Journal of Human Nutrition and Dietetics
NUTRITIONAL SCIENCE You are what you choose to eat: factors influencing young adults’ food selection behaviour L. Hebden, H. N. Chan, J. C. Louie, A. Rangan & M. Allman-Farinelli School of Molecular Bioscience, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
Keywords food labelling, food preferences, food services, obesity, young adult. Correspondence L. Hebden, Level 4 East, Building D17 – Charles Perkins Centre, The University of Sydney, John Hopkins Drive, Camperdown, NSW 2006, Australia. Tel.: +61 2 8627 1690 E-mail: [email protected] How to cite this article Hebden L., Chan H.N., Louie J.C.Y., Rangan A. & Allman-Farinelli M. (2015) You are what you choose to eat: factors influencing young adults’ food selection behaviour. J Hum Nutr Diet. 28, 401–408 doi: 10.1111/jhn.12312
Abstract Background: Young or ‘emerging’ adulthood (ages 18–24 years) is a lifestage characterised by rapid weight gain, particularly among those born in recent decades, when environments have become saturated with cheap, highly palatable, processed foods. Although intervening in the immediate food environments of emerging adults is indicated, little is known about the factors influencing their food selection. The present study aimed to: (i) measure the relative importance of different influences on foods selected by emerging adults for consumption from a tertiary education setting and (ii) examine whether these influences differ according to gender, adiposity status, perceived stress and dieting or physical activity behaviours. Methods: An online survey was administered with 112 emerging adults aged 19–24 years assessing demographics, perceived stress, dieting, physical activity and influences on food selection. Adiposity indicators (body mass index and waist circumference) were measured. Analyses compared the importance of influences on food selection by gender, adiposity, perceived stress, dieting and physical activity. Results: Taste was the most important influence on food selection, followed by convenience (availability), cost, nutrition/health value, smell and stimulatory properties (alertness). Participants with an elevated waist circumference selected foods to help them cope with stress and control their weight. Those reporting a higher level of physical activity placed greater importance on nutritional/health value of foods but less importance on taste. Female dieters also placed less importance on taste and value for money. Conclusions: Health promotion strategies addressing tertiary education food environments of emerging adults should ensure the ready availability of tasty and nutritious foods at a low cost.
Introduction Young adulthood is a life-stage characterised by rapid weight gain and a subsequent increased risk for the incidence of being overweight and associated cardiometabolic risk factors (1–3). Data from high-income countries have consistently shown a greater risk for weight gain among young adult cohorts born during the last few decades (4–7). This has coincided with the development of modern obesogenic environments saturated with cheap, highly ª 2015 The British Dietetic Association Ltd.
palatable, processed foods. Approximately 40% of young adults’ eating occasions occur outside the home (8). This raises concerns, given that foods procured and eaten away from home are often of poorer nutritional quality compared to foods prepared and brought from home, as well as there being evidence for a positive association between eating away from home and obesity (9–11). Emerging adulthood is defined in the health and medical literature as individuals aged 18–24 years and represents a life-stage of transitioning to independence (12). 401
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This life-stage is characterised by the consumption of a poorer quality diet and a period of significant weight gain (13–17) . Understanding the factors influencing food selection behaviour among emerging adults is essential to inform the tailoring of interventions to address their immediate food environments, including retail food outlets within tertiary education settings or workplaces. Despite this, research on influences on food selection outside the home specifically in emerging adult populations is lacking. From the literature available internationally, it is well recognised that food selections away from home are influenced by taste, cost and convenience (18). Food selection behaviour, however, has also been shown to differ according to gender (18), dieting and physical activity behaviours (18,19), level of perceived stress (20,21), and adiposity status (22). For example, young adults with greater perceived stress are more likely to select energy-dense snacks and ready-to-eat foods for consumption (20,21), whereas Georgiou et al. (19) showed the nutritive or health value of foods to have a greater influence on food selection behaviour in young adults identifying as ‘exercisers’ compared to ‘non-exercisers’. Thus, it was hypothesised that emerging adults would place the greatest importance on taste, cost and convenience when selecting foods for consumption outside the home and, in addition, the importance that they place on such influences might differ according to their gender, adiposity status, level of perceived stress and dieting or physical activity behaviours. Hence, the present study aimed to (i) measure the relative importance of different influences on foods selected by emerging adults for consumption from a tertiary education setting and (ii) examine whether these influences differ according to gender, adiposity status, perceived stress and dieting or physical activity behaviours. Materials and methods The present study comprised a cross-sectional analysis of baseline data from a prospective intervention trial aimed at modifying the university food environment (i.e. retail food outlets available on university campuses) because approximately 82% of emerging adults are enrolled in tertiary education studies in Australia (23). Ethical approval for this research was received from the University of Sydney Human Research Ethics Committee (Project no. 2014/136). Participants University students were recruited to participate in this intervention trial aimed at modifying the university food 402
