Awareness, Understanding, and Usage of My Pyramid in College

Home , Food pyramid (nutrition), MyPyramid, Nutrition Education

AWARENESS, UNDERSTANDING, AND USAGE OF MYPYRAMID IN COLLEGE STUDENTS

Mara Lee Beebe

A Thesis

Submitted to the Graduate College of Bowling Green State University in partial fulfillment of the requirements for the degree of

MASTER OF FAMILY AND CONSUMER SCIENCES

May 2010

Committee:

Younghee Kim, Advisor

Pricilla Coleman

Jie Wu

ABSTRACT

Younghee Kim, Advisor

Background. Since the release of the MyPyramid food guidance system in 2005, there has not been any research conducted to assess the knowledge and usage of this important educational tool among college students. The objectives of this study were to assess (1) college students‟ awareness of the MyPyramid, (2) college students‟ perceived understanding of the new components of the MyPyramid and new method of measuring serving sizes, (3) college students‟ usage of the MyPyramid.gov website, (4) college students‟ usage of MyPyramid as a dietary guide, and (5) the relationship of demographic factors with awareness, understanding, usage, and practice of MyPyramid.

Methods. A self-reported quantitative and qualitative online questionnaire was used to collect the data from college students. A recruitment email was used to invite students to participate in the study. Students accessed the questionnaire through a website.

Results. A total of 2,687 students participated in the study. Fifty-six percent of students surveyed, and only 29% of students who were aware of MyPyramid had visited the website. Students reported high levels of perceived understanding for both the MyPyramid messages and the changes in serving size measurement. Students reported low levels of utilization of the

MyPyramid; only 21% used the MyPyramid as a guide and only 39% tried to reflect MyPyramid in their food choices frequently or almost always. Forty-five percent reported making some or substantial change in their diet after learning of MyPyramid. Females were found to be more likely to be aware of MyPyramid (p <.05), use the MyPyramid website (p <.01), made changes in their diet (p <.05), and use MyPyramid as a nutrition plan (p <.05). Furthermore, completion ii of a nutrition class in college resulted in similar positive impacts on awareness (p <.01), usage (p

<.01), and application of MyPyramid (p <.01) regardless of gender.

Conclusion. Students reported moderate levels of awareness for MyPyramid and high levels of perceived understanding of MyPyramid. However, awareness did not translate to usage or practice of MyPyramid, as 21% of the students stated to use MyPyramid as a guide for dietary intake and 45% of the students stated to have made changes in their diets after learning about

MyPyramid. Students who had taken an introductory nutrition class in college had higher levels of awareness, understanding, usage of the website, and reflection of MyPyramid in dietary choices. These findings support the idea that efforts should be made to promote MyPyramid in all facets of the education system. Continued research is needed to find ways to increase student awareness of MyPyramid and to use it to make better food choices.

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ACKNOWLEDGMENTS

First, I would like to thank Dr. Kim for all of her hard work and dedication to the research process. I would also like to thank Jie Wu and Dr. Coleman for agreeing to be on my committee and helping me with the research process. Additionally, I would like to thank the

Family and Consumer Sciences Department for providing funding for the project. Lastly, I would like to thank my husband and my family for being understanding, patient, and supportive while working on my thesis and my graduate degree.

TABLE OF CONTENTS

Page

CHAPTER I. INTRODUCTION ...... 1

Statement of Problem ...... 2

Significance of Problem ...... 2

Objectives ...... 3

Definition of Terms...... 4

CHAPTER II. REVIEW OF LITERATURE ...... 6

History of the Food Guide Pyramid ...... 6

Utilization of the Food Guide Pyramid ...... 7

Criticism of the Food Guide Pyramid ...... 7

Development of MyPyramid...... 10

Technical Research ...... 11

Consumer Research ...... 11

Website Usability Testing ...... 17

Release of MyPyramid ...... 17

Consumer Response to MyPyramid...... 18

CHAPTER III. METHODS ...... 20

Design ...... 20

Participants ...... 20

Questionnaire Design ...... 20

Demographics ...... 21

Awareness ...... 21 v

Understanding ...... 21

Usage ...... 22

Data Analysis ...... 22

CHAPTER IV. RESULTS ...... 23

Response Rate ...... 23

Demographics ...... 23

Awareness ...... 23

Understanding ...... 27

Usage ...... 28

Practice of MyPyramid ...... 28

CHAPTER V. DISCUSSION ...... 31

Limitations ...... 38

Conclusions ...... 38

REFERENCES ...... 40

APPENDIX A. RECRUITMENT EMAIL ...... 44

APPENDIX B. INFORMED CONSENT ...... 46

APPENDIX C. ONLINE QUESTIONAIRE ...... 48

LIST OF FIGURES

Figure Page

1 Final MyPyramid Graphic and Slogan ...... 1

2 Food Guide Pyramid Designed by Willet and Associates ...... 9

3 Phase I Graphic Concepts ...... 14

4 Graphic Concepts for Phase II ...... 15

5 Final Graphic Variations of Concept J...... 16

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LIST OF TABLES

Table Page

1 Phase I Slogans ...... 13

2 Phase II Slogans ...... 16

3 Gender, Class Rank, Field of Study, Meal Behavior, Introductory Nutrition Class, and

Class Covering MyPyramid Frequencies...... 24

4 Gender Differences in the Awareness of MyPyramid, Website Usage, and Application of

Knowledge ...... 25

5 Awareness of MyPyramid Variables ...... 26

6 Impact of Completion of Nutrition Class on Awareness, Usage of Website, and

Application of Knowledge ...... 26

7 Perceived Understanding of MyPyramid Messages ...... 27

8 Perceived Understanding of Portion Size Measurement in MyPyramid Better than

Previous Measurement Method ...... 28

9 Usage of MyPyramid.gov Website ...... 29

10 Practice of MyPyramid Variables ...... 30

CHAPTER I

INTRODUCTION

The MyPyramid Food Guidance System was released in April of 2005. The new three dimensional pyramid graphic includes vertical columns representing the food groups, and includes a figure walking up the pyramid steps to illustrate the new emphasis on physical activity

(1). Also new to the pyramid is the message “Steps to a Healthier You” to promote the notion that changes in diet can occur one step at a time. The graphical MyPyramid, as shown below, is intentionally simple, emphasizing individualization and encouraging consumers to look for more information (1). Additional information for specific nutrition information has been made available on the MyPyramid.gov website, in print form, and on CD-rom (1).

Figure 1. Final MyPyramid Graphic and Slogan

MyPyramid replaced the United States Department of Agriculture (USDA) Food Guide

Pyramid (FGP), which was released in 1992 as an educational tool to help consumers choose foods as part of healthy diet and meet nutritional standards. The 1992 pyramid followed the recommendations of the 1990 Dietary Guidelines for Americans (2). The Food Guide Pyramid was widely distributed and had high levels of awareness by consumers (67%) (3). However, it 2 was found that many Americans were not following the guidelines (3). In addition, the FGP was becoming outdated, as evidenced by the release of the revised Dietary Guidelines for Americans and the establishment of new Dietary References Intakes for vitamins, minerals, and macronutrients by the National Academy of Sciences‟ Institute of Medicine (IOM) (3).

To address these issues, the USDA‟s Center for Nutrition Policy and Promotion initiated a review and revision of the Food Guide Pyramid in 2001 (1). The revision process included technical research of the current food consumption patterns, energy requirements, and intakes patterns in addition to consumer research of graphical representations and consumer messages.

Professional input was also sought from dietitians, nutritionists, educators, and other professionals who could provide expertise (4).

Statement of Problem

After nearly three years since the release of the MyPyramid, there is no currently published research on consumer awareness, understanding, or usage of MyPyramid. Public information on usage is limited to a response statement released by the USDA in August of 2005, only four months after the release of MyPyramid. Information on the number of website users since 2005 is limited to antidotal information provided in USDA press correspondence and data provided in

Federal Registar submissions.

