizations, such as religious, social, or community organizations; others include schools, our places of work, Price Economic theory assumes that relative differences in prices and professional associations© Jones to & which Bartlett we belong.Learning, The LLC © Jones & Bartlett Learning, LLC can partially explain differences among individuals in influence of these organizationsNOT FOR comes SALE from OR their DISTRIBUTION social NOT FOR SALE OR DISTRIBUTION norms as well as their policies and practices. Local, state, terms of their food choices and dietary behaviors. The price and national government policy can govern and deter- of food as purchased is usually per item, by unit weight, or mine the availability and accessibility of opportunities for by volume. However, price can also be considered in terms healthy eating and active living. of the amount of food energy obtained per dollar. Processed © Jones & Bartlett Learning, LLC foods with© addedJones fats & andBartlett sugar areLearning, cheaper to LLC manufac- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ECONOMIC ENVIRONMENT ture, transport, and store than are perishable meats, dairy products, and fresh produce. This is partly because sugar Many factors in the economic environment influence food and fat on their own are both very inexpensive, which is choices and dietary practices, among them the price of in part a result of government agricultural policies. A diet © Jones &food, Bartlett income, Learning, time, and formal LLC education. Nutrition edu© -Jonesmade & upBartlett of refined Learning, grains and LLCprocessed foods with added NOT FORcators SALE must OR consider DISTRIBUTION these factors when designing nutriNOT- FORsugar SALEand fats ORcan beDISTRIBUTION quite inexpensive. Beans are also inex- tion education programs. pensive but animal protein sources may cost 5 to 10 times more per calorie, and fruits and vegetables (except potatoes Resources and bananas) can cost some 50 to 100 times more per calo- People in the United ©States Jones and &United Bartlett Kingdom Learning, spend LLCrie than high-fat, high-sugar,© Jonesmass-produced & Bartlett food products Learning, LLC only about 8–10% of theirNOT income FOR on SALE food, comparedOR DISTRIBUTION with (Drewnowski 2012). Not surprisingly,NOT FOR low-income SALE OR individ DISTRIBUTION- 15% in Europe and Japan, 35% in middle-income coun- uals eat fewer fruits and vegetables. tries, and 45–50% in low-income countries (USDA 2018; Washington State Magazine 2018). However, this is an aver- Time Use age. The© Jones amount & of Bartlett money spent Learning, on food dependsLLC on the Surveys and© Jones time-use & diaries Bartlett show Learning, that the amount LLC of time incomeNOT level FOR within SALE a country. OR DISTRIBUTIONUpper-income individuals people spendNOT on FOR food-related SALE activityOR DISTRIBUTION in the home depends in the United States spend more money on food, but it is on many factors, including whether men or women are a smaller proportion of their income—about 8%. Lower- employed outside the home and whether they have chil- income households economize by buying discounted dren (Robinson and Godbey 1999). In the United States, © Jones &items Bartlett and generic Learning, brands LLC and thus spend less on food;© Jones about & 70%Bartlett of women Learning, and 45% LLCof men are engaged in food NOT FORdespite SALE this, OR food DISTRIBUTION accounts for 30–35% of their incomeNOT FORpreparation SALE and OR cleanup DISTRIBUTION activities each day and of those

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOTroutes. FOR Time SALE spent OR on DISTRIBUTIONthese various media is high: children aged 2–4 years are exposed to about 4 hours per day of various media. This increases to 8 hours per day in middle school. Teens spend an average of 27 hours a © Jones & Bartlett Learning,week LLC online, much of it on social© Jones media. The& Bartlett average adult Learning, LLC NOT FOR SALE OR DISTRIBUTIONspends about 10 hours a day onNOT screen FOR time, SALE 1.2 hours OR onDISTRIBUTION radio and only 0.2 hours with print. With multitasking, there is some overlap of media use (eMarketer 2017). About 30% of time online is spent on social media. TV is still © Jones & Bartlett Learning, LLC important with© Jonespeople spending & Bartlett about Learning, 4 ½ hours perLLC day NOT FOR SALE OR DISTRIBUTION on TV. TheseNOT media FOR are the SALE main OR source DISTRIBUTION of information about food and nutrition for many people, making

Consumers are inundated with food choices at the supermarket. them collectively a major source of informal nutrition education—and a good deal of misinformation. These © Joni Hanebutt/Shutterstock © Jones & Bartlett Learning, LLC © Jonesmedia are & supportedBartlett almostLearning, entirely LLC by advertising, so they NOT FORwho do,SALE women OR spend DISTRIBUTION an average of 8 hours per week NOTare FOR a major SALE source OR of persuasive DISTRIBUTION information as well. It also and men 5 hours in these activities (U.S. Department of means that there is very little time left for physical activity. Labor 2018). Advertising and Priming Time is scarce for all households, regardless of income. The media have demonstrated a powerful capacity to per- Many people with whom nutrition© Jones educators & Bartlett work today Learning, say LLC © Jones & Bartlett Learning, LLC suade. Today advertising occurs in a variety of venues such they are too busy to prepareNOT healthful FOR foods SALE or to OR cook DISTRIBUTION at all. NOT FOR SALE OR DISTRIBUTION This is particularly true of low-income families who often as magazines, the Internet, social media, and video games work long hours. For some households, time constraints as well as television. The U.S. food industry spends close may limit personal investments in healthier behaviors. to $10 billion per year on food marketing and advertising For example, it has been found that men and women who (Federal Trade Commission [FTC] 2012), with $1.8 billion © Jones & Bartlett Learning, LLC aimed at children.© Jones Most &of thisBartlett is spent Learning, by companies LLC that are marriedNOT with FOR children SALE have OR a higher-quality DISTRIBUTION diet than NOT FOR SALE OR DISTRIBUTION single parents, probably because they can share child care produce high-fat and high-sugar products that are highly duties and thus are better able to attend to their own health processed and packaged; examples include $800 million (Macino, Lin, and Ballenger 2004). Nutrition educators need for snack foods, $3.5 billion for beverages, and more than to consider these time constraints in the development of $3 billion for restaurants/fast foods (FTC 2012). These fig- © Jonesnutrition & Bartlett education Learning, interventions. LLC However, it should be © Jonesures probably & Bartlett do not include Learning, all the LLCadvertisements through NOT FORnoted SALEthat Americans OR DISTRIBUTION often spend an average of 20 hours per NOTvarious FOR digital SALE devices. OR FoodDISTRIBUTION advertising is strong in Europe week watching television and another 5 hours per week on and other countries as well (World Health Organization computer use for leisure (U.S. Department of Labor 2018). 2013). Information on the impact of marketing on sales of food products is not easily available because it is considered INFORMATION ENVIRONMENT© Jones & Bartlett Learning,proprietary LLC information. However,© Jones there &is Bartlettevidence thatLearning, LLC NOT FOR SALE OR DISTRIBUTIONthese marketing activities influenceNOT FOR food SALEchoices OR(Story DISTRIBUTION Knowing the information context of the audience is and French 2004; Institute of Medicine 2006). For example, important for nutrition educators to design messages and advertising has an impact through its priming effect. That programs that are appropriate (see BOX 2-1). is, it triggers automatic responses to advertised food. One © Jones & Bartlett Learning, LLC study found that© Jones children & ate Bartlett 45% more Learning, after a cartoon LLC that Media NOT FOR SALE OR DISTRIBUTION contained foodNOT and FOR adults SALE ate more OR of DISTRIBUTIONboth healthful and The current media-saturated environment has undergone unhealthful snack foods after exposure to advertising (Har- revolutionary changes in the past 2 decades, resulting in ris et al. 2009). Another study found similar effects and that the availability to individuals and households of numer- the effects were magnified when individuals are cognitively © Jonesous &television Bartlett channels, Learning, radio LLC stations, websites, social © Jonesoccupied & by Bartlett other tasks Learning, (Zimmerman LLC and Shimoga 2014). NOT FORmedia SALE platforms, OR DISTRIBUTIONand other emerging communication NOTThe FOR ubiquity SALE of advertising, OR DISTRIBUTION together with the amount of

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Food-related© Jones &Determinants: Bartlett Learning, Biology and LLC Experience Social and© EnvironmentalJones & Bartlett Determinants Learning, LLC NOT77 FOR SALE OR DISTRIBUTION 77 NOT FOR SALE OR DISTRIBUTION

77 77 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE77 OR DISTRIBUTION NOT FOR77 SALE OR DISTRIBUTION

77 77 Person-related Determinants© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 7 7 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 77

77 77 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 77 77 77 77 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE77 OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION time people view various media and are exposed to marketing, makes these influences considerable. Priming occurs in other ways as well: the very sight of food ©can Jones trigger & eating. Bartlett Food Learning, is now present LLC in pharma- © Jones & Bartlett Learning, LLC cies, NOTgasoline FOR stations, SALE hardware OR DISTRIBUTION stores, bookstores, and so NOT FOR SALE OR DISTRIBUTION forth, where its very presence triggers eating (Farley et al. 2009). Evidence suggests that such priming makes much of eating automatic (Cohen et al. 2008). The environmental © Jones &influences Bartlett on Learning, food choice LLCand dietary behavior are sum© -Jones & Bartlett Learning, LLC NOT FORmarized SALE in OR FIGURE DISTRIBUTION 2-4. NOT FOR SALE OR DISTRIBUTION

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Person-related Food determinants: environment Intra-person ©Experience Jones with& Bartlett food: Learning, LLC • Food availability/ © Jones & Bartlett Learning, LLC factors: accessibility/ Associative conditioning Motivational NOT FOR SALE OR DISTRIBUTION quality NOT FOR SALE OR DISTRIBUTION • Beliefs • Attitudes Physiological • Motivations Social/cultural Conditioning: • Food meanings environment: Biologically determined • Familiarity: • Values predispositions: • Social settings © Jones & Bartlett Learning, learned LLC safety • Cultural and social© Jones• Cultural & Bartlett practices/ Learning, LLC • Taste/pleasure • Conditioned food norms traditions NOT• Hunger/fullness FOR SALE mechanisms OR DISTRIBUTION preferences • Self-identity NOT FOR• Social SALE structures/ OR DISTRIBUTION • Sweet, sour, salt, bitter, umami • Conditioned satiety policy • Sensory specific satiety Facilitating • Genetics Social conditioning: • Knowledge/skills Economic • Social affective • Self efficacy and environment context self-direction • Resources © Jones & Bartlett Learning, LLC • Parenting © Jones skills & Bartlett• PrLearning,ice LLC practices and • Time NOT FOR SALE OR DISTRIBUTION styles Inter-personNOT FOR SALE OR DISTRIBUTION factors: • Family practices and Informational social networks Environment • Media • Advertising © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Preferences/dislikes: Beliefs, attitudes, norms, Social environmental Food choice and Taste and affective factors knowledge, and skills influences diet-related behaviors

FIGURE© Jones 2-4 Social& Bartlett and environmental Learning, factors LLCinfluence food choices and dietary© behaviors. Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

