Eating Behaviors and Characteristics of Healthy Foods As Perceived by College Students

Eating Behaviors and Characteristics of Healthy Foods as Perceived by College Students

Sangmook Lee, M.S.

A THESIS

RESTAURANT, HOTEL, AND INSTITUTIONAL MANAGEMENT

Submitted to the Graduate Faculty of Texas Tech University in Partial Fulfillment of the Requirements for the Degree of

MASTER OF SCIENCE

Approved

Dr. Deborah Fowler Committee Chair

Dr. Jessica Yuan

Ralph Ferguson Dean of the Graduate School

December, 2010

ACKNOWLEDGMENTS

This thesis would not have been possible without the guidance and help of several individuals who in one way or another contributed and extended their valuable assistance in the preparation and completion of this study.

First and foremost, my greatest gratitude to Dr. Deborah Fowler, whose sincerity and support I will never forget. She helped me to make my thesis accurate with her passion and great effort. Dr. Fowler has been my inspiration as I hurdled all the obstacles while completing this research work. I also offer my sincere appreciation to my committee member, Dr. Jessica Yuan. I appreciate her kind concern and consideration regarding my academic requirements. I will not forget it.

I would also like to say how much I admire Dr. Ben Goh and Dr. Lynn Huffman. They have always supported and trusted this process. I could not have finished this great goal without their help. I would also like to acknowledge Dr. Ji-Hyun Yoon who was my masters’ advisor when I was a graduate student in South Korea. I wrote this thesis based on her guidance.

I would like to express my gratitude to my good friend, and teacher, Barbara Werden, for her help and consideration. She has cared for me as “hanguk adeul” (Korean son). I could not have done this without you. It has been my honor to meet you here in

Lubbock, Texas.

I also want to thank the many other friends who contributed to the success of this study. To Hak-Seon Kim, thank you for your time and effort for my thesis; your care was very helpful. You are a good friend and teacher to me. To my best friends: Hyun-

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Oh Kang, Hyun-Pyo Kim, Kwang-Woo Lee, Hyun-Woo Joung, and Eun-Kyung Choi, thank you for your meaningful contributions to this study and to Eugene, Sung-Ae,

Nae-Hyun, Ho-Gi, Do-Hwan, Joung-Sung, and Hyo-Jung, thank you for all your continuous cheering.

My fiancée, Bo-Ae Jang, gave me much thoughtful support and endless love. I am a very lucky guy because you are with me. I love you.

Finally, I want to thank my parents: Zu-Hong Lee and Bok-Soon Joung, and family:

Tae-Mook Lee, Myong-Jun Lee, Ji-Mook Lee, Myong-Jin Park. Without your financial and emotional support, it would have been impossible to finish my thesis. I love you so much, and you all “make my life.” I want to dedicate this thesis to them.

Thank you, again.

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TABLE OF CONTENTS

ACKNOWLEDGMENTS...... ii

ABSTRACT...... vii

LIST OF TABLES ...... viii

LIST OF FIGURES ...... ix

I. INTRODUCTION...... 1

Research Objectives...... 4

Research Questions ...... 5

The Study Site and Informants...... 6

Limitations ...... 6

II. LITERATURE REVIEWS...... 7

Obesity in the United States...... 7

Trends in the Foodservice Industry...... 9

College Students’ Eating Behaviors...... 13

Healthy Foods ...... 17

Research Objectives ...... 19

Data Collection and Sample Size ...... 19

III. METHODOLOGY ...... 21

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Data and Sample...... 21

Pilot Study...... 21

Data Analysis ...... 22

IV. RESULTS AND DISCUSSION...... 23

Demographics ...... 23

Healthy Food Information Sources ...... 26

Body Mass Index (BMI) and Self-described Body Image ...... 28

Eating Behaviors of College Students...... 34

Healthy Food...... 36

Comparison between Normal Food and Healthy Food...... 36

Color...... 37

Important Healthy Food Features ...... 39

Classification of Healthy Food Factors...... 41

Comparison of Feature of Healthy Food by Gender...... 43

Health Concern and Health Knowledge ...... 45

Correlation...... 45

Gender Comparison ...... 48

V. SUMMARY AND CONCLUSION...... 50

Findings of the study ...... 51

Demographic Characteristics ...... 51

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Features of Healthy Foods ...... 51

College Student Healthy Eating Behaviors...... 53

Healthy Knowledge and Concern...... 54

Implication of the Study ...... 54

Limitations and Future Study...... 55

REFERENCES...... 57

APPENDICES

A. QUESTIONNAIRE ...... 73

B. IRB APPROVAL LETTER...... 76

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ABSTRACT

The rate for obesity has increased steadily in the United States, and approximately two-thirds of U.S. adults over the age of 20 now face the challenge of being overweight or obese. Therefore, the need for dietary changes and eating healthy foods has become crucial. This study was designed to determine the healthy eating behavior of college students and the characteristics of healthy foods as reported by college students at a university in the southwestern United States. Out of two hundred questionnaires distributed, one-hundred-sixty-one questionnaires were collected and analyzed in this study; the response rate was 80.5%. Every informant was asked which factors were important when they chose a healthy food. The results of this study validated the premise that healthy foods could be identified by classifying several features common to them, and that healthy food could then be defined using these characteristics: “low calorie food” (α=.869), “low greasy food & healthy drink”

(α=.764), and “low cholesterol food “ (α=.734). In addition, the results showed the perception of healthy foods was significantly different based upon the demographic characteristics. But, this study found few differing factors for “healthy food choice” decisions as compared to other types of foods among this population of college students. Even though the correlation was not considered to be a strong one, there was a significantly positive correlation between knowledge of healthy foods and health concern (γ = 0.172, p = 0.029). This study helped to classify the characteristics of healthy food and, therefore, this information could be used to develop healthy menus in university foodservice settings and related marketplaces.

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LIST OF TABLES

1 Demographic Characteristics...... 24

2 Healthy Food Information Sources ...... 27

3 Results of ANOVA Demographics and BMI ...... 30

4 Gender Comparison of Self-described Image and BMI...... 31

5 Cross Tabulation of Self-described Body Mass Index...... 33

6 Frequency of Use University Foodservice ...... 34

7 Gender Comparison in Typical Eating Behavior...... 35

8 Paired Sample t-test for Important Factors in Food Choice ...... 37

9 Healthy Food Colors ...... 38

10 Important Feature of Healthy Foods among College Students...... 40

11 Factor Analysis Results of Healthy Food Characteristics

Factors ...... 41

12 Comparison of Feature of Healthy Food by Gender...... 44

13 Result of ANOVA between Health Concern Variables and

Demographic Information ...... 47

14 Gender comparison of Health Concerns and Knowledge of

Healthy Food...... 49

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LIST OF FIGURES

1 Histogram and normal curve of participants’ BMI...... 29

2 Histogram and normal curve of participants’ self-described

BMI ...... 29

3 Diagram of healthy colors by college students...... 39

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CHAPTER I

INTRODUCTION

Approximately two-thirds of U.S. adults over the age of 20 face the challenge of being overweight or obese (Hedley et al., 2004). The obesity rate has increased steadily in the U.S. over the last 30 years (Ogden et al., 2006). National Health and

Nutrition Examination Survey II (NHANES) reported about 15% of adults over 20 years old were obese during 1976–1980. In the 1988–1994 NHANES III, obesity rates increased over than 20%. In 2007 the NHANES reported that over one-third (34%) of

American adults were obese and the majority (65.7%) of American adults are also overweight or obese (Ogden, Carroll, McDowell, & Flegal, 2007). There was a continuous increase in the prevalence of obesity from the NHANES 2003–2004 study

(30.6%) to the 2005–2006 study even though there was no significant increase (Ogden et al., 2007).

Previous research has shown the most important factors predicting food selection among adults are: taste, cost, nutrition, convenience, pleasure, and weight control (Glanz, Basil, Maibach, Goldberg, & Snyder, 1998). Many previous studies have shown people often establish taste preferences and eating habits while they are relatively young (Birch, 1999; Drewnowski & Hann, 1999). However, the most important time of life for food selection choice is when they are college students

(Deshpande & Basil, 2009). When individuals leave the family home to attend college is a critical period for young adults, in which they are given the opportunity to make

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their own food decisions and can have a negative impact on students’ eating behaviors

(Marquis, 2005).

Eating behavior is a modifiable health behavior. Food choices, like many other health behaviors, can be affected by a number of factors. The prevalence of increasing rates of obesity, which is a result of excessive caloric intake in relation to caloric output, is evident across all populations and is raising concern. Additionally, inadequate consumption of nutrients essential to health presents a risk to the nation’s level of wellness (Hendricks & Herbold, 1998). Hendricks and Herbold (1998) constructed a report that summarizes data from the NHANES III and for overall increase in rates of obesity, while demonstrating dietary patterns that are low in iron, folate, and calcium intakes.

Numerous studies have reported college students often have poor eating habits.