Significance of Problem

Research into awareness, understanding, and usage of MyPyramid is needed to evaluate

MyPyramid as a nutrition education tool. Many changes were made to MyPyramid by adding several new components were in order to improve MyPyramid as a dietary guidance. Research on awareness will show if more efforts need to be made to publicize the new guidance system.

Data collection on the understanding of MyPyramid will show whether the changes made are 3 understood by consumers. Determining usage is also important to assess whether the consumers are using MyPyramid as a guide and assess their response to the available online tools.

The evaluation of college student dietary behavior is also important. Research shows that college students are not meeting the recommendations set by the 2005 Dietary Guidelines for

Americans (5). To determine ways to improve dietary habits of college students, it is important to explore in this study student response regarding MyPyramid. Additionally, it is important to explore the reasons why students choose not to follow MyPyramid guidelines. This research could be used to improve nutrition education programs with college students and improve dietary intake of students.

Objectives

The purpose of this study was to assess college student awareness of MyPyramid and the website at MyPyramid.gov, measure students‟ perceived understanding of the new components of

MyPyramid, and analyze student usage of MyPyramid.gov and MyPyramid as a dietary guide.

The objectives of the study were:

1. To assess student awareness of MyPyramid, awareness of the former FGP, and awareness

of MyPyramid.gov.

2. To assess student‟s perceived understanding of the new components of MyPyramid

including the incorporation of physical activity, the vertical food group stripes, and the

new recommendations for oil and fat consumption, as well the new method of measuring

serving sizes for several food groups.

3. To assess student usage of the MyPyramid.gov website, the available tools, the number of

visits to the website, the purpose of the visits, and the easiness of using the website. 4

4. To assess student usage of MyPyramid as a dietary guide and the impact of learning

about MyPyramid on student diets.

5. To determine if there is a relationship between demographics and student awareness,

understanding, usage, or practice of MyPyramid.

Definition of Terms

Added Sugars: Sugars and syrups that are added to foods during processing or

preparation. Added sugars do not include naturally occurring sugars such as those that

occur in milk and fruit.

Dietary Reference Intake: A set of nutrient based reference values that expand upon and

replace the former Recommended Dietary Allowances (RDAs). They are a set of four

reference values: Estimated Average Requirements (EARs), RDAs, Adequate Intake

Levels (AIs), and Tolerable Upper Intake Levels (ULs).

Food Group: A set of food items that have been identified based on similarities in

nutrient content and/or use by consumers and grouped together for purposes of dietary

guidance. In MyPyramid, the basic food groups are bread, cereal, rice, and pasta; fruits;

vegetables; milk, yogurt, and cheese; and meat, poultry, fish, dry beans and peas, eggs,

and nuts. The short-hand name for the bread, cereal, rice, and pasta group is the “grain

group,” for the milk, yogurt, and cheese group is the “milk group,” and for the meat,

poultry, fish, dry beans and peas, eggs, and nuts group is the “meat and beans group.”

Food Subgroup: A distinct subset of foods within a food group with specified similarities,

for which there is a quantity recommendation for consumption. In MyPyramid, the

vegetable group is composed of the following subgroups: dark-green vegetables, orange 5 vegetables, dry beans and peas, starchy vegetables, and other vegetables. The grain group is composed of the whole grains and refined grains subgroups.

MyPyramid Food Guidance System: A set of information and tools to help translate the

2005 Dietary Guidelines for Americans and help consumers follow its recommendations.

The Food Guidance System includes food intake patterns, print and Web-based consumer materials, interactive tools, and information for professionals.

Oils: Fats that are liquid at room temperature, such as the vegetable oils used in cooking.

Oils come from many different plants and from fish. Some common oils are corn oil, soybean oil, canola oil, cottonseed oil, olive oil, safflower oil, sunflower oil, walnut oil, and sesame oil. Some foods are naturally high in oils, like nuts, olives, some fish, and avocados. Most oils are high in monounsaturated or polyunsaturated fats and low in saturated fats. A few plant oils, including coconut oil and palm kernel oil, are high in saturated fats and for nutritional purposes should be considered to be solid fats. Oils that have been partially hydrogenated contain trans fatty acids and for nutritional purposes should also be considered to be solid fats. While oils are not considered a food group, recommended amounts of oils are included in the MyPyramid food intake patterns because oils are a major source of essential fatty acids and vitamin E.

Perceived Understanding: Measurement of how well a person feels he/she understands a particular topic or statement.

CHAPTER II

LITERATURE REVIEW

History of Food Guide Pyramid

The USDA has been providing nutrition recommendations to consumers for more than 100 years. The first formal dietary standards were published in 1894 by W.O Atwater (2). These standards included protein and calorie requirements for the average man. Atwater goal was to create a balanced diet in order to avoid excess weight and diet related disease. The first food guide was published in 1916 providing guidelines for five groups: milk and meat, cereals, vegetables and fruits, fats and fat foods, and sugars and sugary foods (2). The food guide has been updated throughout the years to reflect the situation during that time, such as the depression

(2). World War II yielded The National Wartime Nutrition Guide soon after the first

Recommended Dietary Allowances were established in 1941 (2).

Over time, this wartime guide became known as the Basic Seven, transitioned to the

National Food Guide and eventually became the Basic Four (3). The Basic Four originated in

1956 as part of the Essentials of an Adequate Diet. It was updated in 1979 with the creation of the Hassle-Free Guide, which emphasized the restricted use of fat, sugar, and alcohol and promoted adherence to calorie levels and increased fiber intake (3).

To address new research on the relationships between diet and disease, the first edition of the Nutrition and Your Health: Dietary Guidelines for Americans was published in 1980.

Revisions were made in 1985 and 1990 (2). The original Food Guide Pyramid (FGP) was created from these guidelines over a period of 10 years. Eight goals were established to guide the development of the food guide. The main goals were to promote overall-health, to be based on a 7 foundation of up-to-date scientific nutrition research, to focus on the total diet, and to be useful, realistic, flexible, practical, and evolutionary (2).

Utilization of the Food Guide Pyramid

The FGP became widely distributed during the later 1990s as an educational tool. The graphic version of the pyramid was intended to be a supplement to the 32-page brochure explaining how to use the pyramid. Later, a condensed version entitled “The Food Guide Pyramid…Beyond the

Basic 4,” was released. The effort to promote using the FGP was forceful, and the FGP could be found on posters, in classrooms, on food packaging, and in health clinics (3). The Food Guide

Pyramid replaced the Four Food Groups in textbooks. In addition, the FGP was used in the assessment of dietary intake. For example, the Healthy Eating Index (HEI) incorporates the pyramid in five of its 10 subscales (3). Tailoring the FGP to specific ages and populations became popular, as well as the use of the pyramid shape by other countries and cultures in the development of their own food guides (3).

Criticism of the Food Guide Pyramid

While a 1997 American Dietetic Association survey found that 67% of Americans were aware of the Pyramid, and another study reported that 43% of adults failed to meet fruit recommendations, and 73% failed to meet dairy recommendations (3). In later research, Foote found that over 90% of adults did not meet the recommendations for dairy and grains (6). Furthermore, less than 10% of children met the recommendations for fruit and dairy (7). Additionally, the 1999-2000 HEI showed that 74% of the population‟s diet “needs improvement” (8). Awareness was not translating into practice.

Additionally, the FGP became a source of blame for the rising rates of obesity, especially after the announcement that the FGP was going to be redeveloped. Some researchers argued that 8 the recommendations for a low fat diet to reduce the risk of heart disease were flawed, and the resulting diet high in carbohydrates was a mediating factor for the increased incidence of cardiovascular disease, type II diabetes, and obesity (9). Willet and Stampfer argued that limiting total fat reduced monounsaturated and polyunsaturated fatty acids known to both lower LDL cholesterol and raise HDL cholesterol, which in turn reduces risk for heart disease (10).

Reduction of total fat intake also reduces the intake of essential fatty acids and omega 3 and 6 fatty acids, which limit their health benefits. Willet also argued that consuming the recommended amounts of refined carbohydrates, such as white bread, raises blood glucose to unhealthy levels and can raise blood triglycerides and lower HDL cholesterol levels (11).

