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OCR for page 33
Determinants of Food Choice
and Prospects for Modifying Food
Aides and Behavior
MANY CHANGES have taken place in the United States during
the past century with respect to food selection and attitudes
toward diet and health. In this chapter, these changes are reviewed
by the committee as are the prospects for future changes in behaviors
and attitudes to meet dietary recommendations. The focus is on the
general U.S. population rather than specific high-risk groups.
Recommendations for changing eating habits are more likely to be
adopted if their framers (1) are knowledgeable about the factors known
to affect food choices, (2) recognize current trends in food consump-
tion and attitudes toward food, (3) base their recommendations on
basic theory and research related to changing attitudes and behav-
iors, and (4) learn from previous attempts to change diet for health
purposes. This chapter is organized to address each of these items in
sequence. To select the most appropriate targets of change (e.g., the
most critical beliefs or behaviors), one must know the basic determi-
nants of food choice and which of these are subject to modification.
Likewise, it would not be prudent to recommend specific methods or
programs of change without knowledge of basic theory and research
on the determinants of behavior change and of the techniques that
have already proven successful. For example, it is critical to under-
stand why an individual's knowledge alone about the links between
diet and health is unlikely to change dietary behavior. It is also
important to know what changes are already taking place in the United
States and whether these trends are likely to facilitate or hinder
implementation of dietary recommendations.
33
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34
IMPROVING AMERICA'S DIET AND HEALTH
This chapter concludes with a critical review of some intervention
programs designed explicitly to improve eating patterns. These in-
clude programs instituted at the individual, organizational, and com-
munity levels.
DETERMINANTS OF FOOD CHOICE
Why any group of humans eats what it does is considerably more
difficult to explain than is the eating behavior of other species. In
humans, appetite is not simply a physiological drive toward food
but, rather, a complex set of physical, emotional, and cognitive stimuli
compounded from events widely separated in time and space.
Because humans from birth through childhood depend for their
survival on nurturance provided by other members of their species,
they are uniquely vulnerable to developing affective relationships
with food and feeders. Thus, nourishment for humans almost inevi-
tably becomes associated with powerful emotional attachments. These,
overlaid with beliefs and feelings that continue to accumulate around
food consumption as individuals mature, combine with immediate
environmental stimuli to direct food choices.
Beneath their socialization, however, humans remain animals, en-
dowed with sets of sensors that underlie all their subsequent encoun-
ters with food. Taste is one of these. The evidence is overwhelming,
for example, that humans are innately programmed to like sweet
tastes at birth and even in utero (Montagu, 1962; Weiffenbach, 1977),
and there are very tentative indications that they are also born with
some sort of attraction to meat, to its fat, or to both (Beauchamp and
Moran, 1982; Drewnowski et al., 1985; Farb and Armelagos, 1980;
Harris, 19851. Since many poisons are bitter and fruits become sweeter
as they ripen toward greater nutritiousness, a taste for sweetness
may well have given its possessor a selective advantage. A prefer-
ence for fat would also have favored survival under conditions of
calorie deprivation.
Humans also like salt, although it is not an innately Preferred taste
in infancy (Davis, 1928; Steiner, 1977~.
J 1
People who change to low-
salt foods come to consider formerly acceptable foods too salty. Thus,
the preferred level of saltiness appears to be strongly affected by
experience. Such is not the case for sweetness, however; preferences
for different levels of sweetness appear to be inborn (Desor et al.,
1977~. The ability to taste certain isolated flavor chemicals (e.g., phe-
nylthiocarbamide) varies with individuals and is genetically controlled.
Although there appears to be little genetic control over the liking for
particular foods (Fabsitz et al., 1980), early research on food choice
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DETERMINANTS OF FOOD CHOICE
35
suggested that infants protected from poisonous foods and exposed
only to uncombined foods whose indigenous components have been
neither concentrated nor diluted with added fat, salt, or sweeteners
are able to select fully nutritious diets instinctively (Davis, 1928~.
Humans also appear to be born with automatic regulators of energy
need (of a complexity not yet deciphered) that are set differently at
or before birth (Ravussin et al., 1988; Roberts et al., 1988~.