What Does All This Mean this information to conduct assessments of our audiences © Jones & Bartlett Learning, LLC © Jonesas shown & inBartlett Box 2-1. Learning, The information LLC can also be used NOT FORfor NutritionSALE OR DISTRIBUTION Educators? NOTin theFOR development SALE OR of DISTRIBUTION nutrition education programs, as It is important for nutrition educators to realize that many described below. factors influence eating behavior and that nutrition education needs to develop strategies to address these influ- KNOWLEDGE OR NUTRITION ences, generally referred to© as Jones modifiable & Bartlett determinants Learning, of LITERACY LLC IS NOT ENOUGH© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION behavior. Knowledge is needed for people to be able to make wise In Figure 2-4, a series of concentric circles schemati- choices and to take action. But Figure 2-4 shows us that cally represents the ways in which biological, experiential, knowledge is only one of many, many influences on, or motivating and facilitating personal determinants, and determinants of, food choice and diet-related behaviors. social and© Jonesenvironmental & Bartlett determinants Learning, influence LLC food Additionally,© Jones consumers & Bartlett in the Learning,United States LLC often choice andNOT diet-related FOR SALE practices. OR DISTRIBUTIONNo factor is indepen- say they alreadyNOT know FOR enough. SALE ORFor example,DISTRIBUTION one sur- dent of any other; rather, they are all related, each larger vey found that 7 of 10 consumers said their diet needed circle encompassing the influences of the smaller circles. some improvement. Guilt, worry, fear, helplessness, These concentric circles reflect levels of influence or over- and anger were the primary emotions expressed about © Joneslapping & Bartlett spheres of Learning, influence. NutritionLLC educators can use © Jonestheir diets. However, & Bartlett Learning, they said they LLC knew enough about NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORnutrition: SALE OR “Don’t DISTRIBUTION tell us more” (IFIC, 1999). AnotherNOT FOReating, SALE such ORas making DISTRIBUTION healthful foods available and survey found that about 23% said they actively seek out easily accessible, modeling the desired behavior, serv- healthy foods when grocery shopping and another 56% ing age-appropriate serving sizes, providing health- said they did not seek out healthy foods but just tried ful options and allowing the child to choose among to eat healthy in general,© Jones and the & Bartlettrest said healthLearning, ben- LLCthem, encouraging children© Jones to taste & theBartlett desired Learning, foods, LLC efits were not a factorNOT in their FOR food SALE choices OR (IFIC, DISTRIBUTION 2019). using rewards appropriatelyNOT soFOR children SALE can OR acquire DISTRIBUTION Clearly, although many Americans say their diets need preferences for healthful food, moderately restricting improvement, a majority are not actively interested unhealthful snack foods, using teachable moments, in making changes. Thus, many other factors besides and giving flexible responses to individual differences knowledge© Jones must & Bartlettinfluence Learning,or determine LLC their food shown by© children. Jones & Most Bartlett of these Learning, practices LLCwork with choicesNOT and FOR diet-related SALE ORbehaviors. DISTRIBUTION To be successful, adults asNOT well. FOR SALE OR DISTRIBUTION nutrition education also must address these other determinants, which are discussed below in terms of motivat- NUTRITION EDUCATION ADDRESSING ing and facilitating factors within the three categories of PERSON-RELATED MOTIVATING AND © Jones &food-related Bartlett determinants;Learning, LLC person-related determinants;© Jones FACILITATING & Bartlett DETERMINANTS Learning, LLC and social and environmental determinants. NOT FOR SALE OR DISTRIBUTION NOT FORAlthough SALE biological OR DISTRIBUTION mechanisms and food-related experiences influence eating behaviors directly, psychological NUTRITION EDUCATION ADDRESSING processes can be perhaps even more powerful. Individuals FOOD-RELATED MOTIVATING AND develop attitudes toward foods, values, feelings, beliefs, FACILITATING DETERMINANTS © Jones & Bartlett Learning, LLCand personal meanings, and© Jones these personal & Bartlett determinants Learning, LLC Addressing food-relatedNOT determinants FOR SALE is veryOR importantDISTRIBUTION also influence food choicesNOT and FOR eating SALE patterns. OR In DISTRIBUTION fact, in nutrition education. Food is a powerful primary rein- it is clear that such factors play a central role as motivat- forcer that produces instant gratification in taste and a ing determinants of food-related behaviors. As Epictetus sense of satisfaction and fullness. Because taste or pref- said many hundreds of years ago, “We are troubled not erence© isJones also shaped & Bartlett by repeated Learning, experience LLC with foods so much© by Jones events themselves& Bartlett but Learning, by the views LLC we take and NOTeating, FOR nutrition SALE educators OR DISTRIBUTION working with any age of them.”NOT (Epictetus FOR SALE108). This OR is DISTRIBUTION good news for nutri- group can enhance motivation by creating opportunities tion educators because these perceptions, attitudes, and to offer nutritious and healthy foods such as fruits and beliefs are to some extent modifiable using the under- vegetables frequently in a positive social-affective context standings from the field of psychology—in particular, © Jones &so Bartlettthat individuals Learning, will comeLLC to like nutritious foods.© Jones social & Bartlettpsychology—and Learning, the methodsLLC from the field of NOT FORCooking SALE ORand gardeningDISTRIBUTION experiences can be particularlyNOT FOReducation. SALE Here OR the DISTRIBUTION function of nutrition education is to helpful strategies for both motivating and facilitating enhance individuals’ motivations by understanding why change because they provide opportunities for people to to take action or make changes. become familiar with and enjoy healthful foods and to Once individuals are motivated as to why to make learn how to make healthy foods taste good. Similarly, changes, the function of nutrition education is to facili- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC interventions to decrease the intake of food components tate change by providing the food and nutrition knowl- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION such as fat or salt should help people adopt eating plans edge and skills and behavior-related self-efficacy and that include foods naturally low in these components for self-direction skills they need for how to make changes. a long enough time that people can become used to them Nutrition educators can also build on understandings and come to like them. Indeed, in a long-term nutrition from social psychology about family dynamics and social education© Jones intervention & Bartlett with women,Learning, those LLC who were able networks© to Jones enhance & Bartlettsocial support Learning, for participants LLC as to stayNOT with FOR a low-fat SALE diet OR for 2DISTRIBUTION years or more were those they seekNOT to make FOR the SALE dietary OR changes DISTRIBUTION they have chosen. who came to dislike the taste of fat (Bowen et al. 1994). The next three chapters explore in detail the psychological As nutrition educators, we can also work with fami- foundation for understanding these perceptions, attitudes lies and caregivers in preschool and school settings to and social support factors and thus are not described in © Jones &assist Bartlett them toLearning, adopt practices LLC that encourage healthful© Jones detail & here.Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORNUTRITION SALE EDUCATIONOR DISTRIBUTION ADDRESSING SOCIAL NOTas whereFOR SALEthe foods OR are DISTRIBUTION placed or how they look in vari- AND ENVIRONMENTAL DETERMINANTS ous venues can have a major effect on the food selected and the amount consumed. Thus when sweetened drinks The social and environment determinants influence eat- or snacks are located very visibly in a convenience store, ing patterns both directly and indirectly, and through peo- © Jones & Bartlett Learning,or LLC dessert is the first item offered© Jones in a cafeteria& Bartlett line, Learning, or LLC ple’s interpretations of these determinants. For the direct NOT FOR SALE OR DISTRIBUTIONthe salad bar in a school cafeteriaNOT FOR looks SALE unattractive, OR DISTRIBUTION route, nutrition educators can promote the increased these features influence purchase and thus consump- availability, accessibility, and convenience of whole- tion. Adjusting these factors can have a major impact on some and healthful foods by working with partners what and how much is eaten for a meal or snack. Nutri- and collaborators in schools, childcare sites, worksites, tion educators can take advantage of this observation community© Jones centers, & community Bartlett Learning, gardens, or foodLLC retail © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION by implementingNOT changes FOR SALE to make OR the DISTRIBUTION healthier options venues and national organizations. Examples of activi- more attractive, convenient, and normative, which can ties include collaborating with schools to improve the nudge people to eat the healthier options (Hanks, Just, foods offered for lunch or other meals, coordinating and Wansink 2013; Wansink et al. 2012). Similarly, when with community groups to incorporate healthful foods the high school cafeteria is restructured so that the seat- © Jonesamong & Bartlett the offerings Learning, provided LLC at emergency food sites © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOTing FOR arrangements SALE OR and DISTRIBUTION food service methods resemble and other community-supported efforts, and working those of the commercial venues teens frequent, more of with retailers to better educate consumers about health- them participate in school lunch and they choose healthful eating (e.g., recipe cards, customer newsletters, etc.) ier options (Koch et al. 2019). Nutrition educators can and to emphasize nutritious food choices via product also use an indirect route that focuses on conscious pro- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC placement. cesses by addressing people’s perceptions and attitudes in NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Using the direct route, nutrition educators can also relation to the environment, which also influence food ensure that their programs include the cultural practices choices and dietary behavior. and traditions and social networks and relationships of their intended audience. In collaboration with partners, Beliefs and Attitudes About Availability nutrition© educators Jones & can Bartlett advocate Learning, for policies LLC and sys- Accessibility© means Jones different & Bartlett things Learning,to different people.LLC tems to makeNOT additional FOR SALE resources OR DISTRIBUTION available for the low- Recent immigrantsNOT FOR may consider SALE ORfamiliar DISTRIBUTION food products income audiences with whom they work. For example, “accessible” even if a long car or subway ride is needed to they can partner with farmers and producers to provide get to stores where these foods are stocked. For others, a free fruit and vegetables as snacks to students in low- food is not accessible if it cannot be cooked in the micro- © Jonesresourced & Bartlett schools, Learning, or to provide LLC vouchers for reduced © Joneswave and & ready Bartlett to eat Learning, in 5 minutes. LLC Such differences in the NOT FORprices SALE on fruits OR and DISTRIBUTION vegetables in farmers markets. They NOTinterpretation FOR SALE of accessibilityOR DISTRIBUTION influence individuals’ food can also provide input on policy to bring in more grocery choices and need to be considered in nutrition education. stores that stock high quality culturally familiar fruits and vegetables at affordable prices into the city or com- Beliefs and Attitudes About munity. Nutrition educators© Jones can also & workBartlett with Learning, others the LLC Economic Environment© Jones & Bartlett Learning, LLC to influence the nature NOTof the FOR media SALE and advertising OR DISTRIBUTION Likewise, the economic environmentNOT FOR is SALE based onOR the DISTRIBUTION directed to children. analyses, values, and interpretations of individuals, all Nutrition educators can also use an indirect route to of which have an impact on dietary choices. Economics address environmental determinants. The indirect route is a behavioral science based on the fundamental notion involves ©unconscious Jones & andBartlett conscious Learning, processes LLC (Kremers that human ©wants Jones are infinitely & Bartlett expansible, Learning, whereas LLC the et al. 2006).NOT Unconscious FOR SALE processes OR DISTRIBUTION operate through an means to satisfyNOT them FOR are SALE finite. OR Human DISTRIBUTION wants always automatic or “mindless” route in which the behaviors exceed the means to satisfy them, and there is, therefore, are automatically elicited by the environment through scarcity. Economics is the study of people’s reaction to established envi ronment-behavior links. For nutrition the fact of scarcity—how people make choices when they © Joneseducation, & Bartlett a behavioral Learning, economics LLC approach has much to © Jonesmust choose & Bartlett among Learning,alternatives LLCto satisfy their wants. NOT FORoffer forSALE taking OR advantage DISTRIBUTION of unconscious processes. It is NOTCost FOR can SALEbe seen OR as theDISTRIBUTION sacrifice, or what needs to be based on the recognition that many external cues such exchanged, to obtain what is desired. In this context,