Furthermore, the rapid decline in blood glucose caused by the surge of insulin in response to refined carbohydrate can cause hunger and overeating leading to increased weight gain and obesity (11).

Many researchers at Harvard University came up with a modified version of the FGP in

2001 to reflect corrections to the areas of criticized in the FGP (12). The modified pyramid includes weight control and exercise at the base. To be included next were whole grains and plant oils at all meals. Vegetables were to eaten in abundance and fruits 2-3 times a day. Nuts and legumes were recommended to be eaten 1-3 times a day, and Fish, poultry and eggs eaten 0-

2 times a day. Dairy or calcium supplements were recommended1-2 times a day. Lastly, it advises to limits the intake of red meat, butter, white rice, white bread, white pasta, potatoes, soda, and sweets. Daily vitamins and alcohol in moderation is included on the side of the pyramid. 9

Figure 2. Food Guide Pyramid Designed by Willet and Associates (12).

Some researchers suggested that the consumption of larger than recommended servings of foods is responsible for the obesity epidemic, not the FGP‟s messages. The consumer perception of one serving is often much different from what the FGP recommends as a serving size. For example, ½ cup of cooked pasta or 1 ounce uncooked pasta is considered one serving.

However, many people consume two or more cups of spaghetti at a meal and equate that pasta to one serving instead of the actual four servings (13). Consumer studies in 1999 showed that the commonly perceived portion of grains was 1 ½ to 2 times greater than actual serving sizes (13).

For consumers with this misperception, 6 to 11 servings of grains may seem like a very large amount of grains. Additionally, many consumers felt that 6 to 11 servings represented a suggested range, where 6 was the minimum for consumption and 11 was the maximum (13). 10

Both consumer misunderstanding of servings sizes and number of servings needed have led

Americans to increase their intake of grains by an average of 300 calories per day (14).

However, Goldberg, et al. argued that the pyramid was not to be blamed for the obesity epidemic (14). The authors pointed out that although Americans were not meeting recommendations, they were gaining weight from other reasons, such as increasingly large portion sizes and the large amounts of added fat (comprising 56% of total dietary fat intake) and added sugar (three times the recommended amount) consumed daily (14). Goldberg et al, cited the” multifaceted” nature of obesity and stated that one educational tool cannot be pinpointed as the cause of obesity, when so many factors including decreased physical activity, genetics, the current environment, and economics all played a part in society‟s failure to maintain healthy weight (14).

Development of MyPyramid

In 2001, the USDA‟s Center for Nutrition Policy and Promotion initiated the process for the review and revision of the FGP, which was almost 10 years old (1). Since the creation of the pyramid in 1992, Dietary Reference Intakes (DRI) for 28 vitamins and minerals were issued, and

DRIs for macronutrients, including energy, carbohydrates, fiber, fat, specific fatty acids, and proteins, were established. The DRIs have since been replaced with Recommended Dietary

Allowances (RDA) (1). These changes and the 2005 Dietary Guidelines for Americans were integrated into the new food guidance system. Additionally, the new food guide would adapt to the current consumption patterns of Americans. The food guide graphic would also be changed and a slogan chosen. The revision of the pyramid took place in three phases. The timeline of the development of the food guide is shown below (15):

Winter-Spring 2003: Technical research to develop proposed revisions to Pyramid food pattern. 11

Fall 2003…………...Proposed revisions to Pyramid food patterns published in Federal Registar for peer review and public comment.

Fall-Winter 2003….. Analysis of FR comments and further revision of Pyramid food patterns. Conceptualization and preliminary design of new graphic and consumer materials. The process for updating the Pyramid will be coordinated with the activities of the DGAC.

Spring 2004……….. Consumer testing of proposed new graphic and consumer messages.

Summer 2004………Proposed new Pyramid graphic and consumer messages published in Federal Register for public comment.

Winter 2005……….. Finalization and clearance of revised Pyramid graphic and consumer materials.

Technical Research

The technical research phase addressed the food intakes patterns and updated them based on the new DRIs, 2005 Dietary Guidelines for Americans, and current research. Five steps were completed to develop the food intake patterns (16)

1. Set energy levels based on Estimated Energy Requirements (EER) formulas. 2. Set nutrient goals based on Dietary References Intake (DRI) standards. 3. Establish food groupings based on nutrient content, use in meals, and familiarity. 4. Calculate nutrient profiles based on consumption-weighted average nutrient content for foods in each group. 5. Determine food intake patterns. Iterative process to identify food group amounts that meet nutrient goals within energy level.

Consumer Research

Between 2002 and 2005, six consumer studies were completed by the USDA and the CNPP to obtain consumer feedback on the development of MyPyramid (17). The first round of research addressed consumer understanding of the FGP‟s concepts and messages. Additionally it assessed how consumers use the FGP to guide their food choices and considered barriers keeping consumers from using the FGP (18). The major findings of the study include the following (17):

 Consumers were aware of the FGP and could name key messages, but fewer than 20% could places all food groups in correct level on a blank FGP.  Most consumers could not differentiate between a “portion” and “serving” and felt that common household measurements of cups and ounces instead of “servings” would be easier to understand.  Most of the consumers stated that they did not use the FGP, and the recommended number of servings was the most frequently reported barrier, followed by difficulty to count servings and too much work, time, and/or self-discipline needed.  Consumers recommended using household measurements, providing more detailed information about serving sizes, and providing a more individualized pyramid.

The objective of the next round of research was to assess how consumers understood potential nutrition messages for MyPyramid. Key findings and comments included the following

(17):

 Consumers found recommended amounts of food were easier to understand using household measures instead of number of servings and were interested in more information about how to choose amounts of foods for their gender, age, weight, and activity level.  Practical information and example were need for consumer to understand food group information about whole grains, vegetable subgroups, legumes, fats, and added sugars.  Consumers commonly interpreted their level of physical activity incorrectly and were especially hesitant to label themselves sedentary.

The third round of research investigated consumer response to potential graphics, slogans, and messages for MyPyramid. The research was conducted in two phases. In phase one consumers were asked to rate the graphics shown in Figure 3 in terms of overall appeal and effectiveness in motivating consumers to eat healthier and encouraging consumers to look for additional information (18). 13

Overall, three main themes emerged from the research discussion. First, consumers gravitated toward graphics that communicated success and achievement. The positive reinforcement and depiction of a human figure at the top or moving toward the top made consumer feel they could reach their goals. Next, consumers liked the personal appeal of the graphics with a human figure. Lastly, graphics containing concepts portraying movement were well liked and thought to generate enthusiasm for physical activity (18). Of the graphics, J, N, U,

W, and Y were the highest ranking graphics (18) Recommendations for change in some of the graphics included using solid colors instead of fading colors for graphic N and J and including a human figure at the top of graphic J (18) The staircase in graphic J was also altered to be more detailed.

Ten slogans were tested on the consumers. These slogans are shown below in Table 3.

Consumers preferred slogans that expressed positive messages and were inspiring. The top rated slogans were K, X, and P.

Table 1. Phase I Slogans 17

Reference code letter Slogan

C One pyramid. Many sides. E Your foods. Your moves. Your pyramid. G Your foods. Your moves. Your way. K Eat healthier. Move more. Feel better. M Help yourself to healthier.

P Find your balance. R Balance is beautiful. S Shape your day. T Food & You. What to do. V Teach me to eat. X Eat Smart. Play Hard. 14

Figure 3. Phase I Graphic Concepts 17

In the second phase, graphics that were not eliminated were revised based on the consumer comments and presented to a new group of consumers. The revised graphic concepts are shown in Figure 4. Phase II took place in two segments. During the first research period of phase II, the participants were asked to identify which concept would best represent health eating and physical activity as a national symbol. Concept J was preferred over the other concepts by

41% of the participants (W 23%, N 21%, and B 12%) (18). Open-ended comments from participants who chose concept J frequently identified the staircase was able to illustrate the 15 message of physical activity better than the other concepts (18). Concept J was selected for further research.

