NUTRITION KNOWLEDGE AND PERCEPTION OF VEGETARIAN DIETS IN VEGETARIAN AND NON-VEGETARIAN, MALE AND FEMALE COLLEGE STUDENTS A thesis submitted to the Kent State University College of Education, Health and Human Service in partial fulfillment of the requirements for the degree Master of Science in Nutrition and Dietetics By Brielle Stark Gay December 2018 © Copyright, 2018 by Brielle S. Gay All Rights Reserved ii A thesis written by Brielle Stark Gay B.S., Kent State University, 2017 M.S., Kent State University, 2018 Approved by ________________________, Director, Master’s Thesis Committee Natalie Caine-Bish ________________________, Member, Master’s Thesis Committee Amy Miracle ________________________, Member, Master’s Thesis Committee Karen Lowry Gordon Accepted by ________________________, Interim Director, School of Health Sciences Ellen Glickman ________________________, Dean, College of Education, Health, and Human Services James C. Hannon iii GAY, BRIELLE STARK, M.S., December 2018 Nutrition and Dietetics NUTRITION KNOWLEDGE AND PERCEPTION OF VEGETARIAN DIETS IN VEGETARIAN AND NON-VEGETARIAN, MALE AND FEMALE COLLEGE STUDENTS (142 pp.) Director of Thesis: Natalie Caine-Bish, Ph.D, R.D., L.D. Vegetarianism is becoming a more popular diet option for health, ethical and environmental reasons as well as for religious beliefs. However, most college students are not presently considering the vegetarian diet as a healthy alternative to their current lifestyle. The purpose of this study was to understand the nutrition knowledge and perception of vegetarian diets in male and female vegetarian and non-vegetarian college students. Participants were limited to male and female undergraduate students over the age of 18 years, who completed an online survey with demographic, perception and nutrition knowledge questions. Analysis of the data showed a significant difference in perceptions of the vegetarian diet between males and females, as well as non-vegetarians and vegetarians (p< 0.05).Females had a more positive perception compared to their male counterpart, while vegetarians had a more positive perception than non-vegetarians. However, there were no significant results regarding nutrition knowledge between either gender or diet. Future studies with a larger sample size and questions with a stronger emphasis on vegetarianism are needed to confirm the results of this study. ACKNOWLEDGEMENTS I would like to thank Dr. Natalie Caine-Bish for her guidance and advice throughout this process. When starting graduate school, the abstract idea of a thesis can be daunting. However, with the help of Dr. Bish, I started to understand how the writing process might be broken up into attainable goals. Once I started researching, I could even see how it would be enjoyable. Now, I look forward to the research I’ll do as part of career because this has been such a rewarding experience. Dr. Bish has taught me a great deal about research methods, and I appreciate the time and effort she’s put into guiding me. I would also like to thank Dr. Karen Gordon and Dr. Amy Miracle for their help and advice. Without their instruction and vast knowledge of the research process, I would have not been able to expand my personal knowledge or my methods of research. Additionally, I would like to express gratitude toward the undergraduate students at Kent State University who have participated in the survey I distributed. Without their participation, data collection would have been greatly hindered. Lastly, I am very grateful for the help and support I received from Peter Pribis during the survey development process. He was very supportive and willing to offer any assistance he could in the creation of a survey that fit the needs of my thesis. iv TABLE OF CONTENTS Page ACKNOWLEDGEMENTS………………………………………………………………………iv LIST OF TABLES.……………………………………………………………………………..viii CHAPTER I. INTRODUCTION…………………………………….…...….……………….......1 Statement of the Problem…………………………………………………….….....3 Purpose Statement………………………………………………………...............5 Hypotheses………………………………………………………………………...6 Operational Definitions…………………………………………………………....6 II. REVIEW OF LITERATURE……………………………………………....…….7 What is a Vegetarian Diet?....................................................................................7 Origins of the Vegetarian Diet.……………………………………..…...8 Different Types of Vegetarian Diets………..……………………….…11 Recommendations for Vegetarian Diets…………………………….…13 Epidemiology of Vegetarianism ……………………………………....17 Nutrition Benefits of Vegetarian Diets……………………………………...…18 Body Weight………………………………………………………..…..20 Mortality Rates...……………………………………………………….21 Cardiovascular Disease…………………………………………...…....22 Cancers.....……………………………………………………….…..…23 Type II Diabetes………………………………….…………….