Students tend to eat fewer fruits and vegetables on a daily basis and report high intake of high-fat, high-calorie foods (Driskell, Kim, & Goebel, 2005; Racette, S. S.

Deusinger, Strube, Highstein, & R. H. Deusinger, 2005). A 2006 study by the

American College Health Association revealed only 7.3% of college students eat five or more servings of fruits and vegetable daily. The change to college life often deteriorates dietary habits among students (Grace, 1997) which could contribute to weight problems especially during the first year of college and continue during life of later years (Racette, S. S. Deusinger, Strube, Highstein, & R. H. Deusinger, 2005).

The eating behaviors college students choose may not always be based on scientific evidence. In fact, eating behaviors may be based on advice from friends and family, television and the media, from the variety of diet books available, or from the

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latest trendy diets. Currently, many books which are related to diet and Internet sources are based around a similar idea that all high-calorie food needs to be eliminated or customized in order to lose weight. There are very few studies to support the safety of these diets, or to evaluate the impact. We need to study more about college students’ eating behavior or important factors to evaluate eating behaviors

(Wedig & Nock, 2010).

One quarter of all individuals aged 18–24 in the United States are currently enrolled in the nation’s colleges and universities (Kisch, Leino, & Silverman, 2005).

College students exhibit a distinct decline in nutritional priorities, and poor eating habits often make something worse during this time. Most student diets are compose of fast-food that are high in fat and sodium content (Baskin, Ard, Franklin, & Allison,

2005; General, 2001). In 1986, (Melby, Femea, & Sciacca, 1986) reported that 69% of college students did not eat any fruit even once a day and 48% ate vegetables less than once daily. In addition, the U.S. Department of Health and Human Services reported that the frequency of participating in vigorous exercise three or more times a week declined 6.2 percentage points for men and 7.3 percentage points for women (Kisch,

Leino, & Silverman, 2005).

In 2006 U.S. Department of Education reported in Healthy People 2010 specifically identified postsecondary educational institutions as settings where young adults (aged 18–24) should be targeted for exercise promotion. One aspect of promoting a healthy lifestyle within educational institutions is the presence of required health and physical education courses (Pearman et al., 1997). Although some studies suggest that university-sponsored physical activity and health classes have the

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potential to positively affect the attitudes and behaviors of the students, others have been uncertain (Cardinal, Jacques, & Levy, 2002). In the meantime, knowledge about healthy foods may influence people to develop a healthy diet, but there are very few studies which assessed how college students’ knowledge of the nutritional value of healthy foods affected dietary choice.

Few studies have studied the eating behavior of college students (Galloway,

Farrow, & Martz, 2009; Hekler, Gardner, & Robinson, 2010; Le Grange, Telch, &

Tibbs, 1998; Li et al., 2009; Rucker III & Cash, 1992). This study will assess college students’ eating behavior related to healthy food choices. An enhanced understanding of factors that influence healthy food knowledge, eating behaviors, and characteristics of healthy foods will enable university foodservice or health-care providers to construct more effective interventions or management for improving their health in this population. This research has the potential to benefit the eating habits of university students which merits future consideration.

Research Objectives

The transition to college or university is an important period for young people, who are often facing their first opportunity to make their own food decisions. Young adults can make choices that will have a negative or positive impact on their eating behaviors. Obesity is a very serious problem in the United States, and college students are no exception to the issues of health and healthy food choices that may be offered by the foodservice industry. Therefore, we need to find useful information about healthy foods and classify the characteristics of healthy foods especially for young adults such as college students.

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This study attempts to: (a) provide useful information for foodservice management, (b) find several characteristics of healthy food, and (c) develop and plan healthy menus for college students. Based upon these objectives, the survey instrument was developed to answer the following research questions.

Research Questions

1. Where do college students get information about healthy foods?

2. Does any color(s) represent healthy foods?

3. Which factor(s) are different for healthy food-choice decisions as compared to

other types of foods?

4. What are the characteristics of healthy foods?

5. What are the eating behaviors of college students?

6. D

o demographic characteristics affect college students’ knowledgeable of

healthy foods?

7. Do demographic characteristics affect college students’ eating behavior toward

healthy foods?

8. Do demographic characteristics affect college students’ concerned about

healthy foods?

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The Study Site and Informants

The data were collected at a university in the southwestern United States during the spring of 2010 following a pilot study to test the instrument developed by the researcher. Male and female college students completed the survey, providing information about their height and weight, and how they make food choices.

Limitations

There were limitations in this study. First, even though this study reported on the characteristics of healthy foods and healthy eating behaviors among college students, these results cannot be generalized, because all participants lived only in the

Southwestern part of the United States. Thus, these results may not be representative of all college students in the U.S. Therefore, further study using other college students throughout the country is needed to assure these results.

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CHAPTER II

LITERATURE REVIEWS

Obesity in the United States

Obesity can be defined as a disease in which excess body fat has accumulated such that a person’s health may be adversely affected (Bray, 1985). There are several different techniques used to assess obesity such as the body mass index (BMI), waist circumference, skin-fold thickness, calculation of waist-to-hip circumference ratios, and underwater weighing. The BMI is one of most popular methods used to assess obesity and the World Health Organization (WHO) classified the BMI cutoff point.

However, BMI has some limitations such as BMI does not only measure body fat but muscle and bones (Stein & Colditz, 2004). For example, the athlete or body builder may have a higher BMI than others because of their dense muscle tissue. Therefore

BMI can underestimate or overestimate weight. Even though BMI cannot measure body fat exactly (Stein & Colditz, 2004), there are a number of studies that have found a relationship between BMI and health problems (Franks et al., 2004; Kopelman,

2000; Stein & Colditz, 2004).

Obesity is broadly recognized as a significant and growing health problem in the United States (Flegal, Carroll, Ogden, & Curtin, 2010; Flegal, Carroll, Ogden, &

Johnson, 2002; Flegal, Graubard, Williamson, & Gail, 2005; Mokdad et al., 2003).

Over the past 30 years in the United State, obesity rates among adults have doubled

(Ogden et al., 2006; Ogden, Carroll, & Flegal, 2008) and childhood obesity rates have nearly tripled during the same period (Forshee et al., 2007; Levi, Vinter, Laurent, & 7 Texas Tech University, Sangmook Lee, December 2010

Segal, 2008). Childhood obesity has been recognized as a major public health problem in the U.S. and in many developed countries of the world (Koplan, Liverman, &

Kraak, 2005; Wang, 2001). Childhood obesity is a serious problem because these children have a high possibility to be obese in the future (McDowell, Fryar, Ogden, &

Flegal, 2008; Wang, Monteiro, & Popkin, 2002). The increase of obesity in children and adolescents was found in the U.S., China, Brazil, and Russia, with the highest increased rate occurring of obesity in the U.S. (Wang, 2001).

The U.S. obesity rate among adults (34.3%) is the highest in the countries belonging to the Organization for Economic Cooperation and Development (OECD), followed by Mexico (30.0%), and the United Kingdom (24.0%). Obesity rates in the continental European countries were lower, but are also rising (Organization for

Economic Cooperation and Development, 2006).

Every year, more than 300,000 Americans die from obesity-related diseases and conditions (Centers for Disease Control and Prevention, 2007) and obesity impacts the U.S. economy by at least $215 billion a year directly and indirectly by increased medical expenses and loss of productivity. (U.S. Department of Health and

Human Services, 2010). In the United States, obesity is the second leading cause of preventable disease and death, surpassed only by smoking (Mokdad, Marks, Stroup, &

Gerberding, 2004). Obesity is related with increased risk of hypertension, certain cancers, diabetes, and disability, and an elevated risk for all causes death (Haslam &

James, 2005; Ogden et al., 2008). Even though obesity is a consequence of complex factors including an increase in the consumption of calories and a decrease in physical activity, the prevalence of obesity is influenced by environmental factors as well.

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Several researchers reported on the reasons for the prevalence of the obesity (Levi et al., 2008; Morgan, Peters, & Currie, 2010; Singh, Kogan, Van Dyck, & Siahpush,

2008; Wang & Beydoun, 2007): (1) an increase of daily caloric intake, (2) portion sizes, (3) dining out, (4) decreased access to healthy foods, and (5) lower levels of physical fitness activities were factors associated with obesity (Levi et al., 2008).

Also, lower household education and higher poverty levels, low neighborhood social capital, and increased levels of television viewing are important factors contributing to increased level of obesity (Singh et al., 2008).