9781284169010_CH02_Contento.indd 52 2019-12-16 7:09 PM What Does All This Mean for Nutrition Educators? 53

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORthe SALE full price OR ofDISTRIBUTION a food or dietary practice is not justNOT its FORtime constraints,SALE OR and DISTRIBUTION to use behavioral economics to help monetary price but includes all the costs or sacrifices people eat better. individuals make, such as travel costs for shopping, time to prepare food, or child-care costs while attending a Summary: Nutrition Education Addresses nutrition education ©session. Jones For & examBartlettple, how Learning, willing LLCMany Determinants of© Behavior Jones & Bartlett Learning, LLC are people to sacrificeNOT convenience FOR SALE for moreOR DISTRIBUTIONhealthful People’s biological predispositionsNOT FOR and SALE experience OR DISTRIBUTION with meals? As nutrition educators, we need to learn about food, and their social and physical environment influence the sacrifices individuals are willing to make in order to their food choices and dietary behaviors not only directly engage in a healthy behavior and build these consider- but also through their impact on people’s beliefs and atti- ations© into Jones our programs.& Bartlett Learning, LLC tudes. Consequently© Jones & people’s Bartlett beliefs Learning, and attitudes LLC form a NOT FOR SALE OR DISTRIBUTION central focusNOT of muchFOR of SALE nutrition OR education. DISTRIBUTION Nutr ition education can be seen as the process of addressing all the major Beliefs and Attitudes About Time categories of determinants, as shown in FIGURE 2-5. Build- In the same way, time is both an objective feature of life ing on the contemporary definition of nutrition education, © Jones &and Bartlett a perception. Learning, The time LLC for food-related tasks such© as Jones Figure & Bartlett2-5 shows Learning,that nutrition LLC educ ation is directed at: cooking or eating can be easily quantified in hours and NOT FOR SALE OR DISTRIBUTION NOT FOR77 Motivating SALE OR and DISTRIBUTION facilitating determinants related to minutes. However, the perception of time and its worth biology and food experiences by providing direct expe- to individuals for different tasks varies considerably and riences with food, such as food tastings, cooking or varies by other necessities of life. For example, for some gardening, to increase the familiarity and preferences preparing a home-cooked meal is not perceived as time- © Jones & Bartlett Learning, LLC for healthy foods. © Jones & Bartlett Learning, LLC consuming, and is indeed fulfilling and enjoyable. Oth- NOT FOR SALE OR DISTRIBUTION77 Motivating and facilitatingNOT FOR determinants SALE OR related DISTRIBUTION to ers may prefer to spend the time on other activities and person-related factors by providing audiences with are willing to exchange money for time by purchasing a educational experiences on why-to take action on food that is already prepared. For many, however, there healthy food choices and diet-related behaviors is the economic necessity of two jobs and it is not sur- (through addressing people’s beliefs, attitudes, cul- prising© Jonesthat the &perception Bartlett is Learning, that there is LLC not just scar- © Jones & Bartlett Learning, LLC tural and social norms, or personal and global values) city ofNOT time, FOR but a SALEtime famine. OR DISTRIBUTION This has impacts that are NOT FOR SALE OR DISTRIBUTION and how-to take action (through addressing people’s important for nutrition educators. For example, low-wage food and nutrition related knowledge and skills, and employed parents find there is spillover from working behavior-related self-efficacy and self-direction skills). long hours into family food-related tasks (Devine et al. 77 Social/environmental determinants by providing envi- © Jones &2006): Bartlett there isLearning, stress and fatigue;LLC parents reduce the time© Jones & Bartlett Learning, LLC ronmental supports for behavior change through facil- NOT FORand SALE effort OR spent DISTRIBUTION on family meals, they make trade-offsNOT FOR SALE OR DISTRIBUTION itating specific opportunities for when and where to with other family needs, and they have to develop various take action on healthy choices in the food, social, and time management strategies to cope. Nutrition educators policy and systems environments. need to be mindful of people’s real and perceived economic and time constraints© Jones and & how Bartlett they make Learning, choices LLC Exactly how nutrition© Jones education & Bartlett activities Learning, can LLC in light of these constraints.NOT FOR SALE OR DISTRIBUTIONaddress these determinantsNOT of FORfood choiceSALE and OR dietary DISTRIBUTION NUTRITION EDUCATION IN ACTION 2-1 showcases behaviors is described in detail in the remaining chap- programs that were created to work with economic and ters in this book.

9781284169010_CH02_Contento.indd 53 2019-12-16 7:09 PM 54 Chapter 2 Determinants of Food Choice and Dietary Change: Implications for Nutrition Education

Dietitians in Supermarkets © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Smarter Lunchroom is a Trademark of the Cornell Center for Behavioral NOT FOR SALE OR DISTRIBUTION NOTEconomics FOR inSALE Child Nutrition OR Programs.DISTRIBUTION Used by permission.

Smarter Lunchrooms Movement in U.S. Schools

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Implications for Competencies and communications. Yet as we see in this chapter, food and Skills Needed by Nutrition choices and dietary behaviors are determined by a multi- tude of factors. Understanding behavior and its context is Educators© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION crucial for effectiveNOT FOR nutrition SALE education. OR DISTRIBUTION Additionally, as Nutritionists and dietitians are well grounded in nutrition described in Chapter 1, nutrition education also requires science and medical nutrition therapy and are anxious to knowledge from the field of education in order to design transmit what they know to a variety of audiences in excit- effective strategies of behavior change, whether delivered © Jonesing &ways. Bartlett They areLearning, less well groundedLLC in the social sci- © Jonesdirectly &or Bartlett indirectly. Learning, Finally, effective LLC communication NOT FORences, SALE particularly OR DISTRIBUTIONpsychology, and the fields of education NOTskills FOR are essential.SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Social/environmental determinants: Person-related Food determinants: environment Intra-person Experience with food: • Food availability/ © Jones & Bartlett Learning,factors: LLC accessibility/ © Jones & Bartlett Learning, LLC Associative conditioning Motivational quality NOT FOR SALE OR DISTRIBUTION• Beliefs about NOT FOR SALE OR DISTRIBUTION Physiological benefits, barriers Social/cultural conditioning: • Attitudes environment: Biologically determined • Values • Familiarity: • Social settings predispositions: • Social and cultural learned safety • Cultural practices/ norms • Taste/pleasure • Conditioned food traditions • Self-efficacy © Jones• Hunger/fullness & Bartlett mechanisms Learning, preferencesLLC © Jones• Social & Bartlettstructures/ Learning, LLC • Sweet, sour, salt, bitter, umami • Conditioned satiety policy NOT FOR• Sensor SALEy specific OR satiet DISTRIBUTIONy Facilitating NOT FOR SALE OR DISTRIBUTION • Genetics Social conditioning: • Knowledge/skills Economic • Social affective • Self-regulation environment context skills • Resources • Parenting • Price practices and Inter-person • Time © Jones & Bartlett Learning, LLC styles © Jonesfactors: & Bartlett Learning, LLC • Family practices and NOT FOR SALE OR DISTRIBUTION social netNOTworks FOR InformationalSALE OR DISTRIBUTION environment • Media • Advertising

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Motivating and NOT FOR SALE OR DISTRIBUTION NOTFo FORod choice SALE and OR DISTRIBUTION facilitating determinants: Environmental Nutrition education diet-related behavior Why to and how to change + supports for behavior change behavior

FIGURE 2-5 Nutrition education addresses the many determinants of behavior. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Consequently, what the field needs is nutrition edu- competencies in the broad range of disciplines listed above cators who have a strong background in nutrition science and are summarized below. and who are sufficiently conversant with the relevant 1. Basic food and nutrition knowledge: Describe the fun- fields of psychology, education, and communications to damentals of nutrition science, food groups and the © Jones &be Bartlettable to design Learning, effective LLC nutrition education programs© Jones & Bartlett Learning, LLC dietary guidelines; describe prevention and manage- NOT FORas SALE shown ORin FIGURE DISTRIBUTION 2-6. This book aims to help nutritionNOT- FOR SALE OR DISTRIBUTION ment approaches for major diet-related public health ists develop these competencies. issues; explain different types of nutrition-related study designs; and critically evaluate nutrition-related THE SOCIETY FOR NUTRITION EDUCATION AND claims. BEHAVIOR’S COMPETENCIES© Jones & FOR Bartlett NUTRITION Learning, LLC © Jones & Bartlett Learning, LLC 2. Food science: Describe the functions of food ingre- EDUCATORS NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION dients and basic types of culinary practices; identify The Society for Nutrition Education and Behavior has the effects of food processing; describe best practices developed a list of competencies that nutrition educa- to address safe food handling; and explain how to tors should© Jones have & (SNEB Bartlett 2016). Learning, These reflect LLC the need for plan,© select, Jones prepare, & Bartlett and, manage Learning, foods LLCto enhance NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Food and nutrition Psychology Education Communication for choosing the for how to motivate and for creating educational for effective delivery of behavioral focus and facilitate behavior plans and sequencing program content change activities © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEFIGURE OR 2-6 DISTRIBUTION Nutrition educators need competencies in manyNOT fields. FOR SALE OR DISTRIBUTION

9781284169010_CH02_Contento.indd 55 2019-12-16 7:09 PM 56 Chapter 2 Determinants of Food Choice and Dietary Change: Implications for Nutrition Education