environment using print and online advertising. Printed poster advertisements were distributed across the main University of Sydney campuses and email advertisements were sent in three bursts during March and April 2014 to 12 400 enrolled students (24). All advertisements provided a weblink to an online survey to screen for eligibility criteria: age 19–24 years and a regular consumer (i.e. at least twice per week) at retail food outlets available on university campuses. All participants went into a lottery draw to win a computer tablet in attempt to increase participation rate from males in this nutrition-focused study. Procedure Eligible participants were contacted by the researchers to schedule an appointment at a university clinic. At this appointment, participants (i) provided their informed consent to participate in the trial; (ii) completed a brief online survey; and (iii) had anthropometric measurements [body weight, height and waist circumference (WC)] recorded by trained post-graduate nutrition students. Clinic appointments were conducted during March to May 2014. Measures The online survey comprised questions on (i) demographics including gender, residential postal code, living arrangement and cultural background (i.e. language spoken at home); (ii) adiposity-related factors including dieting and physical activity behaviours; (iii) level of perceived stress; and (iv) influences on food selection behaviour. Residential post-code was used to categorise participants’ socio-economic status (SES) into deciles, with 10 being the highest SES decile, using the Socio-Economic Index for Areas (SEIFA) index of relative socio-economic advantage and disadvantage (IRSAD), commonly used in Australia to inform the SES profile of tertiary education students (25). Dieting was assessed using the question ‘are you currently on a diet to lose weight or for other health reasons’, based on that used in the 2011–12 Australian Health Survey (26). Physical activity in the previous 7 days was self-reported using the validated International Physical Activity Questionnaire (IPAQ), which asks about time spent in vigorous, walking and other moderate intensity activities (27). Physical activity was categorised into levels of high [daily activity in the last week totalling ≥3000 metabolic equivalent of task (MET)-min], moderate (daily activity in the last week totalling ≥600 MET-min) or low (neither high, nor moderate activity level), in accordance with IPAQ scoring protocols (28). Perceived stress was measured using the validated 10-item perceived stress scale (29). ª 2015 The British Dietetic Association Ltd.
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Importance of different influences on food selection was assessed using a modified version of the Food Choice Questionnaire (30), which measures the perceived importance of a range of influences on food selection on a four-point Likert scale. The question used in the present study asked ‘The question in the scale below asks you about your reasons for choosing the foods that you purchase to eat. Please indicate your response by choosing the box representing how important each reason is to you’, with response options coded as 0 = not important at all, 1 = a little important, 2 = moderately important, and 3 = very important. The range of influences examined in the present study included ‘tastes good’, ‘is familiar to me’, ‘is nutritious’, ‘is easily available’, ‘is good value for money’, ‘is cheap’, ‘helps me cope with stress’, ‘helps me control my weight’, ‘looks nice’, ‘makes me feel good’, ‘keeps me healthy’, ‘keeps me awake/alert’, ‘is what I usually eat’, and ‘smells nice’. Anthropometric measurements were performed with participants in light clothing, without footwear, adopting methods consistent with the National Health and Nutrition Examination Survey anthropometry procedures (31). Body weight was measured to the nearest 0.1 kg using digital scales, height to the nearest 0.5 centimetres (cm) using a portable stadiometer, and WC to the nearest 0.5 cm using a tape measure. Body mass index (BMI) was then calculated using the formula [weight (kg)]/ [height (m)2] to categorise participants into underweight (80 cm in females) health risk categories, also developed by the World Health Organization (33). Statistical analysis Complete data were available for all participants except for three participants who were excluded from physical activity data as a result of missing data for the number of days that vigorous or other moderate activities were performed. Descriptive statistics were computed to describe participants’ demographic and anthropometric characteristics as median with associated interquartile range (IQR) or number and percentage (%) of sample (Table 1). These characteristics were compared between genders using chi-square tests for categorical indicators (i.e. living arrangement, language spoken, as well as BMI and WC health risk categories) and nonparametric Mann–Whitney U-tests for SES decile as data presented non-normal distributions. The outcome variable of interest was perceived ª 2015 The British Dietetic Association Ltd.