Trends in the Foodservice Industry

Over the past 30 years, the trend of food consumption has changed in the

United States. The Economic Research Service (ERS) of the United States Department of Agriculture (USDA) reports on the amount of domestic foods available for human consumption in the U.S. The ERS categorized the data for foods consumption as: meats, cheese, eggs, fat, vegetables, fruits, cereals, and beverages. According to the

ERS reports, the total per capita consumption of meat showed a 13.4% increase between 1970 and 2004. Although, the per capita consumption of red meat such as beef, pork, lamb, and mutton decreased a little (15.1%), the per capita consumption of poultry such as turkey and chicken more than doubled (115.1%) during the same period. This data shows that people are concerned about their foods’ fat and cholesterol (Brown et al., 2004). Interestingly, a study reported that women and children preferred consuming chicken more than men (Guenther, Reedy, & Krebs-

Smith, 2008). The per capita consumption of shellfish and fish also increased almost two times (41.0%) during the same period. The per capita food consumption of cheese

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and related products increased sharply (174.6%) during same period. The consumption of vegetables also increased steadily (25.27%) between 1970 and 2004. Consumption of beverages, bottled water, fruit juice, and diet soft drinks increased by 274.1%,

58.9%, and 12.7%, respectively, while the total consumption of milk (low fat, fat free, and skim milk), vegetable juices, and coffee declined sharply by 32.3%, 32.3%, and

31.4%. This might be because children tended to consume more fast food beverages such as soft drinks and less milk (Bowman, Gortmaker, Ebbeling, Pereira, & Ludwig,

2004; Rampersaud, Bailey, & Kauwell, 2003). The data show that food consumption trends keep changing and are related to the change of times.

The U.S. Department of Agriculture estimates that approximately half of every food dollar is spent on food prepared away from home (U.S. Department of

Agriculture, 2007). It includes food purchased at institutional and retail foodservices venues as well as ready-prepared food purchased at grocery stores. The foodservice share of total food sales increased from 41% in 1982 to 49% in 2002 (Sneed &

Strohbehn, 2008), and in 2005, the mean household spending for food away from home (FAFS) was $2,634, a mean of $1,054 per person per month. Restaurant industry sales were forecasted to increase 5% in 2007 to $537 billion dollars, which is

$1.5 billion dollars per day, serving more than 70 billion meals and snacks (National

Restaurant Association, 2007). Also, the Convenience Store News (2006) estimated that global foodservice sales will increase to an estimated $2.7 trillion by 2010. These trends may reflect changes in family composition, lifestyles, and causing less time for food preparation at home (Sneed & Strohbehn, 2008).

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The foodservice industry has undergone a great deal of improvement in recent years (Sneed & Strohbehn, 2008). The restaurant food service industry is an important part of American culture. In 2007 approximately 57% of Americans used “delivery service” to their home or office and about 37% of consumers used “takeout service” according to the National Restaurant Association. The foodservice industry has been modernized by developing technology for automated procurement systems; improved hardware and software interfaces; superior connectivity in multi-unit restaurant facilities; and interactive employee-training tools (Liddle, 2005). Also, food safety in the foodservice industry became one of most important factors. Emphasis on the food safety has increased in recent years because of some factors: (1) increase frequency of meals eaten away from home, (2) more consumer knowledge of food safety, (3) aging population, (4) changes in the foodservice workforce, (6) changes in the foodservice technology, (7) obvious risk factors in the foodservice, and (8) concern about intentional pollution of food (Sneed & Strohbehn, 2008). About half (48%) of consumers who participated in a national survey showed that they had thought about their food safety the last time they ate in a restaurant (Tomazic, Katz, & Harris, 2002).

Increased healthy food consciousness is one of major characteristics in recent times

(Hwang & Lorenzen, 2008).

Several restaurants have replied to people’s increasing healthy food awareness by adding nutritional labeling to their menus (Hwang & Lorenzen, 2008). Recently, many quick-service restaurants have attempted to improve their menus and attract new customers by adding healthy menu items including grilled food, fresh food, yogurt, and low fat milk (National Restaurant Association, 2006). For example, the major

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chains, such as McDonald's, Wendy's, Burger King, and Taco Bell now advertise their healthy menus. These restaurants offer several types of "healthy" options on their menus to attract those who are worrying their weight or those who just want healthier menu options such as salads. For example, salads and salad dressings at McDonalds are relatively low in calories and fat. Also, they are working to change the menus so that McDonalds supports a grilled menu instead of only fried food. Fast food managers are aware that changing some ingredients maybe not be enough; they are changing the cooking. Wendy's also provides some healthier menu items such as broccoli and cheese baked potato instead of French fries. Taco Bell is now offering

"Fresco Style" options that have fewer calories.

The National Restaurant Association (NRA) identified “interest in health and nutrition” among its top 10 consumer trends for 2004. A study of 1,127 menu items lower in fat, 878 regular fat items, and 44% of an unknown classification, from eight restaurant companies found customers were significantly more satisfied with lower-fat menu items than with regular menu items regardless of food type, dining experience, frequency of eating out, or informants’ characteristics (Fitzpatrick, Chapman, & Barr,

1997). In a study by the National Restaurant Association consumers in full-service restaurants reported that they were eating more salads (33%), seafood entrees (30%), chicken entrees (25%), and drinking more bottled water (25%) than they did in the year 2000 (NHR, 2002). Hwang (2008) reported that recently restaurant customers showed the most positive attitudes toward a low-calorie item and were willing to pay more for the item if nutrition information was provided. Foodservice managers may need to use more sophisticated approaches for their companies to survive and make

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money such as providing nutrition information, changing ingredients to healthier choices, and offering organic food. An increased investment in repairing facilities can make more interesting dining environments, and foodservice managers have added

"healthy menus” for their customers. Thus, the managers of this type of foodservice are examining new ways of exploiting market opportunities to satisfy their customers.

For the ultimate success in the foodservice industry, managers must make available healthy menus.

Even though currently many restaurants are trying to change their menus, many foods include extra fat and calories. For example, Wendy's Taco Salad contains about 400 calories if you choose the basic salad. If you add extras, such as cheese, dressing, and fried chicken, the total will rise to nearly 700 calories. This is almost a third of a day's total caloric intake on a 2000 calorie per a day diet when extras are added (National Restaurant Association, 2006). Therefore, foodservice industry managers have to develop an available healthy menu for their customers.

College Students’ Eating Behaviors

The college years are a period of significant change in the lifestyles of young adults. Eating patterns established during college are probably to be maintained for life and may have ongoing influences on college students’ health and their families’ health in the future (Brown, Dresen, & Eggett, 2005). According to several researchers college students have unhealthy eating behaviors, including skipping meals (Huang,

Song, Schemmel, & Hoerr, 1994), frequent snacking on energy-dense food (Skinner,

Salvetti, & Penfield, 1984), and engaging in unhealthy weight-loss methods (Liebman,

Cameron, Carson, Brown, & Meyer, 2001). In addition, dietary intakes of college

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students appear to be higher in fat (saturated fat, cholesterol), and sodium (Hampl &

Betts, 1995), and they are lower in fiber; vitamins A, C, and E; folate; iron; and calcium (Hendricks & Herbold, 1998; Johnston, Solomon, & Corte, 1998). An extensive body of research reveals a diet high in fruits and vegetables is associated with a reduced risk of cancer and heart disease (Glade, 1997; Jacobs, Slavin, &

Marquart, 1995; Hu & Willett, 2002; Terry, Giovannucci, & Michels, 2001; Terry,

Terry, & Wolk, 2001). Researchers report fruit and vegetable consumption of college students is between 2.1 and 5.5 servings per day (Hiza & Gerrior, 2002; Richards,

Kattelmann, & Ren, 2006) which is below the current recommendation of nine servings or 4·1⁄2 cups (United States Department of Agriculture, 2009). Furthermore, college students are less aware than older adults of the health benefits of fruits and vegetables and the effects of poor dietary practices (Chung, Hoerr, Levine, &

Coleman, 2006). Although many nutrition education programs help fruit and vegetable consumption, comparatively few efforts have targeted college students for nutritional interventions (Richards et al., 2006). Traditionally, the most successful programs for diet adaptations have concerned individual contact with a health-care provider or dietitian (Franz, Vanwormer, Boucher, & Pronk, 2006). However, these methods may not fit this population because college students have busy lifestyles and irregular schedules (Skinner et al., 1984). Interestingly, Matvienko, Lewis, & Schafer (2001) reported that participation in a college nutritional science course helped reduce weight and also helped college students translate nutrition knowledge into dietary changes.