For the second half of phase II, concept J was modified to create two similar concepts, C and J. Concept D included different variations of the figure and staircase. The original concept J was modified only slightly to improve artistic appeal. Sixty-one percent of consumer preferred concept J over concept D (39% preferred concept D) (18).

Figure 4. Graphic Concepts for Phase II.

Figure 5. Final Graphic Variations of Concept J

Slogans were modified from phase I and 7 slogans were presented to participants in the first portion of phase II. These slogans are shown in Table 2. The slogan “steps to a healthier you most often given a high appeal ranking by participants (60%) and was chosen by more participants as the best reminder to eat healthy and be physically active (27%) (18).

Table 2. Phase II Slogans

Best Reminder to Eat Healthy and Slogan Be Physically Active (%) Steps to a healthier you 27 Eat smart. Move more. Feel great 21 Eat smart, be active, America 17 Find your balance 10 Be your healthy best 11 Your foods. Your moves. Your pyramid 8 Your foods. Your moves. Your way 6

Nutrition messages for each of the food groups were also evaluated during phase II for ability ease of understanding and ability to help them make better food choices. All of the messages were rated to be easy to understand by more than 80% of the participants and the message “focus on fruits” had the highest rating of 98% (18). These messages included the following:

 Focus on Fruit 17

 Go Lean on Protein  Make Half Your  Grains Whole  Vary Your Veggies  Get Your Calcium-  Rich Foods

From the consumer interface research, graphic concept J and the slogan “steps to a healthier you” were chosen to become the national symbol. All seven food group messages were approved for usage in the final guidance system.

Website Usability Testing

The final component of the consumer research was the testing of a prototype of MyPyramid.gov.

The research was completed using one-on-one interviews with participants as they navigated through the website. Most of the feedback was positive and the participants had little difficulty navigating the website or creating a personalized plan (1). There was some confusion in defining physical activity levels and some individuals wanted more personalization such as modifiers for weight, health, pregnancy, or lactation (1). Other complaints included difficulty finding for information on certain topics. These included vegetable subgroups and substituting beans and nuts for meat. The information was available on the website, but several users were unable to locate the information (1). The recommendations made by the users were addressed before the web site was opened.

Release of MyPyramid

After the final consumer testing of MyPyramid, MyPyramid and the MyPyramid.gov website were launched two months later in April of 2005. The final graphic version of MyPyramid included many changes from the FGP. Though MyPyramid kept the iconic pyramid shape, the food groups became vertical stripes, larger at the base and smaller at the apex (19). Additionally, 18 oils were given a recommended intake, separate from added fats and sugars. New to the pyramid was the addition of figure walking stairs on the side of the pyramid, as well as a slogan “Steps to a healthier you” (19).

The new graphic was designed to convey the new messages of MyPyramid. Vertical stripes represented moderation. Foods lower in added fats and sugars placed at the wider base indicating to choose these foods more often and choose foods with more fats and sugars, placed at the top, less frequently (19). The vertical stripes also conveyed proportionality and variety.

The differing widths of the food group bands indicated that different food groups were to be eaten in the correct proportion and would provide a variety of foods necessary for good health

(19). The exact proportions needed for each individual varies, and these proportions and amounts are found at the MyPyramid.gov website. The web site, slogan, and person on the steps symbolize the personalization of MyPyramid (19). Lastly, the slogan “steps to a healthier you,” conveyed the message that positive change and benefits can be achieved by taking small steps in improving diet and lifestyle (19).

Consumer materials for the website were available at the MyPyramid.gov website and in print. However, the website provided the most detailed and personalized information. The website was designed to personalize a food plan for each individual. After creating a plan, visitors could learn more about each of the food groups and subgroups or use one of the many tools to assess their diet or physical activity. Special sections have been developed for pregnant and breast-feeding mothers, children, youth, and the elderly.

Consumer Response to MyPyramid

Over 45 million people visited the website on the day of release (20). At post five months of release, the website had over 650 million hits. Most users of the site were from the general public 19

(97.5%) (20). Educators, organizations, and federal employees made up the other 2.5% of users.

The average length of time a visitor stayed on the website was over 10 minutes. After visiting the website, over 61% of viewers stated they were likely to make changes to their diet, with 26% expressing they were very likely to make changes (20). In October of 2008, it was reported that

MyPyramid.gov had over 5.7 billion hits, and the MyPyramid tools were receiving over 750,000 page views each day (21).

CHAPTER III

METHODS

Design

This study included both quantitative and qualitative analysis. A questionnaire was used to collect the data from students. The data were collected during April of 2008. Recruitment emails were sent to students inviting them to participate in the study (Appendix A). Reminder emails were sent out after one week and again after two weeks. To improve the student response rate, those students who completed the survey were entered into a drawing for two $75 certificates to the campus bookstore.

Approval for this study was granted by the Human Subjects Review Board at Bowling

Green State University. Informed consent was obtained at the beginning of the questionnaire.

Consent was given by students choosing to continue on to the study questions. (Appendix B).

Participants

Bowling Green State University students were chosen as the target population for the study as a convenience sample. Using a student database of emails, 19,203 students were recruited for participation in the study. The student database included undergraduate, graduate, guest, and all other groups of students. Only students 18 years or older were allowed to participate in the study.

Questionnaire Design

Using SNAP survey software, a program designed to create and publish online questionnaires, a questionnaire was designed to collect data online (Appendix C). A questionnaire format was chosen to collect data from a large sample and to measure multiple areas of interest. The questionnaire consisted of 26 questions, of which 20 were closed-ended and 6 were open-ended.

Several types of closed ended questions were used, including multiple-choice questions allowing 21 only one selection, multiple-choice questions allowing more than one selection, likert-scale questions, and yes or no questions. Open-ended questions were used to allow students to expand on their selection of “other” for a multiple-choice question. The questionnaire was reviewed by a panel of college professors and tested on college age individuals not attending the target sample university. The questions were designed to address student demographics, awareness, understanding, and usage.

Demographics

Six questions were used to measure student demographics. These questions asked about gender, class rank, and primary field of study. Two questions were used to determine if students had taken an introductory nutrition class and if that class covered MyPyramid. One question was used to address student dietary habits in regards to usual place of dining.

Awareness

Awareness of MyPyramid and MyPyramid.gov was addressed using five questions. Students were asked if they were aware of the existence of MyPyramid and MyPyramid.gov. Questions were also used to determine where students have learned about MyPyramid, and if students learned about MyPyramid in a school setting.

Understanding

Six questions were used to assess students‟ perceived understanding of some of the new components of MyPyramid and changes from the previous FGP. Students were asked to rate their understanding of the incorporation of exercise and the companion message, the meaning of the pyramids vertical stripes, MyPyramid‟s overall nutrition message, and the new recommendation for oil and fat consumption. Two other questions were used to determine if 22 students understood the new method for measuring serving size better than the method used in the FGP for four food groups.

Usage

Nine questions addressed usage. Questions asked if students had visited MyPyramid.gov, the number of times the site was visited, the purpose of the visit, the site tools used during visits, and how students would rate the sites ease of use. Two questions addressed student usage of

MyPyramid as a dietary guide. These questions asked students to rate the impact of learning about MyPyramid on their diet and if they tried to reflect what they learned about MyPyramid in their dietary selections. Two more questions addressed the reasons why students do not use.

Data Analysis

Student questionnaire responses were electronically sent to Bowling Green State University‟s

SNAP server. The data were transferred into the analysis program Statistical Package for Social

Sciences (SPSS), version 14. Double submissions were removed from the data file before analysis. Responses to open-ended questions were compiled and grouped according to similarity.

Grouped responses were then coded for qualitative analysis. Due to the large number of different fields of studies, the majors were grouped into broader categories to improve analysis.

Frequencies for gender, college major, and year in school were determined to gauge the demographics of the sample. Frequencies for the awareness, usage, and understanding questions were calculated. To determine if demographic variables were related to awareness, usage, or understanding outcomes, the Chi-Square test of significance was completed, with significance being defined as p ≤ .05.

