Knowledge of college students regarding three themes related to dietary recommendations

Knowledge of college students regarding three themes related to dietary recommendations

Laura McArthur

Abstract: This exploratory study assessed the knowledge of 192 college students regarding three topics related to the 2000 Dietary Guidelines for Americans and Food Guide Pyramid, i.e., food composition, healthful eating, and the relationship between diet and health. Cognitive data were analyzed in the context of demographic, health, and lifestyle variables. There was no significant difference in the mean test scores of males (9.3+-0.5 points) and females (10.0+-0.3 points) out of a possible 15 points. Students with previous education about the Pyramid, first/second year students, students with a diet-related chronic disease, and students who often consume high-fat foods/snacks earned significantly higher mean scores. Findings suggest a need for more learning opportunities for college students about current dietary recommendations.

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Experimental and epidemiological research has produced ample evidence linking diets high in total and saturated fat, cholesterol, and energy and low in fiber to cardiovascular diseases (Kritchevsky, 1998), certain types of cancers (Lichtenstein, Kennedy, Barrier, & Danford, 1998), and diabetes (Pick, Hawrysh, Gee, & Toth, 1996). In the United States, federally sponsored dietary guidelines have been issued since the 1970’s to help consumers delay or prevent the onset of these degenerative conditions. Never the less, the three leading causes of death among U.S. adults, i.e., coronary heart disease, some types of cancer, and strokes, are diet-related (Suter, 2000).

Two nutrition education tools issued jointly by the U.S. Departments of Agriculture and Health and Human Services to assist healthy consumers two years old and older make optimum food choices are the Dietary Guidelines for Americans (Johnson & Kennedy, 2000) and the Food Guide Pyramid (Welsh, Davis, & Shaw, 1992). The Dietary Guidelines for Americans are a set of brief messages focusing primarily on food constituents of public health concern, i.e., total and saturated fat, cholesterol, sodium, sugar, and fiber. By law, the Guidelines are reissued every five years and are based on the most current research concerning the relationship between diet and health. The 2000 Dietary Guidelines for Americans advise consumers to eat a variety of grain products, fruits, and vegetables; choose diets that are low in saturated fats and cholesterol and moderate in total fat; choose foods that limit intake of sugars; and choose and prepare foods with less salt (Johnson & Kennedy, 2000).

The Food Guide Pyramid, first published in 1992, is the graphic depiction of the Dietary Guidelines for Americans. The Pyramid assigns foods to five food groups and recommends the number of servings from each group to comprise a healthful daily diet. Accordingly, consumers are advised to eat six to eleven servings from the bread/ cereals/rice/pasta group, three to five servings from the vegetable group, two to four servings from the fruit group, two to three servings from the dairy group, and two to three servings from the meats/poultry/fish/dry beans/ eggs/nuts group. The peak of the Pyramid features a variety of sweets, fats, and oils that should be consumed in amounts to achieve an appropriate caloric intake. Symbols scattered throughout the graphic identify foods high in naturally occurring and added fat and foods containing added sugar. The arrangement of the food groups in the shape of a pyramid, the recommended number of daily servings from each group, and the amount of a food constituting one serving are intended to promote dietary diversity, moderation, and proportionality (Welsh et al., 1992).

College students comprise a group whose dietary practices and nutritional status are of concern to nutrition professionals (Marietta, Welshimer, & Anderson, 1999; Binger, 1999). These Concerns are based on research that characterizes the diets of college students as low in energy, fiber, calcium, iron, vitamin A and carotinoids, and high in fat (Huang, Song, Schemmell, & Hoerr, 1994; Hertzler, Webb, & Frary, 1995; Schuette, Song, & Hoerr, 1996; Walter and Soliah, 1997). These findings reflect poor food choices and suggest that college students could benefit from an enhanced awareness of and greater compliance with the recommendations presented in the Dietary Guidelines for Americans and the Food Guide Pyramid.