College life is very different compared to that of early adolescence. The physical, mental, and social changes that occur during college life can affect eating

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behaviors and nutritional health. College students face many healthy issues, such as alcohol abuse, chronic disease, common cold, and sexually transmitted diseases

(Lowry et al., 2000; Shaffer, Donato, LaBrie, Kidman, & LaPlante, 2005; Wechsler,

Molnar, Davenport, & Baer, 1999). Also many enviromental factors impact students and cause them to behave in specific manners when it comes to food, drinking, and exercise choices (Lowry et al., 2000; Rozin, Bauer, & Catanese, 2003). These influenes can affect body weight and health (Hoffman, Policastro, Quick, & Lee,

2006). Especially, weight increasing is expected for first-year postsecondary students continues to be perpetuated among young adults. The “freshman fifteen” is one of biggest issues in the United States now (Graham & Jones, 2002). The expression is commonly used in the United States and Canada also, and it means that undergradute students typically gain up to fifteen pounds during the freshman year. The belief that weight gained by college students in the first year of study at college or university. In a recent study on first year college students, more than 90% were aware of the

“freshman fifteen” (Graham & Jones, 2002). Few researchers reported that excess weight gain during the freshman year is due to eat high-calorie food, increase consumption of alcohol and unhealthy foods (Butler, Black, Blue, & Gretebeck, 2004;

Levitsky, Halbmaier, & Mrdjenovic, 2004). Not only freshman but all young people face various health problems, such as iron deficiency, eating disorders, obesitiy, poor nutrition, and dental caries (Horacek & Betts, 1998). Several studies reported that some factors influence students’ the eating behaviors. Of these, taste is one of the most important influences on food choice (Barr, 1999; French et al., 1998; Glansz, Basil,

Maibach, Goldberg, & Snyder, 1998; Horacek & Betts, 1998; Neumark, Story, Perry,

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& Casey, 1999). Nicklas et al. (1998) found that Poor eating habits such as skipping breakfast may affect concentration, learning ability, and school performance, and college students who skipped breakfast had lower daily energy levels, and vitamin and mineral intakes compare to other. Generally, dietary inadequancy was two to five times higher for young people who skipped breakfast than for young people who ate breakfast (Nicklas et al., 1998). Eating away from home, concern about physical appearance, body weight, and heavy shedules all have an effect on eating patterns and food choices (Story, Neumark, & French, 2002). Horacek & Betts (1998) reported that out of 350 students studied only 85 (about 26%) were motivated by their health and weight when making dietary choices. However, these students were more likely to have lower intake of fat and higher nutrient intake as compared with students influenced by other factors, such as taste (Horacek & Betts, 1998; Neumark-Sztainer,

Story, Perry, & Casey, 1999), hunger, or cost (Glanz, Basil, Maibach, Goldberg, &

Snyder, 1998). Today, we live in a media-flood environment that has undergone innovative change during the last two decades (Story et al., 2002). The surroundings of today’s young people, their homes, schools, automobiles, and bedrooms, are filled with media of all kinds. They can choose among many television channels, radio stations, videos, and an infinite number of websites (Subrahmanyam, Greenfield,

Kraut, & Gross, 2001). Television is the favorite advertising medium used by the food industry (Gallo, 1999). Exposure to food advertising, such as fast food, convenience food, and soft drinks can affect a viewer’s food choices (Story et al., 2002).

Advertising and promotion are central to marketing within the United States food supply. The U.S. food marketing system is one of the largest advertisers in the

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economy and a leading supporter of network television, magazines, radio, and newspaper advertisements (Story et al., 2002). In 2006, the food, beverage, and restaurant industry spent over $11 billion annually on advertising (Union, 2006).

Much of this advertising promoted foods that are high in phosphorus, particularly processed meats, soft drinks, and heated goods. Over the last two decades, the consumption of these products has increased dramatically in the general population

(United States Department of Agriculture, 2007).

Healthy Foods

The general awareness of the healthy menu that dominated the 1990s has led to greater menu choices in foodservice for both business and industry. Kwan, Lee and

Yoon (2009) defined a healthy menu item as “a menu item with an increased nutritional value or decreased health risk attributed to a change of food ingredients or cooking methods.” Generally speaking, healthy menus are now being provided with more varied choices including low-fat and lowered calorie menu options. Thus, the foodservice industry is examining new ways of exploiting market opportunities to satisfy their customers.

A report of the Public Health Agency (2001) showed that the term ‘healthy eating’ meant cutting down on fried or fatty foods, and 51% of the informants also said “eating plenty of fruit, vegetables, and salad.” One quarter (25%) thought the term ‘healthy eating’ meant eating plenty of fiber or cutting down on sugar, cakes, and candies. And the report found several things (1) women were more likely to say

‘reduce sugar intake’ (57%), ‘eat more fruit and vegetables’ (55%), and ‘reduce sugar intake’ (29%) than men (50%, 45% and 20%). (2) More adults from the youngest age

17 Texas Tech University, Sangmook Lee, December 2010

group (55%) gave ‘eating fruit and vegetables’ as a healthy eating definition compared with the oldest age group (43%). (3) Adults from the non-social group were more likely to say ‘reduce fat intake’ (59%), ‘reduce sugar intake’ (27%), and ‘eat plenty of fiber’ (29%) than those from the manual social group (50%, 23%, and 20%) and (4) increased fiber intake in the diet was mentioned more often as a definition of healthy eating by adults from a high income household (31%) than those form lower income households. In this study, the informants had tried to make their eating patterns in the past year. The most common changes reported were eating fewer fatty or fried foods

(37%), followed by eating more fruit and vegetables (36%), eating fewer sugary foods

(30%) and eating less generally (24%). Women were more likely than men to report making these dietary changes.

Even though the benefits of healthy eating have been verified, food choice is a difficult process that involves several variables. The study has resulted in an increasing number of people eating away from home and changing meal times from special moments into usual acts (Veiros, da Costa Proença, Kent-Smith, Hering, & De

Sousa, 2006). A study found that 61% of adult informants ignored healthy eating when dining out because they associate restaurant eating with hedonism and pleasure

(Middleton, 2000). People do not consciously think about health while eating, particularly when eating out, which reinforces that care is needed regarding what is offered by food establishments (Middleton, 2000).

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Research Objectives

This study attempts: (a) to provide useful information for foodservice management, (b) to find several characteristics of healthy food, and (c) to develop and plan healthy menus for college students. Based upon these objectives, the survey instrument was developed to answer the following research questions.

Data Collection and Sample Size

The data were collected using the intercept technique during the spring 2010 at a major university in the southwest. The researchers distributed the survey to college students in the library and restaurant at the university. The average length of time for completing the survey was 15 minutes. To encourage participation, each informant was given a $2 small snack package for every completed survey (Appendix A).

During the recruitment procedure, students were informed that participation was voluntary and that they could stop completing the survey at anytime. Out of 200 questionnaires, 161 questionnaires (80.5%) were collected and used for the statistical

19 Texas Tech University, Sangmook Lee, December 2010

analysis. SPSS 17.0 was used to manage, screen, and analyze the data. Range and frequency checks were used to insure that no variables were outside the range of possible values. Scale scores such as BMI were calculated in Excel then imported into

SPSS.

20 Texas Tech University, Sangmook Lee, December 2010

CHAPTER III

METHODOLOGY

Data and Sample

During the recruitment procedure, students were informed that participation was voluntary and that they could stop completing the survey at anytime.

Pilot Study

A pilot study was conducted in the spring 2010. The purpose of this pilot study was to examine whether the question could be clearly understood by informants and to make sure dependability of the instrument. For the pilot study, forty questionnaires were distributed, and 32 questionnaires were collected in April 2010 at the Texas Tech

University. The data from the pilot study was analyzed and examined for frequency of the knowledge section and the reliability of the question scales. Unnecessary items were removed and some necessary items were added.

21 Texas Tech University, Sangmook Lee, December 2010

Data Analysis

Data were compiled and statistically analyzed by using the statistical analysis program SPSS (Statistical Package for Social Science) release 17.0 for windows

(SPSS Inc., Chicago, IL).

The data was analyzed in three steps.

1. Demographic statistics were analyzed to determine the informants’ socio-

demographic factors.

2. The t-Test and analysis of variance (ANOVA) were used to analyze

significant differences among demographic information in the overall level of

college students’ eating behavior, worrying, and knowledgeable of healthy

foods.

3. To test the reliability and internal consistency of each factor, Cronbach’s

Alpha of each factor was determined and the factors with Alpha of .6 were

retained for further analysis. The most commonly reported estimate of

reliability is Cronbach’s coefficient alpha (α), which measures internal

consistency reliability or the degree to which response are consistent across

the items with a single measure. If the internal consistency is low, the content

of the items may be heterogeneous such that the total score is not the best

analysis for the measure.

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CHAPTER IV

RESULTS AND DISCUSSION

Out of 200 questionnaires, 161 questionnaires (80.5%) were collected and used for the statistical analysis. SPSS 17.0 was used to manage, screen, and analyze the data. Range and frequency checks were used to insure that no variables were outside the range of possible values. Scale scores such as BMI were calculated in Excel then imported into SPSS.

Demographics

Descriptive statistics of demographic characteristics were helpful in describing the sample. The socio-demographic characteristics of informants in this study are shown in Table 1. Descriptive statistics including frequencies and measures of central tendencies (mean, median, and mode) and dispersion (range and standard deviation) were used to explore and describe the demographic variables of age, race, classification, self-described body image, and BMI. There are percentages, means, standard deviations, and ranges to summarize the data in the table. Forty-seven percent of the informants were male students and around 53% were female. Eighty percent of the informants were White and 9.9%, 6.8%, 1.9% and 1.2% were Hispanic, African-

American, Native American-Indian, and other, in that order. The most frequently occurring classification group was sophomore (31.7%), followed by senior (30.4%),

Junior (23.0%), freshman (14.3%), and graduate student (0.6%). The most frequently occurring age was 21 years (22.4%), followed by 20 years (19.9%), 22 years (18.0%),

23 Texas Tech University, Sangmook Lee, December 2010

19 year (13.7), older than 23 years (12.4), 18 years (8.1%), and 23 years (5.6%). For the marital status category, approximately 94% informants were single and 3% were married. More than 93% of the students were living alone, and only 6.8% of the students were living with their family.