CHAPTER IV

RESULTS

Response Rate

Of the 19,203 students invited to participate in the study, 2,687(14%) students participated. The response rate was lower than expected. Seventeen students were excluded from the study because they were under the age of 18. Duplicate submissions from the same invitation email address were excluded from the final sample of 2670 completed questionnaires.

Demographics

Frequencies for all categorical variables for the sample are shown in Table 3. Of the total

2760 respondents, 72% were female and 28% were male. The samples were near evenly distributed across the class ranks, with only a small percentage of guest and other students. The respondents were from a broad spectrum of major fields. Only 13% of the sample had completed an introductory nutrition class and 70% of the student indicated that class covered MyPyramid.

Awareness

More students were aware (56%) of the existence of MyPyramid than unaware (44%).

Females were more likely to be aware of MyPyramid than males (p=.000). The association was still significant when excluding students who completed an introductory nutrition class (p=.022).

Females were also more likely to be aware of the former FGP (p=.000). Gender differences are summarized in Table 4. When asked about the MyPyramid.gov website, only 41% reported being aware of website. Schools were the most often identified location of seeing or hearing about MyPyramid. Almost 50% of students reported seeing MyPyramid at doctors‟ offices or other health service provider locations and on food products. Of those students who selected school, 83% reported learning about MyPyramid in high school compared to 48% in college. 24

Additionally, students who had completed a college nutrition class were more aware (p=.000) of

MyPyramid than those who had not taken a class. A summary of the impact of taking a nutrition class on awareness, usage of MyPyramid.gov, and application of MyPyramid is shown in Table

Table 3. Gender, Class Rank, Field of Study, Meal Behavior, Introductory Nutrition Class, and Class Covering MyPyramid Frequencies (total N = 2670)

Characteristic N (%) Gender Female 1931 (72.3) Male 739 (27.7) Class Rank Freshman 536 (20.1) Sophomore 546 (20.4) Junior 513 (19.2) Senior 621 (23.3) Graduate Student 421 (15.8) Field of Study Education 632 (23.7) Social Sciences 384 (14.3) Business 353 (13.2) Health and Nutrition 342 (12.8) Science/Mathematics 263 (9.9) Communication 239 (9.0) Other 446 (16.7) Meal Behavior I eat at campus dining facilities or I eat out 812 (30.4) I shop for and cook my own meals 769 (28.8) I sometimes eat at campus dining/eat out 994 (37.2) and sometimes I cook I eat at home, at my sorority, or at my 81 (3.0) fraternity Other 13 (0.5) College Nutrition Class Completed Yes 355 (13.3) No 2315 (86.7) If Yes, Covered MyPyramid (n= 355) Yes 249 (70.1) No 106 (29.9) 25

Table 4. Gender Differences in the Awareness of MyPyramid, Website Usage, and Application of Knowledge.

Female Male Total N (%) N (%) N (%) Participants 1931 (72.3) 739 (27.7) 2670 (100.0) Awareness Aware of MyPyramid 1174* (78.5) 321 (21.5) 1495 (100.0) How Learned about MyPyramid (check all that apply) School 936 (62.6) 242 (16.2) 1186 (79.3) Food Products/Grocery Store 920 (61.5) 227 (15.2) 1147 (76.7) Health Facilities 581 (38.9) 111** (7.4) 700 (46.8) Media 48 (3.2) 117 (7.8) 596 (39.9) Family and Friends 294 (19.7) 75 (5.0) 369 (24.7) School MyPyramid Learned From High School Only 487 (32.6) 197 (13.2) 654 (43.7) College Only 179 (12.0) 39 (2.6) 218 (14.6) High School and College 301 (20.1) 57 (3.8) 358 (23.9) I did not learn about in school 207 (13.8) 58 (3.9) 265 (17.7) Website Usage Aware of Website 493 (33.0) 33 (2.2) 526 (35.2) Visited Website 355** (23.7) 23.7 (1.6) 426 (28.5) Purpose of Visit (check all that apply) School assignment 174 (11.6) 35 (2.3) 210 (14.0) Learn About the New Pyramid 171 (11.4) 35 (2.3) 206 (13.8) Increase Nutrition Knowledge 155 (10.4) 23 (1.5) 184 (12.3) Gain Information for Weight Loss 98 (6.6) 14 (0.9) 112 (7.5) Application Change Since Learning of MyPyramid Substantial to Some Change 546* (36.5) 129 (8.6) 675 (45.2) Very Little to No Change 628 (42.0) 192 (12.8) 820 (54.8) Reflection of MyPyramid in Food Choices Almost Always to Frequently 482** (32.2) 102 (6.8) 584 (39.1) Seldom to never 692 (46.3) 219 (14.6) 911 (60.9) Nutrition Plan Use MyPyramid 271* (18.1) 50 (3.3) 321 (21.5) Do Not Use MyPyramid 903 (60.4) 271 (18.1) 1174 (78.5) * significantly more than expected at p<.05 ** significantly more than expected at p<.01

Table 5. Awareness of MyPyramid Variables

Awareness Variables N (%) Aware of MyPyramid (n=2670) Yes 1495 (56.0) Medium of Awareness

(check all that apply) School 1186 (79.3) Food products/grocery stores 1147 (76.7) Health Facilities 700 (46.8) Media 596 (39.9) Family and Friends 369 (24.7) School Location of Learning High School Only 654 (43.7) College Only 218 (14.6) High School and College 358 (23.9) I did not learn about in school 265 (17.7) No 1175 (44.0)

Table 6. Impact of Completion of Nutrition Class on Awareness, Usage of Website, and Application of Knowledge

Completed Nutrition Class Total Yes No N % N (%) N (%) All 355 (13.3) 2315 (86.7) 2670 (100.0) Awareness Aware of MyPyramid 284* (19.0) 1211 (81.0) 1495 (100.0) Website Usage Aware of Website 167* (11.2) 451 (30.2) 618 (41.3) Visited Website 143* (9.6) 283 (18.9) 426 (28.5) Application Change Since Learning of MyPyramid Substantial to Some Change 158* (10.6) 517 (34.6) 675 (45.2) Very Little to No Change 126 (8.4) 694 (46.4) 820 (54.8) Reflection of MyPyramid in Food Choices Almost Always to Frequently 153* (10.2) 431 (28.8) 584 (39.1) Seldom to never 131 (8.8) 780 (52.2) 911 (60.9) Nutrition Plan Use MyPyramid 102* (6.8) 219 (14.6) 321 (21.5) Do Not Use MyPyramid 182 (12.2) 992 (66.4) 1174 (78.5) * significantly more than expected at p<.01 27

Understanding

When asked about their perceived understanding of several MyPyramid characteristics, the majority of students indicated a “very good” or “good” level of understanding.

Understanding of the different widths and sizes of the pyramid‟s vertical stripes elicited the highest proportion of students reporting a poor or very poor understanding (31%). Results for message understanding are summarized in Table 7. For the fruits, vegetables, grains, and meats food groups, most students indicated they understood the new measurement system for portion size in MyPyramid better compared to the former FGP. Frequencies for perceived understanding are shown below in Table 8. Over 80% of students also indicated they understood the daily allowance of oil and the recommendation to limit “bad” oils and fats. When excluding students who have completed the introductory nutrition class, females were associated with higher ratings of understanding for the MyPyramid slogan (p=.045) and fruit (p=.000) and vegetable (p=.000) portion sizes.

