HOW DOES KNOWLEDGE AND UTILIZATION OF NUTRITION LABELS DIFFER AMONG INTERNATIONAL AND NON-INTERNATIONAL COLLEGE STUDENTS? A thesis submitted to the Kent State University College of Education, Health, and Human Services in partial fulfillment of the requirements for the degree of Master of Science By Ala S. Alsaddah December 2014 © Copyright, 2014 by Ala S. Alsaddah All Rights Reserved ii Thesis written by Ala S. Alsaddah B.S., King Abdulaziz University, 2009 M.S., Kent State University, 2014 Approved by _________________________, Director, Master’s Thesis Committee Karen Gordon _________________________, Member, Master’s Thesis Committee Natalie Caine-Bish _________________________, Member, Master’s Thesis Committee Amy Miracle Accepted by _________________________, Director, School of Health Sciences Lynne Rowan _________________________, Dean, College of Education, Health and Human Services Daniel F. Mahony iii ALSADDAH, ALA S. , M.S., DECEMBER 2014 Health Sciences HOW DOES KNOWLEDGE AND UTILIZATION OF NUTRITION LABELS DIFFER AMONG INTERNATIONAL AND NON-INTERNATIONAL COLLEGE STUDENTS? (124 pp.) Director of Thesis: Karen L. Gordon, Ph.D., R.D., L.D. The purpose of this study was to compare the knowledge and utilization of nutrition labels among international versus non-international college students. It was expected that there would be a difference in knowledge of the nutrition labels between the international and non-international college students. Also, it was expected that there would be a difference in utilization of nutrition labels among international and non- international college students. An electronic questionnaire was completed by undergraduate and graduate students at Kent State University (n=176). Descriptive statistics were utilized to describe frequencies, standard deviations, and means of all participants’ responses. A t test was used to compare the means of the three subscales (nutrition knowledge, nutrition label use, and attitude toward nutrition labels) among the demographic variables. A P-value was selected a priori 0.05 for significance. Correlation between age and the three scales was used to analyze the relationship between age and scores on each of the three scales. A significant difference was demonstrated in the summed total knowledge scores between non-international and International students (P=.001). This study demonstrated a lack of overall nutrition label knowledge and use among college students, suggesting nutritional-related educational strategies for college students are needed. ACKNOWLEDGMENTS I would never have been able to finish my thesis without the guidance of my advisor, committee members and support from my family and my husband. I would like to express my deepest gratitude to my advisor, Dr. Karen Lowry Gordon, for her excellent guidance, caring, patience, and providing me with an excellent atmosphere for doing research. I would also like to thank my committee members, Dr. Natalie Caine-Bish and Dr. Amy Miracle, for taking the time to read through, and provide their feedback for the development of a stronger thesis. I would also like to thank everyone who helped me reach the participants and all of the students who participated in my study. I also appreciate everyone taking his or her time to teach and guide me through my journey. My father, mother, father and mother in law, grandparents, sisters, brother, aunt Manal and all of my friends were always supporting me and encouraging me with their best wishes. My little daughter, Eliana. She always brings joy and happiness to my life. Finally, I would like to thank my husband, Mohammed Asel. He was always there cheering me up and stood by me through good and rough times. iv TABLE OF CONTENTS ACKNOWLEDGMENTS ................................................................................................. iv LIST OF TABLES ........................................................................................................... viii CHAPTER Page I. INTRODUCTION .....................................................................................................1 Problem Statement ......................................................................................................3 3 Purpose Statement .......................................................................................................5 Hypothesis...................................................................................................................5 Operational Definitions ...............................................................................................5 II. REVIEW OF LITERATURE .....................................................................................7 Overview of Nutrition Labels .....................................................................................7 Front-of-pack (FOP) Labeling ...........................................................................7 Organic Labeling ...............................................................................................8 The Back of the Package....................................................................................8 List of Ingredients ..............................................................................................9 Generally Recognized as Safe (GRAS) ..........................................................10 Food Allergy Labels ........................................................................................10 Footnote ...........................................................................................................11 Daily Value ......................................................................................................11 Serving Sizes ....................................................................................................11 Voluntary/Exempt Labeling.............................................................................12 Meat, Poultry and Fish .....................................................................................13 Dietary Supplements ........................................................................................13 New Nutrition Labelling ..................................................................................14 Nutrition Claims........................................................................................................17 Health Claims...................................................................................................17 Nutrient Content Claims ..................................................................................17 Structure/Function Claims ...............................................................................19 Content of Nutrition Fact Label .......................................................................19 Nutrition Labels for Other Countries ...............................................................19 Recommended Dietary Intake of Adults...................................................................22 Actual Dietary Intake Among College Students ..............................................24 Non-international College Students’ Dietary Intake........................................25 International Students Dietary Intake ..............................................................27 Concerns of Poor Dietary Intake and Lack of Nutritional Knowledge ....................33 Effect of Poor Diet ...........................................................................................33 Lack of Nutritional Knowledge .......................................................................34 v TABLE OF CONTENTS (Continued) CHAPTER Page Purchase Behaviors and Food Choices .....................................................................35 Purchase Behaviors ..........................................................................................35 Food Choices ...................................................................................................37 Use of Nutrition Labels .............................................................................................38 Reasons of Not Reading the Nutrition Labels ..........................................................41 III. METHODS ...............................................................................................................44 Research Design........................................................................................................44 Data Collection Instrument .......................................................................................44 Part One ..........................................................................................................45 Part Two ..........................................................................................................45 Part Three .........................................................................................................45 Part Four ..........................................................................................................46 Sampling ...................................................................................................................46 Procedure ..................................................................................................................47 Scoring of Questionnaire ..........................................................................................48 Part One ..........................................................................................................48 Part Two