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORthe SALE well-being OR DISTRIBUTIONof individuals, families, communities, NOT FORaddress SALE determinants OR DISTRIBUTION in the model; select or design and the food system. appropriate strategies/techniques for diverse audi- 3. Nutrition across the life cycle: Identify the primary ences; apply participatory approaches; develop a dietary issues and challenges at different phases of timeline and budget; and, design process and out- the life cycle and use© Jonesdietary &guidelines Bartlett to Learning, make LLCcome evaluations and assess© Jones progress, & Bartlett and revising Learning, LLC recommendations. NOT FOR SALE OR DISTRIBUTIONprogram as needed. NOT FOR SALE OR DISTRIBUTION 4. Physical activity: Describe national and international 9. Written, oral, and social media communication: physical activity guidelines; describe the benefits of Communicate effectively with diverse audiences in physical activity and identify physical activity oppor- written, visual, and oral form; use simple, clear and tunities© Jonesin daily &living. Bartlett Learning, LLC motivational© Jones language; & Bartlett facilitate Learning, communication LLC 5. FoodNOT and nutritionFOR SALE policy: OR Describe DISTRIBUTION the purpose, among clients/participants;NOT FOR SALE and, OR advocate DISTRIBUTION effectively funding and implementation of various government for nutrition education and healthy diets in various food-related programs to address malnutrition and sectors and settings food security and to promote health; the roles of 10. Nutrition education research methods: Analyze, evalu- © Jones &government Bartlett Learning,agencies in LLCregulating food systems, © Jonesate, &and Bartlett interpret Learning, nutrition education LLC research and NOT FORthe SALE food supplyOR DISTRIBUTION and dietary supplements; describe NOT FORapply SALEit to practice. OR DISTRIBUTION ways to collaborate to create communities and settings where healthy foods are easy, affordable, and desired while unhealthy foods are less prominent ACADEMY OF NUTRITION AND DIETETICS and desired. © Jones & Bartlett Learning,COMPETENCIES LLC © Jones & Bartlett Learning, LLC 6. Agricultural productionNOT and FOR food SALE systems: OR Describe DISTRIBUTION The Academy of Nutrition andNOT Dietetics’ FOR SALE accreditation OR DISTRIBUTION the potential effects of differences in agricultural standards for the education of entry-level dietitians practices and various food processing, packag- (Academy of Nutrition and Dietetics 2018) include some ing, distribution, and marketing practices on food competencies that are related to nutrition education. choices© Jonesand food & availability; Bartlett Learning, explain effects LLC of natu- © Jones & Bartlett Learning, LLC ral resourcesNOT FOR on the SALE quantity OR andDISTRIBUTION quality of the food NOT FOR SALE OR DISTRIBUTION and water supply; and, describe ways to collaborate Core Knowledge for the Registered Dietitian to promote policies supporting systems that produce Upon completion of the program, graduates are able to: healthy food. 7 © Jones7. &Behavior Bartlett and Learning, education theory: LLC Describe the biologi- © Jones7 Demonstrate & Bartlett effective Learning, and professional LLC oral and writ- NOT FORcal, SALE psychological, OR DISTRIBUTION social, cultural, political, and eco- NOT FORten communication SALE OR DISTRIBUTION and documentation. nomic determinants of eating behavior; psychosocial 77 The curriculum must include the role of environment, theories of behavior and behavior change and apply food, nutrition, and lifestyle choices in health promo- them to eating behavior and behavior change; and, tion and disease prevention. 7 apply theory-based learning© Jones and instruction& Bartlett practices Learning, LLC7 Demonstrate an understanding© Jones & Bartlettof cultural Learning, LLC in nutrition educationNOT FOR SALE OR DISTRIBUTIONcompetency/sensitivity. NOT FOR SALE OR DISTRIBUTION 8. Nutrition education program design, implementa- 77 Develop an educational session or program/ tion, and evaluation: Assess population to design educational strategy for a target population. nutrition education for all ages and diverse audiences 77 Demonstrate counseling and education methods to using© theJones following & Bartlett steps: determine Learning, the LLC behavior facilitate© behavior Jones change& Bartlett and enhance Learning, wellness LLC for changeNOT goals FOR of the SALE program; OR DISTRIBUTIONidentify theory-based diverse individualsNOT FOR and SALE groups. OR DISTRIBUTION motivators and facilitators of behavior change using 77 Learning activities must use a variety of educational a participatory approach, including social and envi- approaches necessary for delivery of curriculum con- ronmental influences; select appropriate theoreti- tent to meet learner needs and to facilitate learning © Jones &cal Bartlett models or Learning, frameworks; LLC determine objectives to © Jonesobjectives. & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

9781284169010_CH02_Contento.indd 56 2019-12-16 7:09 PM Chapter Summary 57

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR 7SALE7 The behavioral OR DISTRIBUTION and social science foundation of NOTthe FOR77 Use SALE the information OR DISTRIBUTION to develop nutrition education dietetics profession must be evident in the curriculum. that addresses person-related motivating and facilitat- Course content must include cultural competence and ing determinants of dietary change. human diversity; human behavior, psychology, sociol- ogy, or anthropology.© Jones & Bartlett Learning, LLCSOCIAL/ENVIRONMENTAL© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONDETERMINANTS NOT FOR SALE OR DISTRIBUTION Chapter Summary The physical/built environment influences the foods that People’s food choices and nutrition-related practices are are available and accessible as well as venues for active determined by many factors. This has consequences for © Jones & Bartlett Learning, LLC living such© asJones walkable & Bartlettstreets and Learning, attractive parks. LLC Social nutrition education. settings, cultural practices, social structures, and poli- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION cies related to food choices make it easier or harder to be BIOLOGY AND PERSONAL healthy. The economic determinants of behavior include EXPERIENCE WITH FOOD the price of food and time. The information environment, including the media, is very powerful in influencing peo- © Jones &Humans Bartlett are Learning,born with biological LLC predispositions toward© Jones & Bartlett Learning, LLC ple’s food choices. NOT FORliking SALE the ORsweet, DISTRIBUTION salty, and umami tastes and rejecting sourNOT FOR SALE OR DISTRIBUTION and bitter tastes. Some genetic differences exist between 77 Understand fully the physical, social, economic, and individuals in sensitivity to tastes, and these may influ- cultural settings of your audience and their informa- ence food choices. However, individuals’ preferences for tion environment so that the behavior change recom- specific foods and food© Jones acceptance & Bartlett patterns Learning, are largely LLC mendations you provide© Jones are appropriate. & Bartlett Learning, LLC learned from familiarityNOT with FOR these SALE foods. ORPeople’s DISTRIBUTION liking NOT FOR SALE OR DISTRIBUTION for foods thus can be modified by repeated exposure to KNOWLEDGE AND SKILLS them. Sense of fullness is also learned. ARE NOT ENOUGH Nutrition education applications: Consequently, knowledge and skills are not enough for 77 Check© Jones out the & foodBartlett preferences Learning, and prior LLC experiences © Jones & Bartlett Learning, LLC people to eat healthfully and live actively. Nutrition withNOT food FOR when SALE you work OR withDISTRIBUTION an audience. NOT FOR SALE OR DISTRIBUTION education must address these many other food, person, 77 In nutrition education, address food-related motivat- and environmental determinants of behavior if it is to ing and facilitating determinants by providing food be effective. experiences and other activities to increase preference © Jones & Bartlettfor healthy Learning, food. LLC © Jones77 &Check Bartlett that yourLearning, sessions LLC or intervention includes NOT FOR SALE OR DISTRIBUTION NOT FORactivities SALE ORthat DISTRIBUTIONaddress motivation as well as knowl- PERSON-RELATED DETERMINANTS edge and skills and takes into account other influences on behavior. People acquire knowledge and develop beliefs, expectations, and feelings about foods. These perceptions, atti- © Jones & Bartlett Learning, LLCCONSEQUENCES FOR THE© Jones SKILLS & Bartlett Learning, LLC tudes, beliefs, personal meanings, values, and perceived OF NUTRITION EDUCATORS cultural norms are allNOT powerful FOR SALEdeterminants OR DISTRIBUTION of food NOT FOR SALE OR DISTRIBUTION choice and dietary behavior. Families, social networks, These considerations make it clear that nutrition educa- and cultural groups also influence food choices. tors need an additional set of skills beyond our knowledge of food and nutrition. We need to develop the skills 77 Conduct a thorough assessment of your audience © Jones & Bartlett Learning, LLC to understand© Jones people, & Bartlett their behavior, Learning, and theLLC context before you design any nutrition education in terms of NOT FOR SALE OR DISTRIBUTION of their behaviorNOT FOR in order SALE to ORcreate DISTRIBUTION programs to address their beliefs, attitudes, values, cultural group member- these factors. ship, social networks, and food and nutrition-related knowledge and skills. Check out your own cultural 77 Review your knowledge and skills as an educator and © Jones & Bartlettcompetence. Learning, LLC © Jones &check Bartlett what skills Learning, you still LLCneed to enhance. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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Questions and Activities© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 1. Think about the keyNOT influences FOR SALE on your OR eating DISTRIBUTION and 6. People live within socialNOT networks FOR and SALE may experiOR DISTRIBUTION- physical activity behaviors and list them. Compare ence cultural expectations about how and what they them to the categories of influences described in this eat. Because these can’t be changed by nutrition edu- chapter. Into which categories do the items on your cation, why should nutrition educators be interested list fall?© Jones Are there & Bartlettsome surprises? Learning, How wouldLLC you in such information© Jones & about Bartlett their intended Learning, audience? LLC describeNOT the FOR motivations SALE forOR your DISTRIBUTION eating patterns? 7. DistinguishNOT between FOR SALE food ORavailability, DISTRIBUTION accessi- 2. List at least five biological predispositions people are bility and quality. How can they influence food born with and describe each in a sentence or so. Are choice? How might nutrition educators address they modifiable? If so, provide the evidence. How can these issues? © Jones &the Bartlett information Learning, be useful LLCto nutrition educators? © Jones8. Describe & Bartlett four environmental Learning, LLC factors that influence NOT FOR3. One SALE often OR hears DISTRIBUTION parents say that their child will justNOT FORpeople’s SALE food ORchoices DISTRIBUTION and dietary practices. What can not eat certain healthful foods such as vegetables. nutrition educators do with such information? They believe that such dislikes cannot be changed. Based 9. As stated in this chapter, in terms of healthy eating on the evidence, what would you say to such a parent? and active living, “knowledge is not enough.” In your 4. How can nutrition educators© Jones help & Bartlett young children Learning, LLCview, is that true? Why do© youJones say so? & GiveBartlett evidence Learning, LLC learn to self-regulate theNOT amount FOR of SALE food they OR eat? DISTRIBUTIONfor your view. NOT FOR SALE OR DISTRIBUTION 5. Influences on dietary behavior arising from within 10. In reviewing the competencies suggested by the Soci- the person have been stated to be central to his or her ety for Nutrition Education and Behavior for a nutri- food choices and dietary practices. Why is this so? tion educator, which competencies do you believe Describe three of these influences in a sentence or two, that you already possess? Which ones would you like © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC and indicate why they are so important. How might to develop further? Keep these in mind as you read NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION understandings of these personal factors help people the remainder of this book. make dietary changes?