Research on the dietary practices of college students has identified several behaviors that are associated with the consumption of poor quality diets. Horwath (1991), Hendricks and Herbold (1998), and Marietta and coworkers (1999) have reported that college students frequently skip meals, consume large amounts of fast foods and alcohol, snack on high-calorie foods, avoid certain nutritious foods, and adopt unsound weight loss techniques. Marietta and co-workers (1999) and Huang, Hoerr, and Song (1997) have observed that college students make more food selection and food preparation decisions after moving away from home while simultaneously adapting to an unfamiliar environment and lifestyle. During this transition phase several influential factors can contribute to the adoption of poor dietary practices. These factors include the availability of foods of low nutrient density, preoccupation with weight, financial restrictions, limited food preparation skills, restricted food storage and cooking facilities, difficulty with time management, and nutritional misconceptions (Koszewski & Kuo, 1996; Harris & Murray, 1997; Betts, Amos, Keim, Peters, and Stewart, 1997; Horacek & Betts, 1998a; Horacek & Betts, 1998b).

The misguided dietary practices and poor quality diets of college students are of concern to health educators because of their possible adverse impact on the long-term health status of these young adults. Several authors (Brevard & Ricketts, 1996; Betts et al., 1997; Horacek & Betts, 1998b) have noted that consumption of inadequate diets during young adulthood can trigger unfavorable physiological events conducive to the occurrence of diet-related degenerative diseases later in life. Despite the concerns about the dietary practices and food choices of college students, little research has been conducted to assess their awareness of key nutrition issues, such as food composition, healthful eating, and the relationship between diet and health which are related to the Dietary Guidelines for Americans and Food Guide Pyramid (Marietta, Welshimer, & Anderson, 1999). Considering that there are currently an estimated 14 million individuals between the ages of 18 and 24 enrolled in U.S. colleges and universities, and that this figure is expected to reach 16 million by 2007 (Knutson, 2000), it is critically important to assess the need for nutrition education interventions about these three nutrition topics with the aim of preventing many new cases of diet-related chronic disease. Several investigators (Barnett & Johnson, 1996; Marietta et al, 1999) have found that increased knowledge about healthful food selection can lead to better food choices. Thus, it would be worthwhile to assess the knowledge of college students about food composition, healthful eating, and the relationship between diet and health to identify specific areas that could be targeted with health education interventions. College students already find themselves in an environment that affords ample opportunities for initiating various kinds of learning experiences about these topics. Several authors (Burns, 1999; Dooley & Soil, 1999; Byrd-Brenner & Finckenor, 2000) have developed highly creative nutrition education tools that have been favorably evaluated by college students which could be adapted to convey information about these topics. Such educational efforts could help realize the Healthy People 2010 objective of promoting a more healthful diet among young adults (Hahn, 1999). Therefore, the present exploratory study measured and compared the knowledge of male and female college students about three nutrition topics closely related to the 2000 Dietary Guidelines for Americans and the Food Guide Pyramid, i.e., food composition, healthful eating, and the relationship between diet and health. Cognitive data were analyzed in the context of gender because several authors have reported that male and female college students exhibit different patterns of food selection (Horwath, 1991; Brevard and Ricketts, 1996; Huang et al., 1997; Binger, 1999; Marietta et al., 1999)and differ in their willingness to attempt positive dietary changes (Hendricks and Herbold, 1998). However, no study to date has sought to identify gender-based differences in level of awareness about these three topics related to current dietary recommendations. If gender-based differences also exist with respect to their knowledge about these topics, health and nutrition educators serving college populations may wish to develop and evaluate gender-specific messages aimed at enhancing student awareness in these areas. Additionally, data for males and females were compared in the context of selected demographic, health, and lifestyle variables to further assist health and nutrition educators target interventions at groups of college students most in need of information that would help them comply with current dietary recommendations.