Table 7. Perceived Understanding of MyPyramid Messages

Very Good Good Poor Very Poor MyPyramid Messages N (%) N (%) N (%) N (%) MyPyramid and its nutritional 232 (15.5) 974 (65.2) 260 (17.4) 29 (1.9) messages Different widths and sizes of the 214 (14.3) 825 (55.2) 390 (26.1) 66 (4.4) vertical stripes Slogan “Steps to a Healthier 458 (30.6) 861 (57.6) 150 (10.0) 26 (1.7) You” and Illustration Average Score 301 (20.2) 887 (59.3) 267 (17.8) 40 (2.7)

Table 8. Perceived Understanding of Portion Size Measurement in MyPyramid Better than Previous Measurement Method

Yes No Food Group N (%) N (%) Fruit 1154 (77.2) 341 (22.8) Vegetables 1169 (78.2) 326 (21.8) Grains 805 (53.8) 690 (46.2) Meats 926 (61.9) 569 (38.1) Average Score 1013 (67.8) 482 (32.2)

Usage

Frequencies for usage of MyPyramid are shown in Table 9. Of those students who indicated they were aware of the website, only 29% had visited the website. Most students (66%) indicated visiting the website two or more times. The most frequently cited purposes for visiting the site were school assignment (49%), learning about the new pyramid (48%), and increasing nutrition knowledge (43%). When asked about utilizing the MyPyramid tools, students reported creating a personalized plan (53%) and learning about food groups and portion sizes (52%) most often. Eighty-two percent of students who visited the website indicated that MyPyramid was

“very easy” or “somewhat easy” to navigate and use.

Practice of MyPyramid

Very few students reported making substantial changes in their diet after learning about

MyPyramid (2.9%), but 42% reported making some changes. Less than 20% indicated “no change” in diet. Similarly, only 6% of students reported “almost always” trying to reflect

MyPyramid in their diet, but 33% indicated “frequently”. Females were more likely to try to use

MyPyramid as a guide compared to males (p=.035).

Table 9. Usage of MyPyramid.gov Website

Usage Variables N % Visited MyPyramid.gov website Yes 426 (28.5) Purpose of Visit School assignment 210 (49.3) Learn about the new pyramid 206 (48.4) Increase nutrition knowledge 184 (43.2) Gain information for weight loss 112 (26.3) Work or Teaching 20 (4.7) Number of Visits 1 143 (33.6) 2-3 times 188 (44.1) 4 or more times 95 (22.3) If yes, Use of MyPyramid Tools To create a personalized plan 226 (53.1) To learn about individual food groups and portion sizes 220 (51.6) To enter my daily food intake and exercise 151 (35.4) To learn about a weight loss plan 104 (24.4) None 73 (17.1) Website Ease of Use Very easy 159 (37.3) Somewhat easy 192 (45.1) Neither easy nor difficult 65 (15.3) Somewhat difficult 10 (2.3) No 1069 (71.5)

The most cited reasons for not using MyPyramid as a guide were using a different nutrition plan

(28%), being uninterested (25%), and not desiring guidance (22%). Of note, lack of time and money, as well as not thinking about food was frequent “other” responses. Friends and family was the most selected source of nutrition information apart from MyPyramid (61%), followed closely by internet websites (53%), and magazines (43%). Food labels were the most often reported source of information from respondents that choose “other”. Frequencies for all practices variables are shown in Table 10.

Table 10. Practice of MyPyramid Variables

Practice Variables N % Diet Change Since Learning of MyPyramid (n=1495) Substantial change 43 (2.9) Some change 632 (42.3) Very little change 542 (36.3) No change 278 (18.6) Reflection of MyPyramid in Diet (n=1495) Almost always 96 (6.4) Frequently 488 (32.6) Seldom 665 (44.5) Never 246 (16.5) Reasons for Not Using MyPyramid (n=1495)

(check all that apply) I use a different nutrition plan 422 (28.2) I am not interested in MyPyramid 369 (24.7) I do use MyPyramid 321 (21.5) I do not need guidance 321 (21.5) Other 156 (10.3) I do not understand MyPyramid 117 (7.8) Other Sources of Nutrition Information (n=2760)

(check all that apply) Family or Friends 1633 (61.2) Internet websites 1409 (52.8) Nutrition or fitness magazines 1154 (43.2) Popular diet and nutrition books 448 (16.8) School nutrition classes 328 (12.3) Other 321 (12.0)

CHAPTER V

DISCUSSION

The aim of this research was to evaluate college student awareness, perceived understanding, and usage of the recently established MyPyramid, the most recent nutrition guidance system. This research found that 56% of the students stated they were aware of MyPyramid and 79% of those students who were aware felt they understood MyPyramid‟s messages and 68% felt they understood the changes in measuring serving sizes. However, students were not frequently using

MyPyramid to guide meal choices (22%), and few (29%) students had utilized the

MyPyramid.gov website. Also of significance, females were found to be more likely to be aware of MyPyramid, use the MyPyramid website, make changes in their diet, and use MyPyramid as a nutrition plan. Furthermore, completion of an introductory college nutrition class resulted in similar impacts on awareness, usage, and practice of MyPyramid regardless of gender.

The significant differences in gender found in this study are not surprising, as it is has been well documented from previous research that females more closely adhere to nutrition recommendations, have higher levels of nutrition knowledge, and are more concerned about physical appearance and body image (22-24). These findings continue to support that gender differences are seen in college students as well as the adult population. In contrast, what is remarkable is the finding that taking an introductory nutrition class in college had a similar influence on results. Students who had taken an introductory nutrition class had higher percentages for awareness of MyPyramid. These students also reported higher levels of understanding of the MyPyramid messages and new method of measurement for all food groups.

Furthermore, these students also reported using MyPyramid as a guide and reflecting

MyPyramid in their food choices more often than the rest of the population. This result also may 32 not be considered “surprising,” but the data may provide a foundation for research and development of strategies to promote increased MyPyramid awareness and nutrition education in college students.

Efforts should be made to increase awareness of MyPyramid in college students.

Although 56% of the college students surveyed were aware of the existence of MyPyramid, there remains significant room for improvement. This is evidenced by the finding that of those students not aware of MyPyramid, almost 80% were aware of the FGP. To date, no other studies have measured student awareness.

School systems are an excellent place to promote awareness of MyPyramid, since schools can reach nearly 100% of young adults. In a 2003 position statement on School Nutrition

Services, the American Dietetic Association, the Society for Nutrition Education, and the

American School Food Service Association recommended providing a sequential and comprehensive nutrition education program in the schools systems beginning in pre-school and continuing through the 12th grade (25). A recent study evaluating the progress of school nutrition services published in 2009 found that only 61% of schools sampled were offering nutrition education for each grade level (26). However, nearly 90% were meeting state standards for nutrition education (26). Efforts should be made to encourage state legislature to increase the nutrition education requirements for schools.

At the college level, MyPyramid should also be promoted since it is a time when students are beginning to make their own meal choices, prepare meals, and shop for groceries. Not only should dietary information based on MyPyramid be provided to students through classroom courses, but also MyPyramid should be taught at the dining locations through handouts, posters, 33 table tents, displays, and point of purchase signs to encourage students to learn about MyPyramid and make better food choices.

Additionally, students frequently mentioned hearing about MyPyramid through doctors‟ offices, hospitals, or health clinics. These venues should be utilized to increase awareness of

MyPyramid. Students do not come in contact with dietitians or other nutrition professionals frequently. However, students do make routine visits to see physicians and nursing. These health professionals could promote the use of MyPyramid through discussions of healthy eating and maintaining a healthy weight, as well as providing nutrition related materials in the waiting rooms.

Moderate levels of awareness (56%) did not translate into the same levels of usage of the website (30%) or MyPyramid as a nutrition guide (21.5%) in the college student population. The percentage visiting the website fell to less than 24% when students who took introductory nutrition classes were removed. However, almost all students reported the website being easy or very easy to use. This supports the results of a study completed with all female college students who had never previously used my MyPyramid. Seventy-seven percent of the students in the study reported the website to be easily navigated (27). The usability of the website was not as highly scored in a 2007 study of literacy, linguistic, and cultural factors (28). The results showed the website failed to meet 10 of the 20 usability criteria. Positive outcomes in the two studies using college students may be due to college students having high levels of computer skills.

Usage of the websites tools was also favorable. Over half of the students had created personalized plans and explored the website to learn about individual food groups and portion sizes. Only 17% of students reported visiting the site but not using any of the available tools. The website tools are also popular with American consumers as the Federal Register reported in 34

January of 2009 that 3.3 million people used the MyPyramid Tracker tool to create personalized plans and 2.6 million of those people registered to save the information (29). However, only 10% of those individuals use the tool to track their intake and exercise daily. It also reported that logging daily meals and exercise takes individuals about 30 minutes for each day entered.