Table 1 Demographic Characteristics (N=161)

Frequency Percent Gender Male 76 47.2 Female 85 52.8 Total 161 100 Ethnic White 129 80.1 Hispanic 16 9.9 African-American 11 6.8 Native American-Indian 3 1.9 Asian Oriental 0 0.0 Other 2 1.2 Total 161 100 School Year Freshman 23 14.3 Sophomore 51 31.7 Junior 37 23.0 Senior 49 30.4 Graduate 1 0.6 Total 161 100 Age 18 13 8.1 19 22 13.7 20 32 19.9 21 36 22.4 22 29 18.0 23 9 5.6 Older than 23 20 12.4

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Total 161 100

Table 1(Continued) Demographic Characteristics (N=161)

Frequency Percent Marital Status Single 151 93.8 Married 5 3.1 Other 5 3.1 Total 161 100 Living with Family Alone 150 93.2 With family 11 6.8 Total 161 100

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Healthy Food Information Sources

Table 2 shows the reported sources of where college students get information about healthy food. As you can see the most popular source was Internet (21.6%), followed by classes (17.5%), friends and/or family members (16.6%), book and/or magazines (16.4%), television (16.2%), research journals (3.1%), newspaper (3.1%), and radio (2.7%) were other resources that provided healthy food information.

According to previous studies exposure to food advertising, such as fast food, convenience food, and soft drinks can affect a viewer’s food choices (Story et al.,

2002), and television is the favorite advertising medium used by the food industry

(Gallo, 1999). A study conducted by Freislinga, Haas, and Elmadfa (2010) reported that television and the Internet—as a source of nutrition information—are positively associated with daily fruit and beverage consumption. The U.S. food marketing system is the second-largest advertiser in the economy and a leading supporter of network television, magazine, radio, and newspaper advertisements (Story et al.,

2002). This shows that mass media plays an important part as a source for healthy food information.

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Table 2 Healthy Food Information Sources (N=161)

Information Source Frequency Percent Television 84 16.2 Radio 14 2.7 Book or Magazines 85 16.4 Friends or Family members 86 16.6 Internet 112 21.6 Classes 91 17.5 Research Journals 16 3.1 Newspaper 16 3.1 Other 15 2.9 Total 519* 100 * Multiple choices allowed

27 Texas Tech University, Sangmook Lee, December 2010

Body Mass Index (BMI) and Self-described Body Image

Body mass index (BMI) was grouped into 4 categories using the cut points established by the WHO (World Health Organization). The participants’ Body Mass

Index (BMI) was calculated based on their weight and height by using the BMI formula: BMI= weight (lb)*703/height2 (in2). This is one of the easiest methods to assess a person’s body since it requires only height and weight from the informant, and the method can classify people as underweight, normal weight, overweight, or obese populations. Accordingly, by using the BMI formula, people can compare their own weight to that of the general population.

Figure 1 shows the histogram and normal curve of BMI. The x-axis explains the BMI for participants in the survey (1=underweight, 2= normal weight, 3= overweight, 4= obese) and the y-axis shows the frequency or count for occurrences of

BMI. Figure 2 shows the histogram and normal curve of self-described BMI of participants and uses the same standards for the x and y-axis. As you can see, the mean scores of BMI were different. The mean of “self-described” BMI (2.12) is lower than BMI (2.36). This means that students thought their bodies were slightly thinner than their real BMI.

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Figure 1. Histogram and normal curve of participants’ BMI

Figure 2. Histogram and normal curve of participants’ self-described BMI

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Means of the BMI were compared among the demographic groups such as ethnic, school year, and marital status. As shown in Table 3, significant difference was found among marital status and BMI group regarding the means of BMI. The married group (M = 27.52, SD = 4.34) had a significantly higher level of BMI than singles (M

= 23.62, SD = 3.34) and other (M = 23.94, SD = 1.87) groups. Ethnic group and school year group did not have a significant difference regarding the means of BMI.

Table 3 Results of ANOVA Demographics and BMI (N=161)

N M SD F Ethnic White 129 23.68 3.34 1.05 Hispanic 16 23.97 3.55 African-American 11 25.16 3.85 Asian Oriental 3 20.90 0.95 Other 2 23.25 4.74 Total 161 23.76 3.39 School Year Freshman 23 22.21 2.97 1.83 Sophomore 51 24.08 3.25 Junior 37 23.55 3.28 Senior 49 24.34 3.67 Graduate 1 21.80 . Total 161 23.76 3.39 Marital Single 151 23.62 3.34 3.29* Status Married 5 27.52 4.37 Other 5 23.94 1.87 Total 161 23.76 3.39 * P < 0.05.

30 Texas Tech University, Sangmook Lee, December 2010

The self-described body image and actual BMI among males and females was also compared. As shown in Table 4, results of the t-test showed that there was a significant difference between real BMI status and gender. Male students’ actual BMI

(M = 25.35, SD = 2.93) was significantly higher than female students’ BMI (M =

22.33, SD = 3.14). However, there was no significant difference between “self- described” BMI and gender. This means that female students described their BMI as heavier than their actual BMI. This finding is very different than a previous study.

Davy, Benes and Driskell, (2006) reported that there was a significant difference by sex for self-reported heights and weights.

Table 4 Gender Comparison of Self-described Image and BMI (N=161)

Male Female t

N M SD N M SD

BMI (N=161) 76 25.35 2.93 85 22.33 3.14 6.27***

Self-described Body Image 76 2.17 0.72 85 2.08 0.62 0.84 (N=161) *** P < 0.001.

31 Texas Tech University, Sangmook Lee, December 2010

To compare self-described body image and actual BMI, ranges in a 5-point

Likert scale (1 = very underweight, 2 = slightly underweight, 3 = about the right weight, 4 = slightly overweight, and 5 = very overweight) were merged into the following four categories: 1) Underweight, 2) Normal, 3) Overweight, and 4) Obese.

Categories 1 and 2 were combined into one category called: “underweight,” point 3 was combined with the “normal” category, point 4 was categorized as “overweight,” and point 5 was referred to as “obese.” Then, informants’ BMIs were also categorized into four types of body image: 1) underweight = < 18.5, 2) normal = 18.5~24.9, 3) overweight = 25.0~29.9, and 4) obese = > 30).

Table 5 shows self-described body image and actual BMI status.

Approximately 58% of the informants reported that they thought they had a normal body size, and around 45% of the informants actually were of normal body size (BMI

= 18.5-24.9). About 16% of the students thought they were underweight, but only 4% of these students actually were underweight. More than 25% of informants thought they were overweight, and 16% of informants had real overweight body sizes. A Chi- square test revealed that there was a strong association between self-described body image and BMI status (x² = 83.37, p < .001). More than 65% of informants (65.21%) reported their body image as the same as their real BMI (Table 5). The results showed that most of the participants had a correct body image.

32 Texas Tech University, Sangmook Lee, December 2010

Table 5 Cross Tabulation of Self-described Body Mass Index (N=161)

BMI status Frequenc Self-described y X2 Body Image Overweigh Underweight Normal Obese N (%) t

Underweight 6 17 1 1 25 (15.5) 83.37***

Normal 1 72 19 1 93 (57.8)

Overweight 0 9 26 6 41 (25.5)

Obese 0 0 1 1 2 (1.2)

Total 7 (4.3) 98(60.9) 47 (29.2) 4 (5.6) 161 (100)

*** P < 0.001.

In a previous study, self-reported body image and BMI status were significantly correlated. Kostanski, Fisher, and Cullone (2004) reported that body image dissatisfaction differed significantly depending on gender and body mass. That is, for female informants there was a significant increase in body dissatisfaction across bodyweight, which reflected a predominant desire to be thinner. In contrast, for males, there was a differential pattern with those who were overweight wanting to be thinner, and those who were underweight wanting to be heavier. However, in the current study there was no difference between participants’ self-described body image and real BMI status.

33 Texas Tech University, Sangmook Lee, December 2010

Eating Behaviors of College Students

This research included several items that asked about informants’ eating behaviors. As shown in Table 6, more than half of the students (56%) use a university foodservice more than once a week, but many students (43.5%) were using the university foodservice less than once a week. According to this result, the university foodservice is not a popular place to college students. (Hurst, 1997) reported that college and university foodservice restaurants are facing a dynamic and uncertain environment so that they need to reconsider and improve their service to keep or gain customers. This result also shows that many college students don’t use the foodservice in school. Hence, university foodservice managers need to make an effort to develop and improve their services in order to satisfy their customers.