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORReferences SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Academy of Nutrition and Dietetics. 2018. ACEND Accreditation engagement, and food choice in the U.S.A and in Germany.” Standards for Nutrition and Dietetics Didactic Programs. Food quality and Preference 59: 35–45. Chicago: Academy of Nutrition and Dietetics, Accredita- Baranowski, T., K. W. Cullen, and J. Baranowski. 1999. tion Council for Education© Jonesin Nutrition & Bartlettand Dietetics. Learning, www LLC“Psychosocial correlates of© dietaryJones intake: & Bartlett advancing Learning, LLC .eatrightpro.org/-/media/eatrightpro-files/acend/aboutNOT FOR SALE OR DISTRIBUTION dietary intervention.” AnnualNOT Review FOR of Nutrition SALE 19: OR 17–40. DISTRIBUTION -program-accreditation/accreditation-standards/2017stan Beauchamp, G. K. and J. A. Mennella. 2009. “Early flavor learn- dardsfordpdprograms.pdf?la=en&hash=B981CA74C9196 ing and its impact on later feeding beha vior.” Journal of 79C37830041802FF4E711C9E9CF. Pediatric Gastroenterology and Nutrition 48(Suppl 1): Addessi, E., A. T. Galloway, E. Visalberghi, and L. L. Birch. 2005. S25–S30. “Specific© Jones social influences & Bartlett on the Learning, acceptance of LLC novel foods © Jones & Bartlett Learning, LLC in 2–5-year-oldNOT FOR children.” SALE Appetite OR DISTRIBUTION 45(3): 264–271. Berge, J. M., S.NOT W. Jin, FOR P. Hannan, SALE and OR D. DISTRIBUTION Neumark-Sztainer. Anzman-Frasca, S., J. S. Savage, M. Marini, J. O. Fisher, and 2013. “Structural and interpersonal characteristics of family L. L. Birch. 2012. “Repeated exposure and associative condi- meals: Associations with adolescent body mass index and tioning promote preschool children’s liking of vegetables.” dietary patterns.” Journal of the Academy of Nutrition and Appetite 58(2): 543–553. Dietetics 113(6): 816–822. © JonesArbit, & N.,Bartlett M. B. Ruby,Learning, G. Sproesser, LLC B. Renner, H. Schupp, © JonesBerge, J. &M., Bartlett M. Wall, Learning,D. Neumark-Sztainer, LLC N. Larson, and NOT FORand SALE P. Rozin. OR 2017.DISTRIBUTION “Spheres of moral concern, moral NOT FORM. Story. SALE 2010. OR “Parenting DISTRIBUTION style and family meals:

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEcross-sectional OR DISTRIBUTION and 5-year longitudinal associations.” JourNOT- FORphenotypes SALE OR of DISTRIBUTIONchildhood obesity prevention interven- nal of the American Dietetic Association 110: 1036–1042. tion participants.” Translational Behavioral Medicine 8(5): Birch, L. L. 1992. “Children’s preferences for high-fat foods.” 799–807. Nutrition Reviews 50(9): 249–255. Carnell, S., L. Cooke, R. Cheng, A. Robbins, and J. Wardle. 2011. Birch, L. L. 1999. “Development of food preferences.” Annual “Parental feeding behaviours and motivations. A qualita- Review of Nutrition© 19: Jones 41–62. & Bartlett Learning, LLC tive study in mothers of© UK Jones pre-schoolers.” & Bartlett Appetite Learning, 57(3): LLC ———. 2014. “LearningNOT to eat: FOR Birth SALEto two years.” OR DISTRIBUTION American 665–673. NOT FOR SALE OR DISTRIBUTION Journal of Clinical Nutrition 99(3): 723S–728S. Cecil, J. E., N. A. Colin, W. Palmer, I. M. Wrieden, C. Bolton- Birch, L. L., and S. Anzman-Frasca. 2011a. “Learning to prefer Smith, P. Watt, et al. 2005. “Energy intakes of children after the familiar in obesogenic environments.” Nestle Nutrition preloads: Adjustment, not compensation.” American Jour- Workshop Series Pediatric Program. 68:187–196. nal of Clinical Nutrition 82: 302–308. Birch,© L. Jones L., and J. & A. Bartlett Fisher. 1995. Learning, “Appetite and LLC eating behav- Chakravarthy,© Jones M. V., and& Bartlett F. W. Booth. Learning, 2004. “Eating, LLC exercise, iorNOT in children.” FOR SALE Pediatric OR Clinics DISTRIBUTION of North America 42(4): and ‘thrifty’NOT FOR genotypes: SALE Connecting OR DISTRIBUTION the dots toward an 931–953. evolutionary understanding of modern chronic diseases.” Birch, L. L., L. McPhee, B. C. Shoba, L. Steinberg, and R. Krehbiel. Journal of Applied Physiology 96(1): 3–10. 1987. “Clean up your plate: Effects of child feeding practices Chandon, P., and B. Wansink. 2007. “Is obesity caused by on the conditioning of meal size.” Learning and Motivation calorie underestimation? A psychophysical model of meal © Jones & Bartlett18: 301–317. Learning, LLC © Jones &size Bartlett estimation.” Learning, Journal of MarketingLLC Research 44: 84–99. NOT FORBirch, SALE L. L., OR J. S. DISTRIBUTIONSavage, and J. O. Fisher. 2015. “Right sizing preNOT- FORClark, SALE J. E. 1998. OR “Taste DISTRIBUTION and flavour: Their importance in food vention: Food portion size effects on children’s eating and choice and acceptance.” Proceedings of the Nutrition Soci- weight.” Appetite 88: 11–16. ety 57(4): 639–643. Blissett, J. 2011. “Relationships between parenting style, feed- Cohen, D. A. and T. A. Farley. 2008. “Eating as automatic behav- ing style and feeding practices and fruit and vegetable con- ior.” Preventing Chronic Disease: Public Health Research sumption in early childhood.”© Jones Appetite& Bartlett 57(3): Learning,826–831. LLC Practice, and Policy 5(1):© Jones 1–7. https://www.cdc.gov/pcd & Bartlett Learning, LLC Boone-Heinonen, J., P.NOT Gordon-Larsen, FOR SALE C. I. OR K. M. DISTRIBUTION Shikany, /issues/2008/jan/07_0046.htmNOT FOR SALE OR DISTRIBUTION C. E. Lewis, and B. M. Popkin. 2011. “Fast food restaurants Connors, M., C. A. Bisogni, J. Sobal, and C. M. Devine. 2001. and food stores longitudinal associations with diet in young “Managing values in personal food systems.” Appetite 36(3): to middle-aged adults: The CARDIA Study.” Archives of 189–200. Internal Medicine 171(13): 1162–1170. Contento, I. R., S. S. Williams, J. L. Michela, and A. B. Franklin. Botonowski,© Jones A. and & M. Bartlett Konstadinos Learning, 2010. “Revealing LLC the values 2006.© “Understanding Jones & Bartlett the food Learning, choice process LLC of adoles- behindNOT convenienceFOR SALE food OR consumption.” DISTRIBUTION Appetite 629–638. centsNOT in the contextFOR SALE of family OR and DISTRIBUTIONfriends.” Journal of Ado- Bowen, D. J., M. M. Henderson, D. Iverson, E. Burrows, H. Henry, lescent Health 38(5): 575–582. and J. Foreyt. 1994. “Reducing dietary fat: Understanding Cooke, L. J., L. C. Chambers, E. V. Anez, H. A. Croker, the successes of the Women’s Health Trial.” Cancer Preven- D. Boniface, M. R. Yeomans, and J. Wardle. 2011a.“Eating tion International 1: 21–30. for pleasure or profit: The effect of incentives on children’s © Jones &Breslin, Bartlett P. A. Learning,S., and A. C. Spector.LLC 2008. “Mammalian taste© Jones &enjoyment Bartlett of Learning, vegetables.” LLCPsychological Science 22(2): NOT FOR SALEperception.” OR DISTRIBUTION Current Biology 18(4): R148–R155. NOT FOR190–196. SALE OR DISTRIBUTION Briefel, R. R., M. K. Crepinsek, C. Cabili, A. Wilson, and P. M. Cooke L. J., L. C. Chambers, E. V. Anez, and L. Wardle. 2011b. Gleason. 2009. “School food environments and practices “Facilitating or undermining? The effects of reward on food affect dietary behaviors of US public school children.” acceptance. A narrative review.” Appetite 57(2): 493–497. Journal of the American Dietetic Association 109(2 Suppl): Cooksey-Stowers, K, M. B. Schwartz, and K. D. Brownell. 2017. S91–S107. © Jones & Bartlett Learning, LLC “Food swamps predict obesity© Jones rates better& Bartlett than food Learning, deserts LLC Brillat-Savarin, A. S. 1825.NOT The FOR physiology SALE of taste: OR Meditations DISTRIBUTION in the United States.” InternationalNOT FOR Journal SALE of Environmen OR DISTRIBUTION- on transcendental gastronomy. Reprinted 1949. Translated tal Research and Public Health. 14: 1366. by M. F. K. Fisher. New York: Heritage Press. Reprinted Croker, H., C. Sweetman, and L. Cooke. 2009. “Mothers’ views 2000. Washington, DC: Counterpoint Press. on portion sizes for children.” Journal of Human Nutrition Brown, R., and J. Ogden. 2004. “Children’s eating attitudes and and Dietetics 22(5): 437–443. behaviour:© Jones A &study Bartlett of the modelling Learning, and control LLC theories of de Castro,© J. Jones M. 2000. & “Eating Bartlett behavior: Learning, Lessons learned LLC from parentalNOT FOR influence.” SALE Health OR Education DISTRIBUTION Research 19: 261–271. the realNOT world FOR of humans.” SALE NutritionOR DISTRIBUTION 16: 800–813. Brug, J., K. Glanz, and G. Kok. 1997. “The relationship between ———. 2010. “Control of food intake of free-living humans: self-efficacy, attitudes, intake compared to others, con- Putting the pieces back together.” Physiology and Behavior sumption, and stages of change related to fruit and vegeta- 100(5): 446–453. bles.” American Journal of Health Promotion 12(1): 25–30. Desor, J. A., O. Mahler, and L. S. Greene. 1977. “Preference for © Jones &Burgermaster, Bartlett Learning, M., I. Contento, LLC P. Koch, and L. Mamykina.© Jones &sweet Bartlett in humans: Learning, Infants, children, LLC and adults.” in Taste NOT FOR SALE2018. “BehaviorOR DISTRIBUTION change is not one size fits all: PsychosocialNOT FORand SALE the development OR DISTRIBUTION of the genesis for the sweet preference,