METHODS

SUBJECTS

A non-probability sample of 192 male and female undergraduates was recruited at student dining halls, the library, and the student union building on the campus of a Northeastern university. Subject recruitment rook place over a six-week period. All students seen entering or leaving these facilities by the recruiters were asked if they were willing to participate in this study. Subjects were recruited on different days of the week, excluding weekends, and at different times of day to minimize a selection bias. The objectives of the study and the voluntary nature of participation were explained to each student. No financial incentive or academic credit was

offered for participation, and receipt of a completed questionnaire was interpreted as obtaining informed consent.

Recruitment, distribution of the questionnaire, and collection of completed questionnaires were accomplished by two female undergraduates enrolled in an independent study course on survey research methods taught by the primary investigator. This study was approved by the Committee on Human Research in the Behavioral Sciences at the University.

SURVEY INSTRUMENT

Data were collected using an anonymous self-administered questionnaire. Subjects were asked to complete and return the questionnaire at the distribution sites to protect the quality of the data, i.e., to ensure that the responses were provided by a single subject without the benefit of consulting other individuals or published sources for answers.

Part one of the questionnaire elicited information about demographic, health, and lifestyle variables that was used to analyze cognitive data. Demographic variables included gender, year in school, and whether students had received previous education about the Food Guide Pyramid. Health variables included family and personal history of diet-related chronic diseases and self-reported height and weight. The self-reported nature of these anthropometric data constitute a limitation of this study since it has long been acknowledged that such data may contain errors of under and over estimation (Pirie, Jacobs, Jeffery, & Hannan, 1981; Stunkard & Albaum, 1981). However, it was not practical or feasible to transport scales to the questionnaire distribution sites. Nor were the student recruiters trained to accurately obtain such measurements. The anthropometric data were used to calculate body mass index (BMI) according to the most recent cut-off points issued by the National Institutes of Health (Caruana, Petrie, Davie, & McMurray, 2000). Lifestyle variables included use of food labels and frequency of eating high-fat foods/snacks.

Part two of the questionnaire was a 15-item multiple-choice test comprised of three clusters of questions that assessed knowledge about key themes associated with the 2000 Dietary Guidelines for Americans and the Food Guide Pyramid, i.e., food composition, healthful eating, and the relationship between diet and health. The selected themes and questions were based on an extensive review of the nutrition/health literature concerning dietary recommendations. Each question was followed by three possible answers and a “Don’t know” response option that students were encouraged to use rather than guessing to obtain a more accurate measure of their knowledge.

The cluster concerning food composition consisted of six questions that asked the students to identify the food containing the greatest or least amount of a dietary constituent of current public health concern. Questions from this cluster included: “One serving of which food contains the greatest amount of fiber?” “Which of the following is not included in the fats/sweets group of the Food Guide Pyramid?” and “One serving of which food contains the greatest amount of cholesterol?” The cluster focusing on healthful eating consisted of five questions that assessed awareness of the importance of dietary variety, the recommended number of servings from the five food groups depicted on the Pyramid, and the recommended percent of daily calories from total fat. Questions from this cluster included: “We should eat the greatest number of daily servings from which of the following food groups?” “What percent of our daily caloric intake should come from fat?” and “What is the best way to eat in order to obtain the nutrients and other substances we need to stay in good health?” Lastly, the cluster concerning the relationship between diet and health consisted of four questions asking about the long-term health implications of consuming poor quality diets. Questions from this cluster included: “Eating too many high-fat foods is associated with which of the following health problems?”, “Not eating enough high-fiber foods is associated with which of the following health problems?”, and “Eating too many foods high in salt/sodium is associated with which of the following health problems?”

Content validity of the fifteen-item multiple-choice test was ascertained by having the questions evaluated for their relevance by three nutrition professors with expertise in the content areas and questionnaire design. The questionnaire was also pilot tested with 20 students to determine the clarity of wording and appropriateness of item format. Internal consistency of the items was ascertained by calculating a Cronback’s alpha correlation coefficient for each cluster of questions. Accordingly, the coefficients for the food composition, healthful eating, and the relationship between diet and health clusters were 0.52, 0.55, and 0.49, respectively, suggesting adequate reliability of the questions comprising each cluster.