This physiological base on which eating behavior is built appears
to explain very little about the food choices people actually make.
The experiences of individuals as members of specific families in a
particular culture tend almost inevitably to overwhelm many (if not
all) the signals coming from what lean Mayer long ago called the
"animal within" (Mayer, 1968~. Young babies universally find chili
aversive. Yet, as Rozin and Schiller (1980) have demonstrated, this
innate aversion to chili, along with the innate preference for sweets,
is spontaneously overcome in Mexican children, almost half of whom
at age 6 or 7 years will select a spicy hot snack over a sweet one
when given a choice. In an earlier classic study, Moskowitz et al.
(1975) found that chronic exposure to tamarind among a group of
Asian Indians overrode the relative dislike of the sour taste charac-
teristic among humans. As indicated by the prevalence of overweight
people in the United States, culture can also override in humans the
bodyweight-regulating mechanism that operates effectively in all other
species (except when they are domesticated).
Factors other than physiological ones that affect food choice can
all be attributed to either nurture or culture. However, since culture
heavily affects the ways in which a society nurtures, even this divi-
sion is somewhat artificial. One such factor is early feeding experi-
ences, which involve, in addition to tastes and smells, the sounds,
sights, textures, and emotions associated with feeders. Thus, they
deeply affect infants who are entirely dependent on their feeders for
survival. These individual feelings about eating, implanted in infancy,
may be difficult to modify. There is evidence that food aversions result-
ing from even a single, powerful negative experience with a food can be
very long lasting (Garb and Stunkard, 1974~. Therefore, if patterns es-
tablished in early infancy need modification, recommendations would
need to be directed to food providers, usually parents.
There is no direct evidence, however, that food preferences learned
in infancy are permanent, but there has been little systematic study
of early feeding interactions and their effects on later eating behav-
iors. "There are currently no prospective or longitudinal data with
human subjects to provide support for Ethel assumption that early
food acceptance patterns are . . . reflected in food acceptance patterns
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36
IMPROVING AMERICA 'S DIET AND HEALTH
later in life" (Birch, 1987, p. 127). Nor is it known what makes cer-
tain children like certain foods. Davis (1928) found that infants pre-
viously unexposed to any food but mother's milk, and protected from
outside influences on food choice, expressed a wide range of preferences
when they were allowed to choose from a variety of simply prepared,
unsalted, unsweetened foods. Birch (1987), who investigated food
acceptance by young children, concluded that "sweetness" and "fa-
miliarity" were two characteristics of food that seemed largely to
account for children's food choices in the United States. In this country,
preschoolers are almost unavoidably often exposed to highly sweetened
foods; thus, the sweetness factor that drives food acceptability in this
and similar cultures may arise in large part from familiarity, as may
the preference for spicy hot foods in Mexico. There is evidence that
continuous exposure to sweetness sustains the neonate's preference
for sweetness (Beauchamp and Moran, 19821.
Davis (1934) could not determine whether the initial food choices
of infants in her study were random or whether they were based on
color, odor, or both. It is known that children's acceptance of food
can be influenced by the choices of their eating companions (Birch,
1987~. Since parents or other caretakers normally select the foods to
be made available to very young children and their eating compan-
ions, adults have a strong influence over children's food choices. In
the United States, however, children are exposed from early infancy
to adults other than members of their own households who tell them
what to eat. Many of these adults are seen on television, advertising
edible products consisting largely of sugared cereals, candy, and fast-
service foods. A recent study in Quebec indicated that the parents of
children who watch child-oriented television that carries commer-
cials purchase more brands of breakfast cereal directed specifically
toward children than do the parents of children who watch commer-
cial-free children's programming (Goldberg and Hartwick, 1990~. Thus,
advertising demonstrably influences parents as they select food products
for their children.
In a study of influences on the food choices of elementary school
children and adolescents, Contento and Michela found the two most
important variables in both groups to be "parents serve it" and "tastes
good" (Contento et al., 1988; Michela and Contento, 1986~. Taste
predominated among the adolescents; serving by parents took first
place among the younger children. Although the sweetness variable
was not examined directly in either study, the same authors found in
an earlier investigation that sweetness was a highly salient dimen-
sion in children's spontaneous classification of foods into groups (Michela
and Contento, 1984~.