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORedited SALE by J. OR Weiffenback. DISTRIBUTION Bethesda, MD: U.S. Department NOTFisher, FOR J.O., SALE and T. V.OR E. Kjal.DISTRIBUTION 2008. “Supersize me: Portion size of Health, Education, and Welfare. effects on young children’s eating.” Physiology & Behavior Devine, C. M., M. M. Connors, J. Sobal, and C. A. Bisogni. 2003. 94(1): 39–47. “Sandwiching it in: Spillover of work onto food choices and Food Marketing Institute. 2012. U.S. grocery shopper trends 2012. family roles in low- and moderate-income urban house- Executive summary. Washington, DC: Author. https://www holds.” Social Science Medicine© Jones 56(3): & 617–630. Bartlett Learning, LLC.fmi.org/docs/default-source/document-share/fmi-grocery© Jones & Bartlett Learning, LLC Devine, C. M., M. Jastran, NOTJ. Jabs, FORE. Wethington, SALE OR T. J. DISTRIBUTIONFarell, -trends-2017-final-pdf-06-07-17.pdf?sfrn=2294726e_2NOT FOR SALE OR DISTRIBUTION and C. A. Bisogni. 2006. “A lot of sacrifices: Work–family Frankel, L. A., S. O. Hughes, T. M. O’Connor, T. G. Power, spillover and the food choice coping strategies of low- J. O. Fisher, and N. L. Hazen. 2012. “Parental influences on wage employed parents.” Social Science Medicine 63(10): children’s self-regulation of energy intake: Insights from 2591–2603. development literature on emotion regulation.” Journal of DiSantis, ©K. JonesI., L. L. Birch, & Bartlett A. Davey, Learning, E. L. Serrano, LLC L. Zhang, Obesity 2012:© Jones 327259. & Bartlett Learning, LLC Y. Bruton,NOT and FOR J.O. SALEFisher. 2013. OR “PlateDISTRIBUTION size and children’s Fuemmeler, B.NOT F., C. Yang, FOR P. Costanzo,SALE OR R. H. DISTRIBUTION Hoyle, I. C. Siegler, appetite: Effects of larger dishware on self-served portions R. B. Williams, and T. Ostbye. 2012. “Parenting styles and and intake.” Pediatrics 131(5): e1451–e1458. body mass index trajectories from adolescence to adult- Dovey, T. M., P. A. Staples, E. L. Gibson, and J. C. Halford. 2008. hood.” Health Psychology 31:, 441–449. “Food neophobia and “picky/fussy” eating in children: A Furst, T., M. Connors, C. A. Bisogni, J. Sobal, and L. W. Falk. © Jones &review.” Bartlett Appetite Learning, 50(2–3): 181–193. LLC © Jones1996. & “Food Bartlett choice: Learning, A conceptual LLC model of the process.” NOT FORDrewnowski, SALE A. OR 2012. DISTRIBUTION “The cost of U.S. foods as related to their NOT FORAppetite SALE 26: 247–266. OR DISTRIBUTION nutritive value.” American Journal of Clinical Nutrition Gattshall, M., J. A. Shoup, J. A. Marcahll, L. A. Crane, and 92(5): 1181–1188. P. A. Estabrooks. 2008. “Validation of a survey instrument to Drewnowski, A., J. A. Mennella, S. L. Johnson, and F. Bellisle. assess home environments for physical activity and healthy 2012. “Sweetness and food preference.” Journal of Nutrition eating in overweight children.” International Journal of 142(6): 1142S–1148S. © Jones & Bartlett Learning, LLCBehavioral Nutrition and Physical© Jones Activity &. 5:3.Bartlett Learning, LLC Druckerman, P. 2012. BringingNOT Up Bebe:FOR One SALE American OR MotherDISTRIBUTION Gearhardt, A. N., C. M. Grilo, R. NOTJ. DiLeone, FOR K. D.SALE Brownell, OR and DISTRIBUTION Discovers the Wisdom of French Parenting. New York: M. N. Potenz. 2011. “Can food be addictive? Public health Penguin Books. and policy implications.” Addiction 106(7):1208–1212. E-marketer, 2017. eMarketer updates US time spent with media Geerling J. C. and A. D. Loewy. 2008. “Central regulation of figures. https://www.emarketer.com/Article/eMarketer sodium appetite.” Experimental Physiology, 93 (2): 177–209. -Updates-US-Time-Spent-with-Media-Figures/1016587.© Jones & Bartlett Learning, LLC Genne-Bacon,© E. Jones A. 2014. & “ThinkingBartlett Learning,evolutionarily LLC about Epictetus.NOT 108. Discourses. FOR SALE http://ancienthistory.about.com/od OR DISTRIBUTION obesity.” NOTYale Journal FOR SALEof Biology OR and DISTRIBUTION Medicine. 87(2): /stoicism/a/121510-Epictetus-Quotes.htm. 99–112. Faith, M. S., K. S. Scanlon, L. L. Birch, L. A. Francis, and B. Gillman, M. W., S. L. Rifas-Shiman, A. L. Frazier, H. R. Rock ett, Sherry. 2004. “Parent–child feeding strategies and their C. A. Carmago, Jr., A. E. Field, C. S. Berkey, and G. A. Colditz relationships to child eating and weight status.” Obesity 2000. “Family dinner and diet quality among older children © Jones &Research Bartlett 12(11): Learning, 1711–1722. LLC © Jonesand adolescents.”& Bartlett Archives Learning, of Family LLC Medicine 9(3):235–240. NOT FORFarley, SALE T. A., E. OR T. Baker, DISTRIBUTION L. Futrell, and J.C. Rice. 2009. “The NOTGravina, FOR S. SALE A., G. L. OR Yep, DISTRIBUTION and M. Khan. 2013. “Human biol ogy ubiquity of energy-dense snack foods: a national multic- of taste.” Annals of Saudi Medicine 33(3): 217–222. ity study.” American Journal of Health Promotion 100(2): Grolnik, W. S. and E. M. Pomerantz. 2009. “Issues and chal- 306–311. lenges in studying parental control: Toward a new concep- Federal Trade Commission. 2012. A review of food marketing to tualization.” Child Development Perspectives 3(3): 165–170. children and adolescents©. http://ftc.gov/os/2012/12/121221Jones & Bartlett Learning, Gussow, LLC J. D. 2006. “Reflections© on Jones nutritional & Bartletthealth and Learning,the LLC foodmarketingreport.pdf.NOT FOR SALE OR DISTRIBUTIONenvironment: The journeyNOT to sustainability.” FOR SALE Journal OR DISTRIBUTIONof Feunekes, G. I., C. de Graaf, S. Meyboom, and W. A. van Hunger and Environmental Nutrition 1(1): 3–25. Staveren. 1998. “Food choice and fat intake of adolescents Hanks, A. S., D. R. Just, and B. Wansink. 2013. “Smarter lunch- and adults: Associations of intakes within social networks.” rooms can address new school lunchroom guidelines and Preventive Medicine 27(5 Pt 1): 645–656. childhood obesity.” Journal of Pediatrics 162: 867–869. Fisher, J. ©O. Jones2007. “Effects & Bartlett of age on Learning, children’s intake LLC of large Harper, L. V.,© and Jones K. M. Sanders. & Bartlett 1975. Learning,“The effects of LLC adults’ and self-selectedNOT FOR food SALE portions.” OR ObesityDISTRIBUTION (Silver Spring) 15: eating on NOTyoung children’sFOR SALE acceptance OR ofDISTRIBUTION unfamiliar foods.” 403–412. Journal of Experimental Child Psychology 20: 206–214. Fisher, J. O., A. Arreola, L. L. Birch, and B. J. Rolls. 2007. Harris, J. L., J. A. Bargh, and K. Brownell. 2009. “Priming effects “Portion size effects on daily energy intake in low- of television advertising on eating behavior.” Health Psy- income Hispanic and African-American children and chology 28(4): 404–413. © Jones &their Bartlett mothers.” Learning, American JournalLLC of Clinical Nutrition © JonesHebebrand, & J.,Bartlett O. Albayrak, Learning, R. Adan, J. Antel, LLC C. Dieguez, J. de Jong, NOT FOR86(6):1709–1716. SALE OR DISTRIBUTION NOT FORG. Leng, SALE et al. OR2014. DISTRIBUTION ‘Eating addiction,’ rather than ‘food