DATA ANALYSIS

Data were analyzed using SAS System for Windows (Version 6.12, SAS Institute, Inc., Cary, NC, 1996). Frequencies and percentages were obtained on all data and analysis of variance and chi-square analysis compared cognitive data for males and females in the context of demographic, health, and lifestyle variables. In scoring the 15 cognitive items, one point was assigned to each correct response and zero points to each incorrect and “Don’t know” response. Statistical significance was set at p < 0.05.

RESULTS

DEMOGRAPHIC, HEALTH, & LIFESTYLE PROFILE

Sixty-four male and 128 female students participated in this study. Table 1 compares proportions of males and females on selected demographic, health, and lifestyle variables.

As Table 1 shows, there were no significant differences in the proportions of males and females based on academic classification. There was, however, a significant difference (p < 0.01) in the proportions of males and females who had received previous education about the Food Guide Pyramid, with greater proportions of females reporting that they had received such instruction.

Regarding health-related variables, Table 1 shows that the distribution of males and females across the underweight, normal weight, and overweight categories was significantly different (p < 0.001). Greater proportions of females than males were underweight (BMI < 18.5) and normal weight (BMI = 18.5 to 24.9). Gender comparisons based on a family history of diet-related chronic diseases showed significant differences for two of six conditions. A greater proportion of females reported a family history of breast cancer (p < 0.01) and overweight (p < 0.01). Ten males and 21 females reported having at least one of these six conditions themselves.

Regarding lifestyle variables, Table 1 shows that there were no significant differences in the proportions of males and females with respect to frequency of eating high-fat foods/snacks. Gender differences did occur regarding the use of food labels, with greater proportions of females reading these labels to determine the amount of total fat (p < 0.001) and the number of calories (p < 0.05) in a serving of food.

KNOWLEDGE ABOUT DIETARY RECOMMENDATIONS

The overall mean scores of males (9.3+-0.5 points) and females (10.0+-0.3 points) on the 15-point test assessing their awareness of themes associated with the Dietary Guidelines for Americans and Food Guide Pyramid were not significantly different. Nor were there significant differences in the mean scores of males and females on the clusters concerning healthful eating (2.7+-0.2 points vs. 3.0+-0.1 points, respectively, out of a possible five points), food composition (4.1+-0.2 points vs. 4.5+-0.1 points, respectively, out of a possible six points), and the relationship between diet and health (2.4+-0.2 points vs. 2.5+-0.1 points, respectively, out of a possible four points).

The question from the healthful eating cluster most often answered incorrectly by males (n = 40, 63%) and females (n = 80, 63%) asked which food group from the Food Guide Pyramid should provide the greatest number of daily servings for good health. The response most often selected was the vegetable group rather than the grain/ cereal group. The majority of males and females were aware that items from the peak of the Pyramid should be used sparingly.

The question from the food composition cluster most often missed by males (n = 31, 48%) and females (n = 58, 45%) asked which item did not belong in the fats/ oils/sweets group of the Pyramid. The item most often selected by males and females was sour cream. The majority of males were able to identify foods high in salt/ sodium while the majority of females correctly identified cholesterol-containing foods.

The question from the cluster concerning the relationship between diet and health that was most often missed by males (n=39, 61%) and females (n=76, 59%) asked which health condition was most strongly associated with the consumption of a low-fiber diet. The response most often selected was anemia rather than colon cancer. It is noteworthy that this study took place prior to the publication of data suggesting that dietary fiber conveys no protection from colon cancer (Fuchs et al., 1999; Alberts et al., 2000). The majority of males and females were aware that consumption of a high-fat diet was associated with an increased risk of heart disease.

Table 2 shows main effects, interactions, and contrasts obtained from ANOVA models that analyzed cognitive data for males and females in the context of demographic, health, and lifestyle variables.