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DETERMINANTS OF FOOD CHOICE
37
Examining adolescent food choices more closely, Contento et al.
(1988) found that their subjects could be divided into subgroups "with
different motivations for food choice irrespective of ethnicity and
gender" (p. 2971. Subjects at one extreme were "hedonistic" choos-
ing foods even if they could identify those foods as causing heart
disease or containing sugar or fat. Subjects at the other extreme were
"health oriented" in that they avoided these same foods and ate foods
they perceived as "healthful." Although the food choices of peers
were reported to be an important influence on the "hedonistic" group
and on others, it was not an important factor in all subgroups. The
evidence thus suggests that children, some of them even into adoles-
cence, are heavily influenced by their parents' choices of food to serve.
As they grow older, however, some children choose foods they perceive
as healthful or unhealthful; others are more strongly influenced by
other social and environmental factors and by taste.
Many of the factors known to affect food choice beyond adoles-
cence cannot readily be modified by educational or other populationwide
interventions. These include individuals' positive or aversive food
or eating experiences that may make certain foods especially palatable
or nauseatingly unacceptable, as well as simple familiarity, which
probably plays an important role in determining food choice in adulthood
just as it does among children. But even though education cannot
change an individual's historic relationship with certain foods, food
likes and dislikes can be modified with further experience; a new and
wholesome food, once tried, may become both familiar and liked.
Other variables often identified as determining food choices in adults
include age, sex, race, place of birth, time of day, season of year,
marital status, children's ages, household size, employment status,
income, and perhaps less obviously media events affecting the public's
perception of the safety or wholesomeness of the food supply. A1-
though none of these determinants of food selection can be intention-
ally altered by policymakers, many of them can change over relatively
short or long periods. For example, women's increasing participa-
tion in the work force encourages more frequent eating outside the
home. People at different ages or at different stages of their life cycles
will also respond differently to messages about food. For example,
the population as a whole is aging (DHHS, 1988), and an aging popu-
lation is likely to be more aware of and concerned about health and
may therefore be more disposed to seek out certain food components
(e.g., fiber and calcium) or avoid others (e.g., fat).
Much of the research concerned with modifiable determinants of
food selection has been conducted either by marketers attempting to
determine which appeals will be most effective in selling products or
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38
IMPROVING AMERICA'S DIET AND HEALTH
by researchers interested in the factors that promote overeating.
Yankelovich, Skelly and White, Inc. (1985) identified "convenience,"
"price," "nutrition," "variety," "quality," and "good taste" as the variables
that will establish "competitive parameters for those who will serve
tomorrow's consumers." Rodin (1980), listing "social and immediate
environmental influences on food selection," identified "time of day,"
"accessibility/availability," "expedience," "variety," "media effects,"
"conditioned stimuli," and "emotions."
Many of the factors on both lists are not directly relevant to the
question in this chapter: what factors can be manipulated to affect
food choice in a healthful direction? The only common factor on the
lists is variety, which often represents to a marketer a way of getting
a larger share of the market. In that sense, variety is related to newness,
which appears to be an inducement to consumers to at least try a
product. Evidence indicates that a monotonous diet leads to de-
creased food consumption and the availability of a variety of tasty
foods leads to increased calorie intake, even among animals who are
normally very good at self-regulation (Sclafani and Springer, 1976~.
Humans may have room for a dessert even when they are entirely sati-
ated from previous courses. Thus, increased variety is unlikely to be
helpful in a situation where overconsumption is part of the problem.
Price is often mentioned as influencing food choice, and it has
played an important role in at least two major health-related dietary
changes: the shift from butter to margarine that began during World
War II (Green, 1975) and the shift from red meat to chicken that
began in earnest in 1976. Between 1976 and 1987, chicken consump-
tion increased by 48% while the average retail price of chicken as a
percentage of the price of beef decreased from 40 to 32% (Putnam,
1989~. The importance of price as a factor affecting food choice obvi-
ously varies, however, with the proportion of the family budget spent
on food. Although increased income does not necessarily lead to an
improvement in dietary quality, inadequate funds may limit consump-
tion of costly fish and (at certain seasons) certain fresh fruits and
vegetables. Many other health-promoting foods (e.g., breads and
other grain products, starchy tubers, and dry beans) are relatively
cheap, and many less desirable foods (e.g., sweet and salty snacks,
rich desserts, and heavily marbled beef) are relatively expensive. Thus,
price, combined with appropriate education, is a variable that could
in some cases favor adoption of dietary recommendations.