Table 6 Frequency of Use University Foodservice (N=161)

Frequency Percent

Less than once a week 70 43.5 Once a week 26 16.1 How often do you use 27 16.8 university foodservice? 2-3 times a week 4-5 times a week 12 7.5 At least 6 times a week 26 16.1 Total 161 100

34 Texas Tech University, Sangmook Lee, December 2010

Table 7 Gender Comparison in Typical Eating Behavior (N=161)

Frequency Gender N (%) Typical eating behavior X2 N (%) Male Female How many times do you eat fruit per day? 7.91 0 time 15(9.3) 11(14.5) 4(4.7) 1 time 81(50.3) 39(51.3) 42(49.4) 2 times 48(29.8) 19(25.0) 29(34.1) 3 times 13(8.1) 4(5.3) 9(10.6) More than 3times 4(2.5) 3(3.9) 1(1.2) How many times do you drink soda? 2.92 0 time 87(54.0) 45(59.2) 42(49.4) 1 time 40(24.8) 17(22.4) 23(27.1) 2 times 19(11.8) 7(9.2) 12(14.1) 3 times 11(6.8) 6(7.9) 5(5.9) More than 3times 4(2.5) 1(1.3) 3(3.5) How many times do you eat green salad per day? 7.58 0 time 40(24.8) 23(30.3) 17(20.0) 1 time 99(61.5) 42(67.1) 57(67.1) 2 times 18(11.2) 11(14.5) 7(8.2) 3 times 2(1.2) 0(0.0) 2(2.4) More than 3times 2(1.2) 0(0.0) 2(2.4) How many times do you drink fruit juice? 1.60 0 time 47(29.2) 19(25.0) 28(32.9) 1 time 56(34.8) 27(35.5) 29(34.1) 2 times 36(22.4) 19(25.0) 17(20.0) 3 times 13(8.1) 6(7.9) 7(8.2) More than 3times 9(5.6) 5(6.6) 4(4.7) How many times do you eat hamburger, hotdog or sausage? 12.44* 0 time 69(42.9) 23(30.3) 46(54.1) 1 time 69(42.9) 39(51.3) 30(35.3) 2 times 17(10.6) 9(11.8) 8(9.4) 3 times 4(2.5) 4(5.3) 0(0.0) More than 3times 2(1.2) 1(1.3) 1(1.2) How many times do you eat French fried potato chips? 2.15 0 time 68(42.2) 28(36.8) 40(47.1) 1 time 70(43.5) 35(46.1) 35(41.2) 2 times 17(10.6) 10(13.2) 7(8.2) 3 times 4(2.5) 2(2.6) 2(2.4) More than 3times 2(1.2) 1(1.3) 1(1.2) Total 76(100) 85(100) 161(100)

35 Texas Tech University, Sangmook Lee, December 2010

Healthy Food

Comparison between Normal Food and Healthy Food

A paired t-test was conducted to compare factors of food choice between

“normal foods” and “healthy foods.” Table 8 shows the output for a series of paired t- tests. As seen in the table, There were significant differences in the score for

“reasonable price” between normal food (M = 3.89, SD = 0.975) and healthy food (M

= 4.02, SD = 0.869), and for “nutrition value” between normal food (M = 4.01, SD =

0.802) and healthy food (M = 4.16, SD = 0.880). Those two factors were found to be significant at the 0.05 significance level. This means that these two factors show a significantly different mean value between healthy foods and normal foods. This result is supported by previous studies such as Barratt (1997) who reported that a healthy diet is more expensive than the average diet, and Magnusson, et al. (2003) who reported that organic food is more expensive and healthier than other food. The informants also thought that healthy foods’ price and nutrition value were significantly more important factors than normal foods.

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Table 8 Paired Sample t-test for Important Factors in Food Choice (N=161)

Normal Food Healthy Food t M SD M SD Ingredients 3.88 1.07 3.96 0.89 1.36

Temperature 3.65 1.04 3.68 0.93 0.46

Price 3.89 0.96 4.02 0.87 2.07*

Taste 4.60 0.67 4.50 0.66 1.93

Nutrition Value 4.01 0.80 4.16 0.88 2.45*

Short serving time 3.34 0.88 3.41 0.96 1.30 Suggestions of my friends or 3.17 0.99 3.25 0.97 1.43 family *P < 0.05.

Color

Color is everywhere and is an important source of information. And color is one of most important part in the marketing (Singh, 2006). In a pilot test, I asked that

“which color(s) represent healthy foods?” by using short answer questions. Based on the responses, classified several items in order to ask about the color of healthy foods.

As shown in Table 9 and Figure 3, eight colors were used to define healthy foods color.

Green (34.3%) was the most popular color to represent the healthy foods, followed by orange (14.6%), red (14.0%), yellow (12.7%), white (8.7%), purple (7.9%), and brown

(5.7%). This result is very similar to the “Food Guide Pyramid” which is one way for people to understand how to eat healthfully. A rainbow of colored, vertical stripes represents the five food groups plus fats and oils: orange, green, red, yellow, blue, and purple. Research suggests that people try to eat five different colors of fruits and

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vegetables daily. According to the U.S. Department of Agriculture, It is important to eat a rainbow since disease fighting antioxidants also give foods their color (USDA,

2005). In addition, James, Nadeau, and Underwood (2003) reported that eating colorful fruits and vegetables can prevent many kinds of disease from striking. The authors strenuously insist that eating colorful foods can protect people’s health from diseases (James et al., 2003). The following results (see Table 9) support using the eight healthy colors I classified in this study to identify which colors represented healthy food to the participants.

Table 9 Healthy Food Colors

Rank Color Frequency Percent 1 Green 157 34.3%

2 Orange 67 14.6%

3 Red 64 14.0%

4 Yellow 58 12.7%

5 White 40 8.7%

6 Purple 36 7.9%

7 Brown 26 5.7%

8 Other 10 2.2%

Total 458* 100% * Multiple choices allowed

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Figure 3. Diagram of healthy colors by college students

Important Healthy Food Features

As shown in Table 10, “drink water” was reported as the most important factor

(M = 4.02, SD = 1.00) followed by eat vegetable (M = 3.98, SD = 0.95), drink fruit juice (M = 3.97, SD = 0.98), eat fruit (M = 3.90, SD = 0.94), reduce fatty food (M =

3.58, SD = 1.19), reduce fried food (M = 3.57, SD = 1.19), eat fiber (M = 3.45, SD =

1.06), reduce sugar (M = 3.41, SD = 1.15), eat white meat (M = 3.29, SD = 1.28), reduce salt (M = 3.02, SD = 1.19), and avoid red meat (M = 2.02, SD = 1.19).

According to previous studies, many researchers reported that salt intake has been linked to cardiovascular diseases and obesity and they suggest that people reduce salt intake for health (Desmond, 2006; Dickinson & Havas, 2007; Frieden & Briss, 2010;

He, Marrero, & MacGregor, 2008). Even though, many researchers emphasize reducing salt intake, the participants in this study responded that the “reduce salt”

39 Texas Tech University, Sangmook Lee, December 2010

factor was not a more important factor than any other. This result may mean that this population of college students has misconceptions about healthy food.

Table 10 Important Feature of Healthy Foods among College Students (N=161)

Rank Factors Mean SD 1 Drink water 4.02 1.00 2 Eat vegetable 3.98 0.95 3 Drink fruit juice 3.97 0.98 4 Eat fruit 3.90 0.94 5 Reduce fatty food 3.58 1.19 6 Reduce fried food 3.57 1.19 7 Eat fiber 3.45 1.06 8 Reduce sugar 3.41 1.15 9 Eat white meat 3.29 1.28 10 Eat starch 3.03 1.01 11 Reduce salt 3.02 1.19 11 Avoid red meat 2.02 1.19

40 Texas Tech University, Sangmook Lee, December 2010

Classification of Healthy Food Factors

Factor analysis was used to confirm whether the number of dimensions conceptualized could be verified empirically. In this study, the factor analyses for

“healthy food factors” were classified into three categories: 1) Low Calorie Food, 2)

Low Greasy food & Healthy Drink, and 3) Low Cholesterol Food. As shown in Table

11, each factor had an Eigen value above 1.0 and the total variance was 66.43%.

Table 11 Factor Analysis Results of Healthy Food Characteristics Factors (N=161) Factor Cronbach’s Factors and Items Eigenvalue Variance (%) Loading alpha Factor 1: Low Calorie Food 3.299 27.492 0.869 Reduce sugar .836 Reduce fatty food .745 Eat vegetable .744 Reduce fried food .740 Eat fruit .732 Factor 2:Low Greasy Food 2.378 19.819 0.764 & Healthy drink Drink Water .878 Drink fruit juice .873 Eat Starch .500 Eat fiber .480 Factor 3: Low cholesterol food 2.251 18.761 0.734 Reduce salt .768 Eat white meat .751 Avoid red meat .721 Total 66.072 0.874

41 Texas Tech University, Sangmook Lee, December 2010

The coefficient alpha is the basic statistic to determine the reliability of the measurement based on the internal consistency. One of the most commonly used statistics is Cronbach’s alpha. As shown Table 10, the total Cronbach’s alpha value designated that the model was internally reliable (α=.874). Three factors were above .70 criterions therefore all of the factors were retained for additional analysis based on Cronbach’s alpha values: factor 1 (α=.869), factor 2 (α=.764), and factor 3

(α=.734). The content validity was verified since all items of the measurement were adopted from previous studies (Nunnaly, 1967).