As shown in Table 2, the only statistically significant interaction pertained to gender and previous education about the Pyramid (p = 0.023). The ANOVA models also identified a significant main effect of previous education about the Pyramid on mean scores, whereby students who had received previous instruction about this graphic scored significantly higher than those who had not received such instruction (10.4+-0.3 points vs. 7.1+-0.4 points, respectively, p < 0.001). Another significant main effect was that of academic status on mean scores, with first/second year students scoring significantly higher than third/fourth year students (10.6+-0.4 points vs. 9.2+-0.3 points, respectively, p = 0.005).

Table 2 also shows that a personal history of a diet-related chronic disease was the only health variable having a significant main effect on mean test scores. Students without such a condition scored significantly higher than afflicted students (9.9+-0.3 points vs. 8.4+-0.3 points, respectively, p < 0.05).

Regarding the impact of lifestyle variables on awareness of dietary recommendations, Table 2 shows a significant main effect (p = 0.04) of frequency of consuming high-fat foods/snacks. Students who often consumed such products scored significantly higher than students who reported that they never consumed them (10.2+-0.5 points vs. 7.7+-1.1 points, respectively, p = 0.03). Those who rarely consumed high-fat foods/snacks scored significantly higher than those who sometimes consumed them (10.8+-0.6 points vs. 9.3+-0.4 points, respectively, p = 0.04).

DISCUSSION

The present findings suggest that college students have a low level of awareness about three nutrition topics related to the 2000 Dietary Guidelines for Americans and Food Guide Pyramid, i.e., food composition, healthful eating, and the relationship between diet and health. In their research assessing the knowledge, attitudes, and behaviors of college students about the Nutrition Facts Label, Marietta and co-workers (1999) found a low level of awareness (mean score = 48%) and a limited use of these labels among their sample. The Nutrition Facts Label tells consumers the amounts of those food constituents of public health concern present in one serving of food. If the findings from the study conducted by Marietta and coworkers (1999) were generalized to the present sample of college students, this would suggest that the low scores on the cluster of questions concerning food composition might be attributable to a low level of awareness and infrequent use of food labels.

The present study found no statistically significant gender-based differences in mean scores on the 15-item test or on any of the three clusters comprising this test. These results imply that male and female college students need more learning opportunities that would help them make wise food choices and that emphasize the long-term health benefits of sound dietary practices. Such educational interventions should be interactive and relevant for a youthful audience. Additionally, they should promote a greater understanding of the public health nutrition tools that have been developed to help consumers abide by the Dietary Guidelines for Americans, i.e., the Food Guide Pyramid and the Nutrition Facts Label, and should motivate students to use these tools. Several investigators (Barnett & Johnson, 1996; Marietta et al., 1999) have found that enjoyable health education activities can produce desirable changes in dietary behaviors. For example, Marietta and co-workers (1999) found that previous food label education was correlated with label use. Dooley and Soil (1999) describe how educational interventions can take the form of brief public service announcements aired over on-campus or community radio stations. Additionally, brief messages about topics related to the Dietary Guidelines and Pyramid could be displayed on eye-catching posters in student dining halls. Other posters might emphasize the practical application of these recommendations by featuring easy-to-prepare nutritious recipes for popular foods.

Health promotion activities that aim to enhance student awareness about food composition, healthful eating, and the relationship between diet and health could also take the form of board games such as that described by Burns (1999) titled Nutrition Pursuit, which has been favorably evaluated by several groups of students. This game could be adapted to teach the recommendations presented in the Dietary Guidelines and Pyramid. An alternative activity could be an interactive display such as that described by Byrd-Brenner and Finckenor (2000) which was developed to make college students aware of the kinds and amounts of fat present in commonly consumed foods and to demonstrate the atherogenic process associated with consuming high-fat diets. Another exhibit might display good and poor sources of dietary fiber and show how fiber helps decrease transit time along the intestines to reduce the occurrence of constipation and hemorrhoids. Such games and displays could be featured at student health fairs.