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEaddiction’, OR betterDISTRIBUTION captures addictive-like eati ng behavior.”NOT FORKonner, SALE M. J., OR and DISTRIBUTIONS. B. Eaton. 2010. “Paleolithic nutrition: Neuroscience and Biobehavioral Reviews 47: 295–306. Twenty-five years later.” Nutrition in Clinical Practice 25(6): Hendy, H. M., K. E. Williams, and T. S. Camise. 2005. ‘Kids 594–602. Choice’ school lunch program increases children’s fruit and Kremers, S. P. J., G-J. de Bruijn, T. L. S. Visscher, W. van Mechelen, vegetable acceptance.” Appetite 45(3): 250–263. N. K. de Vries, and J. Brug. 2006. “Environmental influ- Hoerr S. L., S. O. Hughes,© J.Jones O. Fisher, & T.Bartlett A. Nicklas, Learning, Y. Liu, and LLC ences on energy-balance-related© Jones behaviors: & Bartlett A dual-process Learning, LLC R. M. Shewchuk. 2009.NOT “Associations FOR SALE among OR parental DISTRIBUTION feed- view.” International JournalNOT ofFOR Behavioral SALE Nutrition OR DISTRIBUTION and ing styles and children’s food intake in families with limited Physical Activity 3: 9. income.” International Journal of Behavior Nutrition and Kurihara, K. 2015. “Umami the fifth taste: history of studies on Physical Activity 13(6): 55. receptor mechanism and role as a food flavor.” Biomedical Horne, P. J., J. Greenhalgh, M. Erjavec, C. Fergus, S. Victor, and Research International 2015: 189402. C.© J. Jones Whitaker. & 2011. Bartlett “Increasing Learning, pre-school LLC children’s con- Larsen, J. ©K., Jones R. C. Hermans, & Bartlett E. F. Sleddens, Learning, et al. LLC2015. “How sumptionNOT FOR of fruits SALE and vegetables: OR DISTRIBUTION A modeling and rewards parentalNOT dietary FOR behavior SALE andOR food DISTRIBUTION parenting practices intervention.” Appetite 56: 375–385. affect children’s dietary behavior. Interacting sources of Horne, P. J., K. Tapper, C. F. Lowe, C. A. Hardman, M. C. Jackson, influence?” Appetite 2015; 89:246–257. and J. Woolner. 2004. “Increasing children’s fruit and veg- Larson, N. I., D. Neumark-Sztainer, P. J. Hannan, and M. Story. etable consumption: A peer-modeling and rewards-based “Family meals during adolescence are associated with © Jones & Bartlettintervention.” Learning, European JournalLLC of Clinical Nutrition 58(164):© Jones &higher Bartlett diet quality Learning, and healthful LLC meal patterns during NOT FOR SALE1649–1660. OR DISTRIBUTION NOT FORyoung SALE adulthood.” OR DISTRIBUTION Journal of the American Dietetic Asso- Hughes, S. O., T. G. Power, J. Orlet Fisher, S. Mueller, and T. A. ciation 107(9): 1502–1510. Nicklas, 2005. “Revisiting a neglected construct: Parenting Ledikwe, J. H., J. Ello-Martin, C. L. Pelkman, L. L. Birch, styles in a child-feeding context.” Appetite 44(1): 83–92. M. L. Mannino, and B. J. Rolls. 2007. “A reliable, valid ques- Hughes, S. O., R. M. Shewchuk, M. L. Baskin, T. A. Nicklas, and tionnaire indicates that preference for dietary fat declines H. Qu. 2008. “Indulgent© Jones feeding & style Bartlett and children’s Learning, weight LLC when following a reduced-fat© Jones diet.” &Appetite Bartlett 49(1): Learning, 74–83. LLC status in preschool.”NOT Journal FOR of Developmental SALE OR and DISTRIBUTION Behavior Lipchock, S. V., J. A. Mennella,NOT A. I.FOR Spielman, SALE and OR D. R. DISTRIBUTION Reed. Pediatrics 29(5): 403–410. 2013. “Human bitter perception correlates with bitter recep- IFIC, 1999. “Are you listening? What consumers tell us about tor messenger RNA expression in taste cells.” American dietary recommendations.” Food insight: Current topics in Journal of Clinical Nutrition 98: 1136–1143. food safety and nutrition. International Food Information Loth, K. A., J. Nogueira de Brito, D. Neumark-Sztainer, Council© Jones (IFIC) & Foundation.Bartlett Learning, Washington, LLCD.C. J. O. ©Fisher, Jones and J.M.& Bartlett Berge 2018. Learning, “A qualitative LLC explora- IFIC,NOT 2019. FoodFOR and SALE Health OR Survey DISTRIBUTION 2019. International Food tion intoNOT the FORparent-child SALE feeding OR relationship:DISTRIBUTION How parents Information Council Foundation. https://foodinsight.org of preschoolers divide the responsibilities of feeding with /wp-content/uploads/2019/05/IFIC-Foundation their children.” Journal of Nutrition Education and Behav- -2019-Food-and Health-Report-FINAL.pdf ior 50(7): 655–667. Institute of Medicine. 2006. Food marketing to children and Macino, L., B. H. Lin, and N. Ballenger. 2004. “The role of eco- © Jones & Bartlettyouth: Threat Learning, or opportunity LLC. Washington, DC: National© Jones &nomics Bartlett in eating Learning, choices and LLC weight outcomes,” in Agricul- NOT FOR SALEAcademies OR DISTRIBUTIONPress. NOT FORtural SALE Information OR DISTRIBUTION Bulletin No 791. Washington, DC: U.S. Israel, B. A, and K. A. Rounds. 1987. “Social networks and social Department of Agriculture, Economic Research Service. support: A synthesis for health educators.” Health Educa- MacIntosh, W. A. 1996. Sociologies of food and nutrition. tion and Promotion 2: 311–351. New York: Plenum Press. Kaya, I. H. 2016. “Motivation factors in consumers’ food choice.” Mallya, A., F. A. Mensah, I. R. Contento, and P. A. Koch. 2012. Food and Nutrition© Sciences Jones 7: 149–154.& Bartlett Learning, LLC “Extending science beyond© Jones the classroom & Bartlett door: Learning, Learn- LLC Kittler, P. G., K. P. Sucher,NOT and FORM. Nahikian-Nelms. SALE OR DISTRIBUTION2017. Food ing from students’ experienceNOT FORwith the SALE Choice, OR Control DISTRIBUTION & and culture. Boston, MA: Cengage. Change (C3) curriculum.” Journal of Research in Science Koch, P. A., I. R. Contento, H. L. Gray, M. Burgermaster, Teaching 49: 244–269. L. Bandelli, E. Abrams, and J. Di Noia. 2019. “Food, Martinez Steele, E., B. M. Popkin, B. Swinburn, and Health, & Choices: Curriculum and Wellness Interventions C. A. Monteiro. 2017. “The share of ultra-processed foods to© Decrease Jones Childhood& Bartlett Obesity Learning, in Fifth-Graders.” LLC Journal and overall© Jones nutritional & Bartlett quality ofLearning, diets in the US:LLC evidence ofNOT Nutrition FOR Education SALE andOR Behavior DISTRIBUTION, 51(4): 440–455. fromNOT a nationally FOR SALErepresentative OR DISTRIBUTION cross-sectional study.” Koch, P. A., R. L. Wolf, R. J. Trent, and L. Guerra. “School Trans- Population Health Metrics 15: 6. formation and Redesign of Cafeterias (STARCafé) increases Mathias, K. C., B. J. Rolls, L. L Birch, T. V. Krajl, E. L. Hanna, reported participation, time to eat and positive attitudes A. Davry, and J. O. Fisher. 2012. “Serving larger portions of towards school lunch: A Three Case Pilot Study.” Healthy fruits and vegetables together at dinner promotes intake of © Jones & BartlettEating Research Learning, 13th Annual LLC Grantee Meeting. Robert Wood© Jones &both Bartlett foods among Learning, young children.” LLC Journal of the Academy NOT FOR SALEJohnson OR Foundation. DISTRIBUTION March 13–15, 2019. NOT FORof SALE Nutrition OR and DISTRIBUTION Dietetics 112(2): 266–270.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORMattes, SALE R. D. 1993. OR “Fat DISTRIBUTION preference and adherence to a reduced-fat NOTPatrick, FOR H., SALE E. Hennessy, OR DISTRIBUTION K. McSpadden, and A. Oh. 2013. diet.” American Journal of Clinical Nutrition 57(3): 373–381. “Parenting styles and practices in children’s obesogenic ———. 1997. “The taste for salt in humans.” American Journal behaviors: scientific gaps and future directions.” Childhood of Clinical Nutrition 65(2 Suppl): 692S–697S. Obesity 9 (Suppl 1): S73–S86. Mennella, J. A. and N. K. Bobowski. 2015.”The sweetness and Patrick, H., T. A. Nicklas, S. O. Hughes, and M. Morales. 2005. bitterness of childhood:© InsightsJones from & Bartlett basic research Learning, on LLC“The benefits of authoritative© feeding Jones style: & BartlettCaregiver feed Learning,- LLC taste preferences.” PhysiologyNOT &FOR Behavior. SALE 152: OR502–507. DISTRIBUTIONing styles and children’s foodNOT consumption.” FOR SALE Appetite OR 44:DISTRIBUTION Mennella, J. A., C. E. Griffin, and G. K. Beauchamp. 2004. “Flavor 243–249. programming during infancy.” Pediatrics 113(4): 840–845. Pelchat, M. L., and P. Pliner. 1995. “Try it. You’ll like it.’ Effects Mennella, J. A., C. P. Jagnow, and G. K. Beauchamp. 2001. of information on willingness to try novel foods.” Appetite “Prenatal and postnatal flavor learning by human infants.” 24(2): 153–165. Pediatrics© Jones 107(6): E88.& Bartlett Learning, LLC Peters, J. C., H.© R. Jones Wyatt, W.& T.Bartlett Donahoo, Learning, and J. O. Hill. LLC 2002. Monteiro,NOT C.A., J.C.FOR Moubarac, SALE G.OR Cannon, DISTRIBUTION S. W. Ng, and B. “From instinctNOT to FOR intellect: SALE The challengeOR DISTRIBUTION of maintaining Popkin. 2013. “Ultra-processed products are becoming healthy weight in the modern world.” Obesity Reviews 3(2): dominant in the global food system.” Obesity Reviews 69–74. 14(Suppl. 2): 21–28. Pliner, P., M. Pelchat, and M. Grabski. 1993. “Reduction of neo- Morland, K., S. Wing, and A. Diez Roux. 2002. “The contextual phobia in humans by exposure to novel foods.” Appetite © Jones &effect Bartlett of the local Learning, food environment LLC on residents’ diets: The © Jones20(2): & 111–123. Bartlett Learning, LLC NOT FORatherosclerosis SALE OR riskDISTRIBUTION in communities study.” American Jour- NOTPontzer, FOR H., SALE B. M. Wood,OR DISTRIBUTION and D. A. Raichlen. 2018. “Hunter- nal of Public Health 92(11): 1761–1767. gatherers as models of public health.” Obesity Reviews. Moss, M. 2013. Salt, fat, sugar. New York: Random House. 19(suppl. 1): 24–35. National Cancer Institute. 2007. Health information national Powell, L. M., S. Slater, D. Mirtcheva, Y. Bao, and F. J. Chal oupka. trends survey. http://hints.cancer.gov/docs/HINTS2007 2007. “Food store availability and neighborhood charac- FinalReport.pdf. © Jones & Bartlett Learning, LLCteristics in the United States.”© Jones Preventive & MedicineBartlett 44(3): Learning, LLC Neumark-Sztainer, D., P. J.NOT Hannan, FOR M. SALE Story, J. OR Croll, DISTRIBUTION and 189–195. NOT FOR SALE OR DISTRIBUTION C. Perry. 2003. “Family meal patterns: Association with Remington, A., E. Anez, H. Croker, J. Wardle, and L. Cooke. sociodemographc characteristics and improved dietary 2012. “Increasing food acceptance in the home setting: intake among adolescents.” Journal of the American Dietetic A randomized controlled trial of parent-administered taste Association 103: 317–322. exposure with incentives.” American Journal of Clinical Nicklaus, ©S., JonesV. Boggio, & C.Bartlett Chabanet, Learning, and S. Issanchou. LLC 2004. Nutrition ©95: Jones 72–77. & Bartlett Learning, LLC “A prospectiveNOT FOR study SALE of food OR preferences DISTRIBUTION in childhood.” Rhee, K. 2008.NOT “Childhood FOR SALE overweight OR andDISTRIBUTION the relationship Food Quality and Preference 15: 805–818. between parent behaviors, parenting style, and family func- Ochs, E. and M. Beck. 2013. “Dinner.” In: Fast-forward family: tioning.” Annals of the American Academy of Political and Home, work, and relationships in middle-class America. Social Science 615(1): 11–37. Editors: E. Ochs and T. Kremer-Sadlik. Berkeley, CA: Rittenbaugh, C. 1982.” Obesity as a culture-bound syndrome.” © Jones &University Bartlett of CaliforniaLearning, Press. LLC © JonesCulture & Bartlett and Medical Learning, Psychiatry 6:LLC 347–361. NOT FORO’Connor, SALE T. M., OR S. DISTRIBUTIONO. Hughes, K. B. Watson, T. Baranowski, NOTRobinson, FOR SALEJ. P., and OR G. Godbey. DISTRIBUTION 1999. Time for life: The surpris- T. A. Nicklas, J. O. Fisher, A. Beltran, et al. 2010. “Parent- ing ways Americans use their time, 2nd ed. University Park, ing practices associated with fruit and vegetable consump- PA: Pennsylvania State University Press. tion in pre-school children.” Public Health Nutrition 13(1): Robinson, T. N., M. Kiernan, D. M. Matheson, and K. F. Haydel. 91–101. 2001. “Is parental control over children’s eating associated O’Connor, T. M., L. C. Masse,© Jones A. W. Tu, & BartlettA. W. Watts, Learning, S. O. LLCwith childhood obesity? Results© Jones from a &population-based Bartlett Learning, LLC Hughes, M. R. Beauchamp,NOT T. Baranowski, FOR SALE et al. OR 2017. DISTRIBUTION“Food sample of third graders.” ObesityNOT Research FOR SALE 9(5): 306–312. OR DISTRIBUTION parenting practices for 5 to 12 year old children: A concept Rokeach, M. 1973. The nature of human values. New York: Free map analysis of parenting and nutrition experts input.” Press. International Journal of Behavioral Nutrition and Physical Rolls, B. 2000. “Sensory-specific satiety and variety in the meal,” Activity 14: 122. in Dimensions of the meal: The science, culture, business, Pai, H. L.,© and Jones I. R. Contento. & Bartlett 2014. “Parental Learning, perceptions, LLC feed- and art of© eating Jones, edited & by Bartlett H. L. Meiselman. Learning, Gaithersburg, LLC ing practices,NOT FOR feeding SALE styles, OR and DISTRIBUTIONlevel of acculturation of MD: AspenNOT Publishers. FOR SALE OR DISTRIBUTION Chinese Americans in relation to their school-age child’s Rose, D., J. N. Bodor, C. M. Swalm, J. C. Rice, T. A. Farley, and weight status.” Appetite 80: 174–182. P. L. Hutchinson. 2009. Food deserts in New Orleans? Illus- Patrick, H., and T. A. Nicklas. 2005. “A review of family and trations of urban food access and implications for policy. social determinants of children’s eating patterns and diet Presented at Understanding the Economic Concepts and © Jones &quality.” Bartlett Journal Learning, of the American LLC College of Nutrition. 24(2): © JonesCharacteristics & Bartlett of Learning,Food Access. USDA,LLC Washington, DC. NOT FOR83–92. SALE OR DISTRIBUTION NOT FORJanuary SALE 23, 2009. OR University DISTRIBUTION of Michigan National Poverty