Very little is known about how individuals (or populations) ac-
quire taste preferences. Familiarity appears to be important among
adults as well as among children; however, what tastes good or ap-
propriate at a given time to any one person undoubtedly relates to
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DETERMINANTS OF FOOD CHOICE
39
some of the factors identified by Rodin (1980), for example, "condi-
tioned stimuli" (a cocktail with the evening news, popcorn at the
movies, hot cocoa at bedtime), "emotions" (candy during times of
sadness), or "time of day" (ham and eggs for breakfast). Food pref-
erences governed by such factors would be amenable to change if
education leads to changed social norms.
In discussing factors that affect food choice, a distinction must be
made between what is and what is perceived to be reality by the po-
tential consumer. In that sense, quality (like nutritiousness or health-
fulness) is a belief factor. Quality can mean very different things to
different consumers all the way from the fact that a food bears a
well-known brand name to the fact that it bears no brand name at all
and is purchased fresh from the farmer who produced it. The char-
acteristics of foods that groups of people associate with quality can
obviously change over time (e.g., among certain groups, marbling in
beef has been replaced as a quality factor by beef raised without
hormones).
Nutritiousness has recently become identifiable as one characteris-
tic of a quality product, although no more than 15 years ago, manu-
facturers resisted nutritional marketing appeals on the grounds that
people were simply not interested (Belasco, 1989~. At present, consumers
will, at least some of the time, select food they believe to be nutritious.
Perceived nutritiousness, especially in a food already highly desired,
is a selling tool.
Low calorie is another quality appeal in a culture in which at any
given time 33% of women and a smaller percentage of men claim to
be dieting (Calorie Control Council, 1989~. The astonishing success
of the marketing of diet soft drinks, whose consumption shot up
from approximately 1 to 8 gallons per capita between 1954 and 1987
(USDA, 1989), is a clear indicator that identifying a product as diet or
low calorie will increase the likelihood that it will be selected by a
substantial segment of the population. The selling of the potato as a
low-calorie food (Dugas, 1985; Ketchum Communications, 1989) is an
example of a marketing approach that might be used to some advan-
tage in implementing dietary recommendations.
The fact that $3.7 billion is spent annually on food advertising (Advertis-
ing Age, 1989) has led to a popular conviction that advertising, especially
on television, is a major influence on food choice. Although advertising
agencies survive by convincing clients that this is true, the direct
effects of the media on food selection are difficult to isolate from all
the other promotional factors to which an individual is exposed. Ad-
vertising induces people to try new products that might otherwise g
unnoticed; it has encouraged the belief that all thirst must be quenched
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IMPROVING AMERICA'S DIET AND HEALTH
from a bottle not from the water tap; it can lead consumers to switch
from one brand of soda or tuna to another; and the repeated picturing
on television of highly palatable food may induce snacking (Falciglia
and Gussow, 1980~.
Of all the factors affecting food selection, two availability of foods
and knowledge of and beliefs about foods and health are perhaps
the most powerful of those amenable to modification. Availability is
a much less obvious concept than it seems, incorporating such notions
as convenience and technological progress.
Real availability-the presence of enough varied food to eat is
not an issue in the United States, where variety and quantity abound.
However, the sheer number of choices does sometimes constrain
availability, since food stores tend to feature the products that sell
fastest, so that, for example, refined flour products have been more
readily available than those made of whole grains. Nevertheless,
certain desirable products such as lower-fat meat and a greater vari-
ety of fresh fruits and vegetables are now becoming increasingly avail-
able (Duewer, 1989; Greene, 1988~.
Perceived availability is a different sort of factor. It changes over
time among different groups with different skills and expectations.