Even though the present study found no significant differences in the level of awareness of male and female college students regarding food composition, healthful eating, and the relationship between diet and health, the gender issue should not be ignored when designing interventions intended to enhance their knowledge about these topics. Male and female college students have gender-specific concerns and show gender-specific eating patterns (Horwath, 1991; Huang et al., 1994; Huang et al., 1997). Therefore, educational efforts to enhance awareness of these topics among this population should include some interventions that are gender-specific, such as weight management and attaining healthy skin, which are generally more important to females than males.

Cognitive data from the present study revealed specific deficits in knowledge about nutrition concepts related to the Dietary Guidelines and the Pyramid that could serve as the focus for various kinds of educational interventions. For example, regarding healthful eating, many students thought that the vegetable rather than the grain/cereal group should provide the greatest number of daily servings for good health. This implies that the recommendation to eat more vegetables is being heard, if not followed, while the recommendation to eat the greatest number of servings from the base of the Pyramid is not being recalled to the same degree. These findings suggest that future educational efforts need to promote greater consumption of grain/cereal products. Since such foods are often misperceived by college students as fattening, they need to be promoted as helpful in weight management due to their high-fiber, low-fat content.

Analysis of variance revealed significant main effects of several demographic, health, and lifestyle variables on knowledge about the three topics related to the Dietary Guidelines and the Pyramid. The finding that first/second year students scored significantly higher on the test than third/fourth year students implies that basic information about food composition, healthful eating, and the relationship between diet and health needs to be reinforced in upper level health-related courses. The finding that students without a chronic disease earned significantly higher mean scores than students with such a condition needs to be interpreted with caution since few students were afflicted with these conditions. If future studies with larger samples confirm this finding, this would suggest a need to target afflicted students with messages and programs emphasizing how a healthful diet can help them manage their condition. Lastly, the finding that students who reported often consuming high-fat foods/snacks earned significantly higher mean scores than students who reported never consuming these products suggests that the students who frequently consume them do not perceive this behavior as a personal health risk. This behavior does not appear to reflect their ignorance of the association between high-fat diets and cardiovascular disease, since the majority of students were aware of this association. This finding lends credence to the recommendation of Brevard & Ricketts (1996), Betts and co-workers (1997), Horacek & Betts (1998) that educational interventions for college students need to emphasize the long-term health consequences of consuming high-fat diets during young adulthood.

CONCLUSIONS

Findings from the present study suggest a low level of awareness among college students about three topics related to the 2000 Dietary Guidelines for Americans and the Food Guide pyramid, i.e., food composition, healthful eating, and the relationship between diet and health. However, these results were generated by a small non-probability sample and need to be validated by other studies using larger probability samples. If future studies confirm the present findings, this would suggest a need for health educators to develop more nutrition messages and experiential learning opportunities about the public health nutrition tools that aim to help consumers select healthful daily diets. Such health promotion interventions should stress the long-term benefits of making desirable dietary changes and the health risks associated with the types of poor quality diets often consumed by college students.