The three factors were identified as “low calorie food” (α=.869), “low greasy food & healthy drink” (α=.764), and “low cholesterol food” (α=.734). The low calorie food dimension included five items that pertained to calories: reduce fatty food, reduce fried food, reduce sugar, eat vegetable and eat fruit. There were four items in the low greasy food & healthy drink dimensions: eat starch, eat fiber, drink water, and drink fruit juice. In the low cholesterol food dimension, there were three items: reduce salt, eat white meat, and avoid red meat. Therefore, to classify the characteristics of healthy food, a factor analysis was conducted for “low calorie food,” “low greasy food

& healthy drink,” and “low cholesterol food.” This dimension was defined as

“Healthy food.” The total Cronbach’s value was .874 making it higher than the .70 criterion. Therefore, this model has an acceptable reliability coefficient (Nunnaly,

1967).

42 Texas Tech University, Sangmook Lee, December 2010

Comparison of Feature of Healthy Food by Gender

The survey included items what college students thought about several features of healthy food among the college students. As shown in Table 12, a t-test reported that there were some significant differences between male and female students. Many responses about the features of healthy foods showed similar patterns of differences among college students, but four specific features of healthy food showed difference between genders: 1) reduce gender, 2) eat fruit, 3) eat vegetable, and 4) reduce fried food. Especially, more female students thought that eating vegetables was more important (M = 4.24, SD = 0.78) than male students reported (M = 3.67, SD = 1.03) significantly (P < 0.001). The categories: eat fruit, reduce fried food, and reduce fatty food were also important features to female students. Even though many features of healthy foods showed no significantly different between males and females informants, scores for all categories for the female students were higher than male students’ responses. In a previous study, the female student group demonstrated at least 20% greater concern than did males about their health (Kowpak, 1991). This study also showed that the features of healthy foods were more important to female students when compared to male students.

43 Texas Tech University, Sangmook Lee, December 2010

Table 12 Comparison of Feature of Healthy Food by Gender

Feature of Healthy Male Female t Food N M SD N M SD

Avoid red meat 76 1.87 1.18 85 2.16 1.19 1.58

Eat white meat 76 3.16 1.31 85 3.40 1.26 1.20

Reduce salt 76 2.86 1.17 85 3.18 1.19 1.72

Drink water 76 3.86 1.10 85 4.16 0.90 1.97

Drink fruit juice 76 3.83 1.06 85 4.09 0.89 1.72

Reduce sugar 76 3.22 1.31 85 3.58 0.97 1.95

Reduce fatty food 76 3.24 1.31 85 3.88 0.98 3.52**

Eat fruit 76 3.66 0.97 85 4.12 0.87 3.15**

Eat vegetable 76 3.67 1.03 85 4.24 0.78 3.89***

Reduce fried food 76 3.30 1.28 85 3.80 1.07 2.66**

Eat starch 76 3.07 1.02 85 3.00 1.00 0.41

Eat fiber 76 3.30 1.08 85 3.58 1.03 1.65 **P < 0.01, *** P < 0.001.

44 Texas Tech University, Sangmook Lee, December 2010

Health Concern and Health Knowledge

Correlation

The relationship between worrying about health and healthy knowledge about health eating practice are significantly correlated (γ = 0.172, P = 0.029) and direction was positive. Even though college students who were worrying about their health were knowledgeable about healthy food significantly, but the correlation was not strong (P

< 0.05). The previous studies found that a positive correlation between health knowledge and dietary habit (Cason & Wenrich, 2002; Grainger, Senauer, & Runge,

2007). Research has also found that concerning diet and disease, knowledge of nutrition and the benefits of a healthy diet can affect healthy behavior (Dijkstra &

Brosschot, 2003; Gracey, Stanley, Burke, Corti, & Beilin, 1996; Trepka, Murunga,

Cherry, Huffman, & Dixon, 2006). This study also showed similar results when compared to previous researches. According to this result, health knowledge can have a positive impact on other health concerns.

Table 13 reported that results of ANOVA health concern variables and demographic information. Means of the variables were compared among the demographic information such as gender, marital status, ethnics, age, and BMI. As shown in Table 13, two demographic factors were significantly differences which are age and ethnics group. In the age group, concern about information related with my health (F=2.21, P < 0.05) and concern about harmful chemical in my food (F=3.25, P

< 0.01) were significantly differences. Also, there was significant differences in

45 Texas Tech University, Sangmook Lee, December 2010

concern about information of food label (F=3.07, P < 0.05) and concern about harmful chemical in my food (F=2.87, P < 0.05) in terms of ethnic groups. Except these two factors, there were no significant differences among the demographic information and health concerns. Male and female students had similar patterns of health concern in the variables. More than 23 years group perceived higher concern of information related with my health and harmful chemical in my food than other age groups.

Similarly, Asian and other group perceived higher concern about information of my food label and information related with my health than other ethnic groups.

46 Texas Tech University, Sangmook Lee, December 2010

Table 13 Result of ANOVA between Health Concern Variables and Demographic Information Mean Value for the Health Concern Variables Demographic Information Water Information My Harmful chemical Information(N) related with my quality of food label health in my food health Gender Male (76) 3.45 3.33 3.79 3.25 2.88 Female (85) 3.62 3.56 4.06 3.49 3.11 F-test 0.80 1.99 3.58 2.54 1.59

Marital Status Single (151) 3.53 3.46 3.94 3.36 2.99 Married (5) 3.40 3.60 3.80 3.40 3.20 Other 4.00 3.20 3.93 4.00 3.00 F-test 0.37 0.19 0.11 1.05 0.08

Age 18 (13) 3.38 3.15 3.69 3.31 2.85 19 (22) 3.55 3.45 3.82 3.25 3.14 20 (32) 3.53 3.50 4.09 3.44 3.00 21 (36) 3.42 3.28 3.78 3.31 3.11 22 (29) 3.48 3.28 3.72 3.07 2.48 23 (9) 3.56 3.56 4.00 3.22 2.44 > 23 (20) 3.95 4.10 4.50 3.90 3.75 F-test 0.45 1.79 2.21* 1.60 3.25**

Ethnics White(129) 3.47 3.32 3.82 3.33 2.95 Hispanic(16) 3.81 4.00 4.31 3.63 2.81 African- 3.73 3.82 4.27 3.09 3.64 American(11) Asian/Oriental(3) 4.67 4.33 4.67 4.00 3.67 Other(2) 3.00 4.50 5.00 5.00 3.50 F-test 1.05 3.07* 2.87* 2.33 1.43

BMI Under weight(7) 3.86 3.29 4.43 3.00 3.00 Normal (98) 3.65 3.48 3.94 3.43 3.05 Over weight(47) 3.32 3.34 3.81 3.23 2.81 Obesity(9) 3.22 3.89 4.11 3.89 3.44 F-test 1.10 0.76 1.11 1.63 0.98 *P < 0.05, ** P < 0.01.

47 Texas Tech University, Sangmook Lee, December 2010

Gender Comparison

Many researchers reported on the differences in regard to concern about health or knowledge of healthy practices between males and females informants (Cason &

Wenrich, 2002; Gracey et al., 1996; Kowpak, 1991; Trepka et al., 2006). This study also showed differences in health concern and knowledge of healthy foods (see Table

14). There were no significantly differences except with one item (P < 0.05) which pertained to health concern. Result for this showed that female students (M = 4.06, SD

= 0.79) were more interested in information about their health than male students (M =

3.79, SD = 1.01). A previous research also reported similar results about the differences in regard to concern about health between males and females. That study showed that female students were more interested in their health and health information than male students (Kowpak, 1991). Even though many other health concerns showed a slight difference based on gender- such as worry about water quality or concern about harmful chemicals in their foods- but there was not significant. Interestingly, there were no differences in knowledge of healthy foods in terms of gender group. Male and female students showed a similar knowledge of healthy foods.