For many people, a food is now considered to be available only when
it can be acquired in a few minutes or is ready to eat at any time of
the day or night at a nearby location. This definition of availability
restricts many people's food choices; for example, what is available
for immediate consumption in many settings may be limited to a
variety of bottled liquids and a collection of small packaged snacks.
Increasingly, especially in urban areas, there are specialty shops that
sell foods with highly concentrated energy components premium
ice cream and freshly baked cookies, for example. With regard to
these prepacked or proportioned street foods, it is usually more "ex-
pedient" (to use Rodin's word) to eat the whole thing the whole
cookie (however enormous), the whole package of crackers or nuts,
or the whole bottle of beer or soda regardless of actual appetite,
since that is what is available. Because snacks and fast-service foods
of all kinds are ubiquitous, they are seen as choices, even though
they provide a limited variety and less control over fat, sodium, and
sugar intake than people might want.
Convenience a term applied to something that promises to save
work or time-is a subset of availability. To someone who feels
time-constrained, a food that requires extended preparation is not
perceived as available. To someone without cooking skills, a raw
chicken is not available. Technology's impact on food choices results
partly from its ability to continually redefine perceived availability.
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DETERMINANTS OF FOOD CHOICE
41
Microwave ovens, for example, lead to increased availability, and
thus consumption, of microwavable snacks (Erickson, 1989~. Thus,
instant heating makes hot snack foods more available.
Cultural availability is important, because one's culture determines
what constitutes food; all cultures reject some edible parts of their envi-
ronments. In the United States, dogs, cats, and horses are seldom eaten,
although they are readily available, and Americans do not think of hunting
birds and squirrels in parks. In many cultures, milk is considered to be
an inappropriate food for adults, and in many others, bread is not spread
with butter or margarine as it is in the United States. Because this
country is relatively young and culturally diverse, it has no traditional
national cuisine no foods that most of its citizens have eaten for
generations. Regional foods (e.g., baked beans and brown bread or
grits and red-eye gravy) have tended to be displaced by the cuisine
offered at franchise restaurants. This lack of a long-standing, strong
food tradition may prove to be an advantage to those attempting to
produce dietary changes directed toward health.
Cultural factors determine not only what but also when, where,
how much, and how quickly food is to be eaten. Since the U.S.
population has traditionally bolted its food (Fletcher, 1899), fast-service
food is nothing really new. People in the United States also spend
more time alone than people in many other countries do (Szalai, 1972)
and they often eat alone in cars, at their desks, by the refrigerator,
or close to vending machines (Lantis, 19621. Foods are increasingly
available in quantities designed to be eaten alone, which means that
any attempt to alter eating patterns must be directed at different
population segments, not merely at adults, since they are no longer
the "gatekeepers" identified by Lewin (1943~. Efforts to affect eating
patterns need to be attentive to these ambiguous cultural messages
since what will be eaten is so often dependent on where, when, and
how quickly it is to be eaten.
1 1
~ . . . .
As documented later in this chapter, consumers have become more
concerned about the relationship between diet and health and report
that they are trying to change their diets accordingly. This interest is
confirmed by the increasing emphasis on healthfulness as an important
food marketing tool. During the past few decades, there have been
substantial changes in overall food consumption patterns (Putnam,
1989~. Survey data show a widespread verbal commitment to eating
for health, but consumption data show that declining consumption of
beef, eggs, butter, whole milk, and other traditional contributors of
saturated fat and cholesterol has been countered somewhat by a rising
consumption of cheese, premium ice cream, and other rich sources of
saturated fat (Popkin et al., 1989; Putnam, 1989~. In providing con
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42
IMPROVING AMERICA 'S DIET AND HEALTH
sumers with information that will allow or induce them to act on
their stated health concerns, attention will need to be paid to helping
them place the confusing bits of information they encounter into a
coherent overall picture of the association of diet with health.
CHANGES IN FOOD SELECTION
It is evident from the preceding discussion that learning why people
eat what they do is a complicated undertaking. Finding out exactly
what individuals eat is only marginally easier (see, for example, NRC,
1989 and Woteki, 1986). It is possible, however, to obtain reasonably
good data on overall changes in the U.S. food supply over time. These
are useful for tracking trends in food demand and can be examined
to learn whether food consumption patterns are changing in a direc-
tion consistent with dietary recommendations.