Table 1. Demographic, Health, and Lifestyle Characteristics

of College Students

Characteristic Males Females p Value

(N=64) * (N=128) *

Academic Classification

First/Second Year 29 45.3 60 46.9 >.05

Third/Fourth Year 31 48.4 63 49.2

Previous Education About

Food Guide Pyramid

Yes 39 69.9 105 82.0 >.01

No 25 31.1 23 18.0

Body Mass Index

Underweight 1 1.6 3 2.4 <.001

Normal 31 48.4 108 85.0

Overweight 32 50.0 16 12.6

Family History of Chronic Disease

Diabetes Yes 12 18.8 40 31.3 >.05

No 52 81.2 88 68.7

Heart Disease Yes 11 17.2 22 17.2 >.05

No 53 82.8 106 82.8

Hypertension Yes 11 17.2 22 17.2 >.05

No 53 82.8 100 78.1

Overweight Yes 3 4.7 24 18.8 <.01

No 61 95.3 104 81.2

Colon Cancer Yes 1 1.6 7 5.5 >.05

No 63 98.4 121 94.5

Breast Cancer Yes 0 0.0 15 11.7 <.01

No 64 100.0 109 88.3

Frequency of Eating High-

fat foods/snacks

Never 5 7.9 4 3.1 >.05

Rarely 12 19.0 15 11.8

Sometimes 27 42.9 69 54.3

Often 19 30.2 39 30.7

Reads Food Labels

Total Fat Yes 22 34.4 93 72.7 <.001

No 42 65.6 35 27.3

Calories Yes 19 29.7 61 47.7 <.05

No 45 70.3 67 52.3

Salt/Sodium Yes 14 21.9 29 22.7 >.05

No 50 78.1 99 77.3

Sugar Yes 12 18.8 33 25.8 >.05

No 52 81.2 95 74.2

Fiber Yes 12 18.8 18 14.1 >.05

No 52 81.2 110 85.9

Cholesterol Yes 11 17.2 24 18.8 >.05

No 53 82.8 104 81.2

(a) Totals do not always equal 64 due to missing data

(b) Totals do not always equal 128 due to missing data

Table 2. Analysis of Variance for Mean Test Scores

Based on Demographic, Health, and Lifestyle Variables.

p

Variable Source D.F. M.S. F values>F

Academic Status

Gender 1 19.53 2.04 0.155

Academic Status 1 75.85 7.94 0.005

Gender X Academic Status 1 14.35 1.50 0.222

Contrast: 1st/2nd yr.

males vs. females 1 0.19 0.02 0.887

Contrast: 3rd/4th yr.

males vs. females 1 34.73 3.64 0.058

Previous Ed. About Food Guide Pyramid

Gender 1 6.64 0.75 0.387

Previous Ed. 1 352.4 39.9 <0.001

Gender X Previous Ed. 1 46.3 5.24 0.023

Contrast: Yes -previous

males vs. females 1 3.88 3.5 0.063

Contrast: No-previous

males vs. females 1 15.54 1.76 0.186

BMI Weight

Gender 1 29.69 2.70 0.102

BMI 1 0.02 0.00 0.963

Gender X BMI 1 19.83 1.80 0.181

Contrast: overweight

males vs. females 1 35.04 3.18 0.076

Contrast: normal BMI

males vs. females 1 0.82 0.07 0.785

Health Status

Gender 1 5.73 0.54 0.465

Health Status 1 51.76 4.84 0.029

Gender X Health Status 1 1.42 0.13 0.720

Contrast: With disease

males vs. females 1 24.54 2.30 0.131

Contrast: No disease

males vs. females 1 0.21 0.02 0.889

Family History (FH): Chronic Disease

Gender 1 18.85 1.72 0.191

Family History 1 1.20 0.11 0.742

Gender X FH 1 18.43 1.68 0.200

Contrast: Yes FH

males vs. females 1 38.67 3.53 0.062

Contrast: No FH

males vs. females 1 0.00 0.00 0.992

Reading Food Labels (FL)

Gender 1 0.21 0.02 0.890

FL 1 3.72 0.34 0.559

Gender X FL 1 34.73 3.20 0.075

Contrast: FL males vs. females 1 9.80 0.90 0.343

Eat High-fat (HF) Foods

Gender 1 18.08 1.68 0.196

HF 1 32.06 2.98 0.039

Gender X HF 1 6.75 0.63 0.598

Contrast: Often

males vs. females 1 1.50 0.14 0.709

Contrast: Sometimes

males vs. females 1 21.07 1.96 0.163

Contrast: Rarely

males vs. females 1 10.24 0.94 0.333

Contrast: Never

males vs. females 1 6.42 0.60 0.441

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Laura McArthur, PhD, RD, is with the Department of Nutrition and Hospitality Management at East Carolina University in the Rivers Building (room 225), Greenville, NC 27858, mcarthurl@mial.ecu.edu. Frances M. Grady, B.S., and Rachel I. Rosenberg; B.S., are in the Environmental Program, and Alan B. Howard, M.S. is with Academic Computing Services at the University of Vermont. Address all correspondence to Dr. McArthur.

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