……....23 Other Diseased States.………………………………..……..…....…….24 Nutrition Concerns of Vegetarian Diets…….………………………………….25 Protein Needs…..………………...…………………………………….…25 Vitamin B12 Deficiency…..…………………………….…………….…..26 Iron Deficiency…………………………………………………….….…27 Calcium and Vitamin D Deficiency…..……………………………....….28 At-Risk Populations…………………………………………………...…29 Pregnant Women………………...……………….…………...29 v Breastfeeding Women and Infants..……………………..…..31 Children………………………………………………………32 Eating Behaviors of Vegetarians...…………………………………………..….33 Reasoning for Practicing a Vegetarian Diet…….……………………………....34 Current Trends in Dietary Intake and Behavior in College Students…………..37 Lifestyle Behaviors in College Students……………..………..………..38 Health Concerns for College Students….……………..…………..……40 Prevention and Interventions………...………………………………….42 Current Nutrition Knowledge in Men and Women College Students……….…45 Current Perception of Vegetarian Diets in Men and Women…………………..49 Gender Differences in Dietary Intake and Behavior…..…………………….....52 III. METHODOLOGY……………………………………………………………....55 Overview….……………………………………………………………………..55 Participants.……………………………………………………………………...55 Instrumentation…….………………………………………………………….…56 Survey Development…………..………………………………………...56 Survey Components……………………………………………………..57 Part I: demographics.……………………………………………58 Part II: perceptions toward vegetarianism.…..………………….59 Part III: general nutrition knowledge...………………...………..59 Data Collection Procedures….………………………………………………….60 Data Analysis Procedures…….…………………………………………………61 IV. JOURNAL ARTICLE…………………………………………………………..63 Introduction…………………………………………………………………....63 Methodology………………………………………………………………...…66 Instrumentation....…………………………………………………...….67 Data Collection Procedures……………………………………………..68 Data Analysis Procedures……………………………………………….69 Results………………………………………………………………………....70 Demographics…..……………………………………………………….70 Perceptions toward Vegetarianism……………………………………...72 General Nutrition Knowledge…………………………………………..79 Discussion……………………………………………………………………...88 Characteristics of Study Population……………………………………..88 Perceptions of Vegetarianism………………………………………..….89 vi Knowledge of General Nutrition……………………………………......92 Limitations……………………………………………………………………...94 Applications………………………………………………………………….…95 Conclusion………………………………………………………………..….…97 APPENDICES………………………………………………………………………………….99 APPENDIX A. NUTIRITION KNOWLEDGE AND PERCEPTION SURVEY…….....100 APPENDIX B. RECRUITMENT E-MAIL………….…………………………………..115 APPENDIX C. STUDY CONSENT FORM…………...………………………………..117 APPENDIX D. SURVEY BY PETER PRIBIS.…………………………………………119 APPENDIX E. SURVEY BY DR. AMY MIRACLE…………………………………...125 REFERENCES…………………………………………………………………………………130 vii LIST OF TABLES Table Page 1. Demographics of Undergraduate College Students Surveyed at a Midwestern University on Nutrition Knowledge and Perception of the Vegetarian Diet (N=1,191)……… ………...…………………………………...………………….......71 2. Perceptions of Vegetarianism of Male and Female Undergraduate College Students Surveyed at a Midwestern University (N=1,191)……………...……………………..72 3. Perceptions of Vegetarianism of Vegetarian and Non-Vegetarian Undergraduate College Students Surveyed at a Midwestern University (N=1,191)…….……….…...75 4. Perception Scores of Vegetarianism of Male and Female Undergraduate College Students Surveyed at a Midwestern University (N=1,191)…………………...……...78 5. Perception Scores of Vegetarianism of Vegetarian and Non-Vegetarian Undergraduate College Students Surveyed at a Midwestern University (N=1,191)………………….79 6. General Nutrition Knowledge of Male and Female Undergraduate College Students Surveyed at a Midwestern University (N=1,191)…...………...……………………...80 7. General Nutrition Knowledge of Male and Female Undergraduate College Students Surveyed Using Fill-in-the-Blank Question at a Midwestern University (N=1,191)...83 8. General Nutrition Knowledge of Vegetarian and Non-Vegetarian Undergraduate College Students Surveyed at a Midwestern University (N=1,191)…...…...………...83 9. General Nutrition Knowledge of Vegetarian and Non-Vegetarian Undergraduate College Students Surveyed Using Fill-in-the-Blank Question at a Midwestern University(N=1,191)………...…………………………………...……………….......86 10. Comparing General Nutrition Knowledge of Male and Female Undergraduate College Students Surveyed at a Midwestern University (N=1,191)….…………………..…...87 11.Comparing General Nutrition Knowledge of Vegetarian and Non-Vegetarian Undergraduate College Students Surveyed at a Midwestern University(N=1,191).....88 viii CHAPTER I INTRODUCTION Vegetarianism is most commonly known as a diet that excludes the consumption of meat, including fowl, seafood and other products containing those foods (Craig and Mangels, 2009). The vegetarian diet is as healthy as an omnivore diet,