Changes in foods available to the public from 1909 to the present
can be identified by examining U.S. Department of Agriculture (USDA)
data on the disappearance of foods into wholesale and retail markets.
The amounts of foods available to the public in a given year are
estimated by subtracting data on exports, year-end inventories, and
nonfood uses from data on total production, imports, and inventories
at the beginning of the year. These quantities are larger than those
actually consumed, since they do not include losses from processing,
marketing, and home use (NRC, 1989; Putnam, 19891. USDA has also
surveyed food use of households and dietary intakes and patterns of
individuals in the Nationwide Food Consumption Surveys (NFCS)
and the Continuing Surveys of Food Intake by Individuals (CSFII).
Since the overall pattern of changes in both the NFCS and CSFII are
generally consistent with the patterns shown in the disappearance
data (Popkin et al., 1989), only the latter are presented here.
1 1
Table 3-1 presents the quantities of food available for consumption
per person from periods extending from 1909 to 1987 (the latest data
available when this report was prepared). Since data on some foods,
especially processed vegetables and fruits, were not collected in the
earlier years, comparisons of the consumption of these products over
time are difficult to make.
Changes from 1909 to 1987
Since the first settlers arrived in a New World that was teeming
with game, meat has had a dominant position in the diets of its in-
habitants. Although beef consumption in 1987 was the lowest since
the 1960s, it remained approximately 40 to 50% higher than that dur
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DETERMINANTS OF FOOD CHOICE
43
ing World War II and the preceding years back to 1909. Much of the
apparent decrease noted in 1987 may be misleading, however, since
retail cuts were much more closely trimmed of fat in that year than
they were in the past (Putnam, 1989~. Thus, past disappearance data
probably included some weight that was trimmed before consumption.
Although year-to-year fluctuations in pork consumption have often
been quite high, the long-term average weight of pork available per
person has varied little during the past eight decades. The-most
remarkable change has occurred in poultry consumption, which now
averages 78 lb per person nearly five times higher than pre-World
War II levels. This increased intake of poultry and a much smaller
increase in fish consumption have more than made up for the decrease
in beef, veal, and lamb. The annual consumption of total red meat,
poultry, and fish in 1987 was not only the highest ever in the United
States but it also exceeded that of the traditional leaders Australia
and New Zealand. Consumption of dairy products peaked in 1945.
Per-capita consumption decreased until the 1960s and 1970s, when
consumption of low-fat milk, cheese, and frozen dairy products such
as ice cream began to increase. Low-fat milk (1 to 2% fat, skim,
buttermilk, and some flavored milk) consumption almost doubled
between 1971 and 1987, when consumption of low-fat milk overtook
that of whole milk.
Egg consumption has decreased to 67% of its World War II high,
but is only 15% less than its prewar level and has remained fairly
constant in the 1980s. Although butter and margarine use combined
has changed relatively little since the 1940s, margarine use has increased
at the expense of butter. Consumption of fats and oils has steadily
increased, reaching a point in 1987 that was approximately 50% higher
than that recorded in the period from 1909 to 1913. Per-capita use of
salad and cooking oils has increased markedly in the past two decades.
Data on average vegetable consumption are less clear than those
for other food groups because the sources of these data have changed.
For example, current data are no longer available on several veg-
etables. Putnam (1989) reported, however, that per-capita consump-
tion of nine major fresh vegetables asparagus, broccoli, carrots, cau-
liflower, celery, corn, lettuce, onions, and tomatoes reached a record
high in 1987. In the past decade, per-capita consumption of frozen
vegetables has increased while consumption of canned vegetables
has decreased. Based on disappearance data, fresh fruit consump-
tion has increased dramatically in the past two decades. However,
food consumption survey data give a somewhat different picture.