Though not assessed, students may be less likely to use the tracking tool consistently due to the required time. A lack of time was a frequently cited reason for not using MyPyramid as a diet guide.

These results and previous research on use of the internet as a source of health information shows that the website could be a good tool to educate students about MyPyramid.

Research completed by the Pew Internet and American Life Project reported that in 2007, 74% of Americans were online and 61% were using the internet to find health information (30). The research showed that 68% of adults 18-32 were searching for health information and 63% of adolescents have looked for information on body image and nutrition (30, 31). A 2006 Canadian study found that 40% of respondents reported using the internet “frequently” to find nutrition information and another 47% reported using the internet from “time to time” (32). Only books and magazines were reportedly used more often when searching for nutrition information.

The popularity of the internet and the increasing utilization of the internet to find health and nutrition information should be exploited to reach individuals with accurate, reliable, and scientific based nutrition information. An effort to take advantage of this fact was made when the

MyPyramid.gov website was created during the revision of the FGP. However, even though college students and young adults spend large amounts of time on the internet and look for health and nutrition information on the internet, few students visited the MyPyramid website. 35

One possible strategy to increase the usage of the MyPyramid.gov website would be the use of social media to promote MyPyramid in the cyber places young adults “hangout”. Social media uses strategies to market information online using social networking sites. The Center for

Disease Control (CDC) website is an example of how social media can be used to promote a health campaign (33). The CDC can be found on Twitter, Facebook, YouTube, iTunes, Second

Life Island, DailyStrength, and Flickr. CDC also is using blogs, podcasts, RSS Feeds, Widgets, eCards, eGames, email updates, mobile updates, and other media tools to communicate with the public and keep them updated. The use of these social networking sites and online-based tools, which are popular with college age students, are helping the CDC reach more people about key health issues. The same strategies could be used to promote MyPyramid to college students.

MyPyramid is currently only utilizing Twitter and podcasts. Expanding on the current social media being used by the MyPyramid.gov website would increase the number of places where college students become exposed to MyPyramid and increase opportunities to visit MyPyramid.

When asked why they were not using MyPyramid, many students reported not being interested, not having time, or not thinking about nutrition. The website should include specific information relevant to busy college students and young adults. Currently, the website provides tailored information for kids (age 2-11) and pregnant or breastfeeding mothers. The college population currently falls into information for the general population. Information on how to eat right on campus or how to shop on a student budget might keep students at the website longer instead of just displaying general information.

Currently, only 21.5% of students reported using MyPyramid as a guide for their diet.

Similarly only 39% of students aware of MyPyramid reported reflecting MyPyramid in their food choices “frequently” or “almost always.” However, when students had visited the website, 36 nearly half of the students reported making “some change” or “significant change” in their diet.

These results could be interpreted to indicate that usage of the website may help increase the utilization of MyPyramid in dietary choices. Of interest, the percent of students likely to make changes in their diet after visiting the website (45%) was lower than the 61% of respondents found in a USDA poll (20).

It is unclear why college students are less likely to make diet changes than the adults surveyed in the USDA poll. However, this survey did reveal common themes on why students are not using MyPyramid as a nutrition plan (80%). Many students indicated they used some other nutrition plan or were not interested or did not need guidance. In the open-ended responses, a common theme of indifference toward nutrition either through a lack of interest, time, or motivation was seen in many responses. A few students indicated that MyPyramid was too hard to follow or understand and others thought it was too expensive to follow. Efforts should be made to increase interest in nutrition during college and subsequent young adult periods. This could be accomplished by the methods discussed above to promote awareness of MyPyramid and to include nutrition information during orientation and basic college courses.

Many colleges provide an introductory class, which currently includes topics on how to use campus resources, how to properly study and prepare for class, what campus organizations, and events are available, etc. This class provides an excellent opportunity to include information on how to stay healthy at school by eating right and exercising. Materials on MyPyramid could be provided during the class as resource information. Furthermore, students should be encouraged to take an introductory nutrition class. As discussed earlier, students who took an introductory nutrition class reported high levels of awareness, usage, and practice of MyPyramid. 37

This data supports the proposed strategy discussed above to implement more comprehensive nutrition education in schools.

Providing more aggressive nutrition education in schools would help provide accurate and scientific based nutrition information to students. This survey showed students are currently getting information from unreliable sources. Students reported friends and family as the most used source of nutrition information at 61%. This result is not favorable since most consumers do not have a significant knowledge of nutrition or find nutrition information from reputable sources. Internet websites were the second most popular response. A large portion of the students also used nutrition and fitness magazines. The results of this research complement the findings by Marquis & Dubeau that found adults reported using, in descending order, magazines, books, internet, food labels, brochures, family/friends, television, newspapers, dietitians, physicians, and grocery stores to find nutrition information (32). The student responses raise the question as to if students are finding valid and scientific based nutrition information. This stresses the importance of promoting MyPyramid to students beginning in elementary school and continuing into college so students know where to find reliable sources of information.

In contrast to the low reported usage of MyPyramid by those students aware of

MyPyramid, students reported a high level of perceived understanding of MyPyramid characteristics and messages. These characteristics and messages assessed reflect some of the changes made from the original FGP. Students expressed an understanding of the incorporation of physical activity and the meaning of the vertical stripes. Students also reported a greater understanding of the new methods of measurements for serving sizes for several food groups compared to the previous methods. Of interest, the fruit and vegetable food groups received a higher percentage of students‟ understanding the new measurement better (77% and 78%, 38 respectively) compared to the grains (54%) and meats (62%) groups. The fruit and vegetable groups were measured in cups, where as the meat and grains groups were measured in ounces.

These results support the consumer research completed during the development period of

MyPyramid, which found consumers preferred using common household measurements such as cups and teaspoons (16). The research also supports that the changes and additions made to the

FGP were appropriate and effective for the fruit and vegetable groups, but the serving sizes for the grains and meats groups may still not be clear to consumers.

Overall, this research showed that MyPyramid has the potential to be an effective tool for teaching nutrition education to college students. This could be accomplished by including comprehensive nutrition education in all grade levels, marketing MyPyramid to college students, and tailoring the information to be most appropriate for college students or young adults. Also, highlighted in the research is that awareness does not necessarily produce usage or practice in everyday life. The ADA, SNE, and ASFSA stated in their position paper that 50 hours of instruction and exposure are needed to impact behavior (25). Students currently only receive 13 hours of instruction (25). Implementing and requiring nutrition education at all levels of education may be the only way to provide the necessary hours to translate awareness of

MyPyramid into practice.

Limitations

The study is limited by the use of a convenience sample of college students from only one mid- west university. The results of the study may not be applicable to college students from large universities in other regions of the United States. The study‟s response rate was lower than average and data on non-responders was not available. The sample also had a high percentage of female responders, which may have influenced the results. 39

Conclusion

This exploratory study of student awareness, usage, and understanding of MyPyramid showed more than half of students are aware of the existence of MyPyramid. However, awareness did not translate into usage of MyPyramid, as less than a quarter of the students stated to use

MyPyramid as a guide for dietary intake and less than half of the students stated to have made changes in their diets after learning about MyPyramid. Students did report a good understanding of MyPyramid, its new messages, and the changes in the measurement of serving sizes. The findings showed students who had taken an introductory nutrition class had higher levels of awareness, understanding, usage of the website, and reflection of MyPyramid in dietary choices.

These findings support the idea that efforts should be made to promote MyPyramid in all facets of the education system and to encourage students to take nutrition courses in college in order to facilitate the movement from only awareness to utilization and practice. Continued research is needed to find ways to increase student awareness and increase the number of students using

MyPyramid to make better food choices.

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24. Kiefer I, Rathmanner T, Kunze M. Eating and dieting differences in men and women. J Mens

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25. Position of the American Dietetic Association, Society for Nutrition Education, and

American School Food Service Association: Nutrition services: An essential component of

comprehensive school health programs. J Nutr Educ Behav. 2003;35:57-67.