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALECenter/USDA OR DISTRIBUTION Economic Research Service. http://wwwNOT FORSmall, SALE D. M., and OR J. Prescott.DISTRIBUTION 2005. “Odor/taste integration and .npc.umich.edu/news/events/food-access/index.php. the perception of flavor.” Experimental Brain Research Rosland, A. M., E. Kieffer, B. Israel, M. Cofield, G. Palmisano, 166(3–4): 345–357. B. Sinco, M. Spencer, et al. 2008. “When is social support Smith, D., S. Cummins, C. C. Clark, and S. Stansfeld. 2013. important? The association of family support and pro- “Does the local food environment around schools affect fessional support with© Jones specific &diabetes Bartlett self-management Learning, LLC diet? Longitudinal associations© Jones in &adolescents Bartlett attending Learning, LLC behaviors.” JournalNOT of General FOR InternalSALE MedicineOR DISTRIBUTION 23(12): secondary schools in London.”NOT FOR BMC PublicSALE Health OR . DISTRIBUTION13: 70. 1992–1999. Sobo, E. 1997. “The sweetness of fat: Health, procreation, and Rozin, P. 1988. “Social learning about food by humans,” in Social sociability in rural Jamaica,” in Food and culture: A reader, learning: Psychological and biological perspectives, edited by edited by C. Counihan and P. Van Esterik. New York: Rout- T. R. Zengall and G. G. Bennett. Hillsdale, NJ: Lawrence ledge, pp. 251–255. Erlbaum.© Jones & Bartlett Learning, LLC Society for© Nutrition Jones &Education Bartlett and Learning, Behavior. 2016. LLC Compe- ———.NOT 1996. FOR “Sociocultural SALE OR influences DISTRIBUTION on human food tenciesNOT for nutritionFOR SALE educators. OR www.sneb.org/nutritionDISTRIBUTION selection,” in Why we eat what we eat: The psychology of -educator-competencies/. eating, edited by E. D. Capaldi. Washington, DC: American Spill, M. K., L. L. Birch, L. S. Roe, and B. J. Rolls. 2010. “Eating Psychological Association. vegetables first: The use of portion size to increase vegetable Rozin, P., and A. E. Fallon. 1987. “A perspective on disgust.” intake in preschool children.” American Journal of Clinical © Jones & BartlettPsychology Learning, Review 1: 23–41. LLC © Jones &Nutrition Bartlett 91(5): Learning, 1237–1243. LLC NOT FORRozin. SALE P, A. OR K. Remick,DISTRIBUTION and C. Fischler. 2011. “Broad themesNOT of FOR———. SALE 2011. “Serving OR DISTRIBUTION large portions of vegetable soup at the difference between French and Americans in attitudes to start of a meal affected children’s energy and vegetable food and other life domains: Personal versus communal intake.” Appetite 57(1): 213–219. values, quantity versus quality, and comforts versus joys.” Stanek, K., D. Abbott, and S. Cramer. 1990. “Diet quality and Frontiers in Psychology 2: 177. the eating environment of preschool children.” Journal of Running, C. A., B. A. Craig,© Jones and R.D. & Mattes. Bartlett 2015. “Learning,Oleogustus: LLC the American Dietetic Association© Jones 90: & 1582–1584.Bartlett Learning, LLC The unique taste ofNOT fat.” Chemical FOR SALE Senses OR40: 507–516. DISTRIBUTIONStory, M., and S. French. 2004.NOT “Food FOR advertising SALE OR and DISTRIBUTION mar- Salvy, J. S., M. Howard, M. Read, and E. Mele, 2009. “The pres- keting directed at children and adolescents in the US.” ence of friends increases food intake in youth.” American International Journal of Behavioral Nutrition and Physical Journal of Clinical Nutrition 90(2): 282–287. Activity 1(1): 3. Satia-Abouta, J., R. E. Patterson, M. L. Neuhouser, and J. Elder, Stunkard, A. 1975. “Satiety is a conditioned reflex.” Psychoso- 2002.© Jones “Dietary & Bartlettacculturation: Learning, Applications LLC to nutrition matic© Medicine Jones 37(5): & Bartlett 383–387. Learning, LLC researchNOT FOR and dietetics.” SALE OR Journal DISTRIBUTION of the American Dietetic SupermarketNOT News. FOR June SALE 3, 2013. OR Study DISTRIBUTION shows shoppers’ digi- Association 102(8): 1105–1118. tal health trends. http://supermarketnews.com/datasheet Satter, E. 2000. Child of mine: Feeding with love and good sense. /june-3-2013-study-shows-shoppers-digital-health 3rd ed. Boulder, Colorado: Bull Publishing. -trends. Savage, J. S., J. O. Fisher, and L. L. Birch. 2007. “Parental influ- Tepper, B. J. 2008. “Nutritional implications of genetic taste © Jones & Bartlettence on eating Learning, behavior: LLC Conception to adolescence.” Jour© -Jones &variation: Bartlett The Learning, role of PROP sensitivityLLC and other taste phe- NOT FOR SALEnal of ORLaw andDISTRIBUTION Medical Ethics 35(1): 22–34. NOT FORnotypes.” SALE AnnualOR DISTRIBUTION Review of Nutrition 28: 367–388. Savage, J. S., I. H. Halsfield, J. O. Fisher, M. Marini, and L. L. Trabulsi, J. C., and J. A. Mennella. 2012. “Diet, sensitive peri- Birch. 2012. “Do children eat less at meals when allowed to ods in flavor learning, and growth.” International Review serve themselves?” American Journal of Clinical Nutrition of Psychiatry 24: 219–230. 96(1): 36–43. Tucker R. M., R. D. Mattes, and C. A. Running. 2014. “Mecha- Schwartz, S. H. 1992. “Universals© Jones in & the Bartlett content and Learning, structure LLC nisms and effects of “fat© taste” Jones in humans.” & Bartlett Biofactors Learning, 40(3): LLC of values: TheoreticalNOT advances FOR andSALE empirical OR DISTRIBUTIONtests in 20 313–326. NOT FOR SALE OR DISTRIBUTION countries,” in M. Zanna (ED), Advances in Experimental U.S. Department of Agriculture. 2016. Food security status of Social Psychology Vol 25, pp 1–66. New York: Academic United States households. Washington, DC: USDA, Eco- Press. nomic Research Service, https://www.ers.usda.gov/topics Sclafani, A., and K. Ackroff. 2004. “The relationship between /food-nutrition-assistance/food-security-in-the-us/key food© Jones reward and& Bartlett satiation revisited.” Learning, Physiology LLC and Behav- -statistics-graphics.aspx.© Jones & Bartlett Learning, LLC iorNOT 82(1): FOR 89–95. SALE OR DISTRIBUTION ———. 2 017.NOT Food FOR Environment SALE AtlasOR. DISTRIBUTIONWashington, DC: USDA, Shepherd, R. 1999. “Social determinants of food choice.” Pro- Economic Research Service. http://www.ers.usda.gov/data ceedings of the Nutrition Society 58(4): 807–812. -products/food-environment-atlas.aspx. Skinner, J. D., B. R. Carruth, B. Wendy, and P. J. Ziegler. 2002. ———. 2 018 . Food Expenditures. Washington, DC: USDA Eco- “Children’s food preferences: A longitudinal analysis.” nomic Research Service. https://www.ers.usda.gov/data © Jones & BartlettJournal ofLearning, the American LLC Dietetic Association 102(11):© Jones &-products/ag-and-food-statistics-charting-the-essentials Bartlett Learning, LLC NOT FOR SALE1638–1647. OR DISTRIBUTION NOT FOR/food-prices-and-spending/. SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORU.S. Department SALE OR of Labor,DISTRIBUTION 2012. Supplemental Poverty Measure NOT FORstatus SALEamong children, OR DISTRIBUTION ages 10–12 years in eight European Thresholds: Imputing School Lunch and WIC Benefits to the countries: the ENERGY cross-sectional study.” Interna- Consumer Expenditure Survey Using the Current Population tional Journal of Behavioral Nutrition and Physical Activ- Survey. https://www.bls.gov/pir/spm/spm_pap_wic12.pdf. ity 10: 58. U.S. Department of Labor, 2018. American Time Use Statis- Wang, Y., M. Beydoun, J. Li, Y. Liu, and L. A. Moreno. 2011. “Do tics, 2017. Washington,© DC:Jones United & StatesBartlett Department Learning, LLCchildren and their parents eat© aJones similar diet?& Bartlett Resemblance Learning, LLC of Labor, Bureau of LaborNOT Statistics, FOR SALEhttps://www.bls.gov OR DISTRIBUTION in child and parental dietaryNOT intake FOR– systematic SALE review OR and DISTRIBUTION /news.release/pdf/atus.pdf . meta-analysis.” Journal of Epidemiology and Community Van der Horst, K., S. Kremers, I. Ferreira, A. Singh, A. Health 65(2): 177–189. Oenemaand, J. Brug. 2007. “Perceived parenting style and Wansink B., D. R. Just, C. R. Payne, and M. Z. Klinger. 2012. practices and the consumption of sugar-sweetened bev- “Attractive names sustain increased vegetable intake in erages© by adolescents.” Jones & Bartlett Health EducationLearning, Research LLC 22(2): schools.” Preventive© Jones Medicine & Bartlett 55(4): 330–332.Learning, LLC 295–304.NOT FOR SALE OR DISTRIBUTION Wardle, J., L. L.NOT Cooke, FOR E. L. Gibson,SALE M. OR Sapochnik, DISTRIBUTION A. Sheiham, Vaughn, A.E., D. S. Ward, J. O. Fisher, M. S .Faith, S. O. Hughes, and M. Lawson. 2003. “Increasing children’s acceptance S. P. Kremers, D. R. Musher-Eizeman, et al. 2016. “Funda- of vegetables; a randomized trial of parent-led exposure.” mental constructs in parenting practices: A content map Appetite 40(15): 155–162. to guide future research.” Nutrition Reviews 74(2): 98–117. Washington State Magazine. 2013. Annual income spent on © JonesVentura, & Bartlett A. K., and Learning, L. L. Birch. LLC2008. “Does parenting affect © Jonesfood. & [map]. Bartlett Washington Learning, State University. LLC http://wsm.wsu NOT FORchildren’s SALE eatingOR DISTRIBUTION and weight status?” International Journal NOT FOR.edu/researcher/WSMaug11_billions.pdf. SALE OR DISTRIBUTION of Behavioral Nutrition and Physical Activity 5: 15. Williams, J., P. Scarborough, A. Matthews, G. Cowburn, C. Ver Ploeg, M., V. Breneman, T. Farrigan, K. Hamrick, Foster, and M. Rayner. 2014. “A systematic review of the D. Hopkins, P. Kaufman, Biing-Hwan Lin, et al. 2009. influence of the retail environment around schools on “Access to affordable and nutritious food—measuring obesity-related outcomes.” Obesity Reviews 15: 359–374. and understanding food© deserts Jones and & their Bartlett consequences.” Learning, World LLC Health Organization. 2013.© MarketingJones & of foodBartlett high in Learning, fat, LLC Report to Congress. UnitedNOT States FOR Department SALE OR of Agricul DISTRIBUTION- salt and sugar to children: updateNOT 2012–2013. FOR SALE Copenhagen, OR DISTRIBUTION ture, Administrative Publication No. (AP-036). Denmark: WHO Regional Office for Europe. Vik, F. N., H. B. Bjornara, N. C. Overby, N. Lien, O. Andr outsos, Zimmerman, F., and Shimoga, S. V. 2014. “The effects of L. Maes, Jan Natasa, et al. 2013. “Associations between food advertising and cognitive load on food choices.” BMC eating meals, watching TV while eating meals and weight Public Health 14: 342. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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