48 Texas Tech University, Sangmook Lee, December 2010

Table 14 Gender comparison of Health Concerns and Knowledge of Healthy Food (N=161)

Male Female t N M SD N M SD

I am concerned about my 3.4 1.3 3.6 1.8 76 85 0.89 drinking water quality. 5 2 2 6

I usually read the 3.3 1.1 3.5 1.0 76 85 1.41 ingredients on food label. 3 0 6 2

I am interested in 3.7 1.0 4.0 .07 Health information about my 76 85 1.87* Concern health. 9 1 6 9

I am concerned about my 3.2 0.9 3.4 0.9 76 85 1.60 health all the time. 5 9 9 5

I worry that there are 2.8 1.2 3.1 1.0 harmful chemicals in my 76 85 1.26 food. 8 2 1 4

I am knowledgeable about 4.0 0.8 4.0 0.6 76 85 0.06 healthy foods. 4 4 5 5

Health I have more knowledge of 3.7 0.8 3.7 0.8 Knowledg healthy foods than my 76 85 0.01 e friends. 6 9 9 8

I am confident in knowing 4.0 0.8 3.9 0.7 which food is good for my 76 85 0.63 health 7 2 9 5 * P < 0.05

49 Texas Tech University, Sangmook Lee, December 2010

CHAPTER V

SUMMARY AND CONCLUSION

The purpose of this study was to provide useful information for foodservice management so that they could develop and plan healthy menus for college students.

This study used an intercept technique during the spring 2010 at a major university in the south west.

The results of this study validated the premise that healthy foods could be identified by classifying several features common to them, and that they could then be defined using these characteristics. In addition, the results clearly showed that perception of healthy foods showed significantly different features among demographic characteristics. Also, this study found few different factors for “healthy food choice” decisions as compared to other types of foods among this population of college students. Even though the correlation was not considered to be a strong one, there was a significantly positive correlation between knowledge of healthy foods and health concern. Finally, this study helped to classify the characteristics of healthy food and, therefore, this information could be used to develop healthy menus in university foodservice settings and related marketplaces.

50 Texas Tech University, Sangmook Lee, December 2010

Findings of the study

Eight research questions were developed and tested for this study. Four research questionnaires were used to identify the features of healthy foods: Q1, Q2, Q3, and Q4, and one research questionnaire (Q5) were used to study eating behaviors among college students. Research questionnaires 6 to 8 were used to study about healthy knowledge and concern of college students.

Demographic Characteristics

The number of male (47%) and female (51%) students were almost evenly distributed. Approximately, 94% of the informants were single and only 3% were married. Ninety-three percent of the students were living alone and approximately 7% of the students were living with their family. Eighty-seven percent of the informants were White and approximately 10% were Hispanic. The most frequently occurring classification group was sophomore (31.7%) and followed by senior (30.4%). Fifty- seven percent of the student participants used on campus foodservice more than once a week.

Features of Healthy Foods

Research question 1 asked where college students get information about healthy foods. Multiple choice questions were used for this item. The primaries

“healthy food information sources” were: Internet (21.6%), classes (17.5%), friends or family (16.6%), book and/or magazines (16.4%), television (16.2%), research journals

(3.1%), newspapers (3.1%) and radio (2.7%). Mass media such as Internet or

51 Texas Tech University, Sangmook Lee, December 2010

television were important source, and classes or books were also shown to be the important sources for information about healthy foods.

Research question 2 asked students to indicate color(s) representing healthy foods. Multiple choices were used for this question also and the result showed that green was the primary color to represent healthy foods (34.3%), followed by orange

(14.6%), red (14.0%), yellow (12.7%), white (8.7%), purple (7.9%), and brown (5.7%).

Color has already been used as an important marketing strategic (Singh, 2006).

Several quick-service restaurants are using green to advertise their healthy menus.

McDonald’s used green on commercial billboards to advertise their healthy food. This finding also showed that green was the primary color that represented healthy food. In addition, orange and yellow were also considered as colors to explain the healthy food concept.

Research question 3 asked students to indicate which factor(s) are different for healthy food choice decisions as compared to other types of foods. A paired t-test was conducted to compare factors of food choice between normal foods and healthy foods.

There were two significant differences: reasonable price and nutrition value. College students thought that price (M = 4.02, SD = 0.869) and nutrition value (M = 4.16, SD

= 0.880) were very important factors even though those two factors were also important factors for normal foods (M = 3.89, SD = 0.975; M = 4.01, SD = 0.802).

Those two factors’ mean score of healthy foods were significantly higher than for other types of foods.

Research question 4 asked students to describe characteristics of healthy foods.

The mean score and standard deviation were used to identify features that were

52 Texas Tech University, Sangmook Lee, December 2010

important when college students choose their food. The most important feature was drink water (M = 4.02, SD = 1.00) followed by eat vegetable (M = 3.98, SD = 0.95), drink fruit juice (M = 3.97, SD = 0.98), eat fruit (M = 3.90, SD = 0.94), reduce fatty food (M = 3.58, SD = 1.19), reduce fried food (M = 3.57, SD = 1.19), eat fiber (M =

3.45, SD = 1.06), reduce sugar (M = 3.41, SD = 1.15), eat white meat (M = 3.29, SD =

1.28), reduce salt (M = 3.02, SD = 1.19), and avoid red meat (M = 2.02, SD = 1.19).

In another study sweet beverages and soda were associated with weight gain and obesity (Malik, Schulze, & Hu, 2006). As shown in this result, many college students also thought that drinking water and fruit juice were very important features of healthy foods. However, avoid red meat (M = 2.02, SD = 1.19) was not considered to be an important feature of healthy foods to this population of college students. In addition, factor analysis was used to confirm whether the number of dimensions conceptualized could be verified empirically. In this study, the factor analysis for healthy food features classified three factors: 1) Low calorie food, 2) Low greasy food & Healthy drink, and 3) Low cholesterol food. As shown in the result, each factor had an

Eigenvalue above 1.0, the total Cronbach’s value was .874, and the total variance was

66.43%. Therefore, the healthy foods were classified as “low calorie food,” “low greasy food & healthy drink,” and “low cholesterol food.”

College Student Healthy Eating Behaviors

Research question 5 asked students to describe their eating. Many students

(43.5%) were using the university foodservice less than once a week, but more than half of the students (56%) used a university foodservice more than once a week.

53 Texas Tech University, Sangmook Lee, December 2010 Healthy Knowledge and Concern This study attempted to find determine college students’ “knowledge of healthy food” and the “concerns of their health.” Two research questions—Question 7 and Question 8 sought to correlate demographic characteristics with eating behaviors and concern about healthy foods. The correlation analysis was used to test the relationship between “health concern” and “health knowledge.” The result showed that health concern and knowledge of healthy food are positively correlated but the relationship was not strong (γ = 0.172, p = 0.029). According to the result, college students who were worrying about their health were knowledgeable about healthy food choices (P < 0.05). Implications of the Study

The results are relevant for foodservice establishments working with consumers. Understanding the perception of the healthy foods and determining the healthy eating behaviors and healthy knowledge of college students can help in the development of strategies for foodservice industry management. Meaningful strategies for promoting healthy food consumption are important to encourage people about the benefits of healthy food choices to the general population. Foodservice managers need to fully understand the importance of healthy eating behaviors, characteristics of healthy foods, and the propensity toward healthy foods, which can help reduce the frequency of obesity and related health problems.

For accomplishing this study goal, foodservice companies need to understand the desires of consumers regarding their healthy food choices; especially since young adults as college students are important consumers in the foodservice industry

(Paeratakul, Ferdinand, Champagne, Ryan, & George A. Bray, 2003). 54 Texas Tech University, Sangmook Lee, December 2010

University foodservice managers can create healthy food just by changing a cooking method or ingredients to make healthier foods. Providing these healthier foods will satisfy consumers, and they will come back the place or recommend it to their friends. The current finding also supports the earlier research that healthy food is an important marketing strategic to foodservice companies (Arredondo, Castaneda,

Elder, Slymen, & Dozier, 2008). Foodservice managers need to know “what is healthy food?” and “what kinds of healthy food do customers want to eat?” Hence, the managers of university foodservices need to develop strategic plans for including healthy foods on menus to provide more sustainable healthy food options based on customers demand and correct knowledge of healthy food.

Limitations and Future Study

Second, this study asked about college students about their BMI in order to learn their status of their weight. Although the BMI is one of most popular methods used to assess obesity and the World Health Organization (WHO) classified the BMI cutoff point, the BMI does not only measure body fat but also muscle and bones

(“Healthy Weight,” n.d.; Stein & Colditz, 2004). Therefore, for any future study, it might be helpful to ask about participants’ majors (to gather additional demographic

55 Texas Tech University, Sangmook Lee, December 2010

information) or to use more advanced technology to calculate BMI such as BIA

(Bioelectrical Impedance Analysis).

There are many studies regarding knowledge about healthy food and nutrition.

Several researchers have found a positive correlation between health knowledge and improved eating behaviors (Cason & Wenrich, 2002; Grainger, Senauer, & Runge,

2007). However, there were limited studies about the fundamental definition of healthy foods and the specific characteristics of healthy foods. Future studies are needed to increase our understanding of the interrelated factors (or features) for healthy food choices.

56 Texas Tech University, Sangmook Lee, December 2010

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APPENDIX A

QUESTIONNAIRE

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APPENDIX B

IRB APPROVAL LETTER

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