26. Longley C, Sneed J. Effects of federal legislation on wellness policy formation in school

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27. Samuels E, Martinex-Pederson S, Pan J, Foord-May L, Metallino-Katsaras E. Is there room

for improvement for MyPyramid.gov as nutrition education tool? Top Clin Nutr.

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28. Neuhauser L, Rothschild R, Rodrigues F. MyPyramid.gov: Assessment of literacy, cultural

and linguistic factors in the USDA food pyramid web site. J Nutr Educ Behav. 2007;39:219-

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http://www.cdc.gov/socialmedia/. Accessed August 16, 2009.

APPENDIX A: RECRUITMENT EMAIL

Hello Students,

I am a Master's degree student in the Family and Consumer Sciences Department. I would like to invite you to participate in my thesis research project. The purpose of the study is to assess university student awareness, understanding, and usage of MyPyramid.

You will be asked to complete a short online questionnaire that takes less then five minutes. If you complete the survey, you will be entered into a drawing to WIN ONE OF TWO $75.00 BGSU BOOKSTORE GIFT CERTIFICATES!

To participate in the study please follow the link http://survey.bgsu.edu/surveys/ir/mypyramid/mypyramid.htm?id=q82 0 to complete the survey. By completing the survey you are indicating consent to participate in the study. Please complete by May 1,2008. Although your responses will remain confidential, in order to contact you if you win one of the prizes, you will be asked to provide an email address. To further protect your confidentiality, you may wish to use an email address that does not in any way identify you (e.g., "[email protected]") rather than using your BGNET account. The email address you provide will be used ONLY for contacting you if you win a prize. This email address will not be shared with anyone at any point.

If you have any questions about the survey, please contact me at my email address: [email protected].

Thank You for Your Participation! !!

Mara Lee Beebe Graduate Student School of Family and Consumer Sciences Bowling Green State University

APPENDIX B: INFORMED CONSENT

Informed Consent to Participate in a Research Study

You are being asked to volunteer for a research study. Please read the information below and email or call about any questions you may have about the study before agreeing to participate.

Project Title: “University Students‟ Awareness, Understanding, and Usage of MyPyramid”

Principal Investigators: Mara Lee Beebe

Advisor: Dr. Younghee Kim Ph. D.

Purpose of the Research Study: The purpose of the study is to assess university students‟ awareness, understanding, and usage of MyPyramid Food Guide System.

Procedures: If you are 18 years of age or older and consent to participate in the research study, you will be asked to complete an online questionnaire. Completion of the questionnaire will take approximately 5 minutes. By completing this questionnaire and clicking the “submit” button you are indicating your consent to participate in the study. Please remember to clear your browser‟s cache and page history after you submit the questionnaire in order to protect your privacy.

Risks and Benefits of Being in the Study: There are no foreseeable risks associated with participation in the study. Students who complete the questionnaire will be entered into a drawing for two $100 bookstore gift certificates. Additionally, by participating in the research, your information will contribute to the body of knowledge on college students‟ and MyPyramid.

Anonymity: The study is completely anonymous. Your name in no way will be linked to your answers, and your questionnaire will be added to other student questionnaires. However, e-mail is not 100% secure, so it is possible that someone intercepting your e-mail will gain knowledge of your interest in the study. Although your responses will remain anonymous, in order to contact you if you win one of the prizes, you will be asked to provide an email address. The email address you provide will be used ONLY contacting you if you win a prize. This email address will not be shared with anyone at any point.

Voluntary Nature of the Study: Participation in this research study is completely voluntary. If at any time you do not want to continue, you may choose to withdrawal from the study. Your decision to participate or not participate will have no impact on your grade, class standing or relationship to BGSU

Contacts and Questions: The researchers conducting this research study can be contacted by email at [email protected] if you have any questions or concerns about the study. You may also contact my advisor at [email protected]. The chair of Human Subjects Review Board, Bowling Green University may be contacted at (419) 372-7716 or [email protected] if you have any problems or concerns regarding your rights as a research participant.

Please keep this copy of information for you own records.

Mara Lee Beebe Graduate Student School of Family and Consumer Sciences Bowling Green State University

APPENDIX C: ONLINE QUESTIONAIRE

University Student Questionnaire

Please read and follow directions carefully and answer all questions as truthfully as possible. Please enter or select the most appropriate answer. 1. What is your gender? a. male b. female

2. What is your current class level/rank at the university? a. freshman b. sophomore c. junior d. senior e. graduate student f. guest student g. other

3. What is your major? Drop down box to select major from will be here.

4. Where do you eat your meals most of the times? a. I eat at campus dining facilities or I eat out. b. I shop for and cook my own meals c. I sometimes eat at campus dining/eat out and sometimes I cook my own meals. d. Other Please specify

5. Have you taken an “Introductory Nutrition” class in college? a. Yes b. No (skip to #6)

6. If „yes‟ to question #4, did the class cover MyPyramid? a. Yes b. No

7. Are you aware or familiar with the existence of the MyPyramid Food Guide? a. Yes b. No

8. If no, were you aware of the existence of the previous version, which is the Food Guide Pyramid? a. yes b. no (Skip to #26)

9. Where have you seen or heard of MyPyramid? Check all that apply. a. school b. home c. food products d. grocery stores e. Doctors offices/hospitals/health clinics f. media g. Other ______

10. If you learned about MyPyramid in school, where did you learn about it? a. High school b. College c. Both 11. Are you aware of the existence of the MyPyramid.gov website? a. yes b. no

12. Have you ever visited MyPyramid.gov website? a. Yes b. No (skip down few questions)

13. What was the purpose or occasion for your visit? Check all that apply. a. School assignment b. Increase nutrition knowledge c. Learn about the new pyramid d. Gain information for weight loss e. Other ______

14. How often have you visited the site? a. once b. 2-3 times c. 4 or more times

15. Have you used any of the following MyPyramid tools? Check all that apply. a. To enter your own information and create a personalized plan for calorie intake and food group amounts. b. To learn about individual food groups and portion sizes. c. To enter your daily food intake and exercise and receive information about intake and expenditure. d. To learn about using MyPyramid as a weight loss plan. e. None 51

16. How easy was Mypyramid.gov to use? a. very easy b. somewhat easy c. neither easy nor difficult d. somewhat difficult e. very difficult

17. How would you describe your understanding of MyPyramid and its nutritional messages? a. excellent understanding b. good understanding c. some understanding d. somewhat poor understanding e. very poor understanding

18. How would you describe your understanding different widths and sizes of the vertical stripes representing each of the food groups? a. excellent understanding b. good understanding c. some understanding d. somewhat poor understanding e. very poor understanding

19. MyPyramid uses cups to calculate your daily allowance of fruits and vegetables. Do you find this easier to understand than using servings as used in the previous Food Guide Pyramid? Fruits a. yes b. no Vegetables a. yes b. no

20. In MyPyramid, the recommended amount of grains and meats is measured in ounces. Do you find this easier to understand than using servings as used in the previous Food Guide Pyramid? Grains a. yes b. no Meat a. yes b. no

21. MyPyramid recommends your daily allowance of oil and recommends limiting “bad” oils and fats. Do you feel you understand this message? a. yes b. no

22. How would you describe your understanding of the slogan “Steps to a Healthier You” and the illustration of steps on the side of the pyramid to represent the importance of exercise and changing your diet one step at a time? a. Very Good b. Good c. Poor d. Very Poor

23. How would you describe the change in your diet after learning about MyPyramid? a. Substantial change b. Some change c. Very little change d. No change

24. Do you try to reflect MyPyramid when making choices about your food intake? a. Always b. Frequently c. Seldom d. Never

25. If you do not use MyPyramid, what are your reasons for not using MyPyramid? Check all that apply. a. I DO use MyPyramid b. I do not understand MyPyramid c. I use a different nutrition plan d. I am not interested in MyPyramid e. I do not need guidance f. Other ______

26. Where else do you look for nutritional information? Check all that apply. a. Internet websites b. Nutrition or fitness magazines c. Popular nutrition books d. School nutrition classes e. Family or Friends f. Other ______