According to USDA, consumption of fruits and vegetables among
women ages 19 to 50 actually declined by an average of 7% between
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DETERMINANTS OF FOOD CHOICE
TABLE 3-3 Sources of Health Communications
73
Network Level
Extended social networks
Peer groups
Families
Organization Level
Work sites
Restaurants
Grocery stores
Food producers and processors
Institutional food providers
Schools
Mass media organizations
Health-care organizations
Public health organizations
Government organizations
Community Level
Integrates network and organization levels, leading to change
in public opinion, social norms, legislation, food production, and
the social environment
live and lasting change. This conclusion is based on the studies
showing transitory effects in small groups, and on school or work-
site programs conducted in isolation from broad, reinforcing community
influences. The committee's review of these studies supports the
common sense notion that change is more readily achieved if nutri-
tion change programs include all three levels of communication.
It is clear from the studies discussed above that well-designed nu-
trition education programs are successful in a variety of settings and
for a variety of people. Study results also demonstrate that unimagina-
tive, information-only programs are not successful. The imagination
of the learners must be captured; they must feel that the messages
are personally relevant and that a stepwise course of action that avoids
too much personal discomfort will yield tangible benefits (Bandura,
1986; Crouch et al., 1986; Killen et al., 1988; Meyer and Henderson,
1974~.
Success requires both an adequate quantity and mix of effective
instructional components. Appreciable changes in eating patterns
have been maintained for 6 to 12 months in schools, work sites, and
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74
IMPROVING AMERICA'S DIET AND HEALTH
adult groups after approximately 7 to 15 hours of instruction given
over a few months (Crouch et al., 1986; Killen et al., 1988; King et al.,
1988; Meyer and Henderson, 1974). In addition, many people have
improved their eating habits appreciably after being exposed to mul-
tifactor, comprehensive, community-based programs that included
prolonged and intermittent exposure to approximately 2 hours of
nutrition education per year for approximately 2 to 4 years (Farquhar
et al., 1977, 1990).
Ingredients for success in both selected and general populations
seem to require approximately equal proportions of (1) alerting, inform-
ing, and changing attitudes; (2) step-by-step active learning of self-
directed behavior change methods; and (3) prevention of recidivism.
Key elements of the first category include transmission of knowledge
concerning diet-disease links and the provision of evidence of their
relevance to the individual so that personal attitudes are changed.
The learner must also gain knowledge of high-risk dietary patterns
and of his or her own eating patterns. To accomplish this, the individual
must learn monitoring methods, gain confidence from early successes,
identify internal and external barriers to change, learn how to resist
social pressures to change, and practice new skills in restaurant menu
selection, label reading, food shopping, and food preparation and
tasting. This effort is assisted by continued social support and main-
tenance incentives provided by others.
SUMMARY
The factors affecting food choices are numerous and complex. Some,
such as inherent taste preferences and demographic trends, can be
controlled little or not at all. Others more subject to modification
include social norms, attitudes, skills, and availability of health-pro-
moting foods. Over the past several decades, there have been important
changes in food consumption patterns. Some of these changes are
consistent with dietary recommendations (e.g., an increase in fish
and vegetable consumption), but others are not (e.g., an increase in
the consumption of high-fat ice cream). Similarly, recent changes in
consumer attitudes and beliefs provide cause for both optimism and
concern. Although there is a general trend toward recognition of the
role of diet in disease prevention, surveys indicate that people are
sometimes confused about which foods and food components are
health-promoting and which are not.
Nevertheless, a review of current theory and practice with respect
to attitude and behavior changes suggests that modification of food
preferences and eating patterns is possible, but will require more
OCR for page 75
DETERMINANTS OF FOOD CHOICE
75
than simply providing information to the population. People will
need to be motivated to accept the information, see its personal relevance
to them, integrate it into existing belief structures, acquire new skills
and self-perceptior~s, and learn how to apply newly acquired atti-
tudes to appropriate actions and to prevent recidivism. Various studies
conducted within schools, at work sites, and in communities have
indicated that intervention programs based on the communication/
persuasion model and the social learning model can be effective in
producing substantial reductions in risk factors for diet-related diseases,
particularly when they involve several components that reinforce each
other arid include the mass media. It seems very reasonable to infer
from these studies that new national programs that implement favorable
regulatory and food supply changes will enhance the impact of com-
prehensive education on the public's dietary patterns.
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Representative terms from entire chapter:
social learning