Factors influencing young adults’ food selection Table 1 Participant anthropometric and demographic characteristics by gender (n = 112) Males (n = 42) Socio-economic status decile Body mass index category Underweight (80 cm) Living arrangement At home with family University accommodation Off campus Language spoken at home English Other
Females (n = 70)
Median (interquartile range) 9 (7 – 10) 9 (6 – 10) n (%) 2 (5) 9 (13) 30 (71)
51 (73)
10 (24)
10 (14)
n (%) 38 (90)
62 (89)
4 (9)
8 (12)
n 28 3 11 n 32 10
(%) (67) (7) (26) (%) (76) (24)
50 (71) 3 (4) 17 (24) 53 (76) 17 (24)
importance of influences on food selection, which was compared across binary explanatory variables of gender (male versus female), BMI category (underweight or normal weight versus overweight or obese), WC category (low risk versus increased risk), level of perceived stress (below versus above median), level of physical activity (low-moderate versus high) and dieting behaviour (not on a diet versus currently on a diet) using nonparametric Mann–Whitney U-tests because the outcome variable was ranked categorical data that followed a non-normal distribution. These analyses were then also stratified by gender (other than gender itself), given previous evidence that influences on food selection differ by gender (18,21). Data for participants’ perceived stress were normally distributed and hence is reported as the mean (SD) with independent sample t-tests performed to compare genders. All analyses were conducted in SPSS, version 22 (IBM Corp., Armonk, NY, USA). P < 0.05 was considered statistically significant. Results Participant characteristics Table 1 presents participants’ anthropometric and demographic characteristics by gender. Participants resided in higher socio-economic areas, with the average IRSAD decile for New South Wales being 5.5 (25). The majority of participants also reported speaking English at home, 403
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with approximately half of other languages spoken at home being Chinese (n = 14/27). Most also lived at home with their family and were classified within the normal weight range on the basis of BMI (Table 1). Note that approximately two-thirds of Australian tertiary education students live at home with their parents or partner (34). Influences on food selection Taste was the most important influence on food selection in both males and females, with a median (IQR) score of 3.0 (2.0–3.0) reflecting taste to be a ‘very important’ perceived influence. This was followed by moderately important influences of ‘is easily available’ 2.0 (2.0–3.0), ‘is good value for money’ 2.0 (2.0–3.0), ‘is cheap’ 2.0 (1.0–3.0), ‘is nutritious’ 2.0 (1.3–3.0), ‘keeps me healthy’ 2.0 (1.0–3.0), ‘makes me feel good’ 2.0 (1.0–2.0), ‘smells nice’ 2.0 (1.0–2.0), as well as ‘keeps me awake/alert’ 2.0 (1.0–2.0). Comparing males and females, there were no significant differences in the perceived importance of any of the examined influences. Comparing results across category of BMI, no significant differences were found in perceived importance of influences on food selection. However, comparing across category of WC (Fig. 1), influences perceived as being significantly more important to participants in the increased health risk category (i.e. WC > 94 cm in males, >80 cm in females) included helping them cope with stress (U = 281.0, P = 0.001) and controlling their weight (U = 365.5, P = 0.021). Participants reporting a high level of physical activity (i.e. daily activity in the last week totalling ≥3000 METmin) perceived nutritional value (U = 983.5, P = 0.008) and keeping them healthy (U = 1086.5, P = 0.049) as being more important influences on their food selection compared to those reporting less physical activity (Fig. 2), whereas tasting good was perceived as being less impor-
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tant (U = 962.0, P = 0.001). Gender comparisons revealed that among males reporting a high level of physical activity, keeping them healthy (U = 126.0, P = 0.020) was a more important influence, whereas tasting good (U = 139.5, P = 0.032) was a less important influence on food selection, compared to males reporting less physical activity. Similarly, among females, reporting a high level of physical activity tasting good (U = 349.5, P = 0.029) was a less important influence compared to less active females, whereas nutritional value was perceived to be a more important influence (U = 299.0, P = 0.009), which was not found among males. Among participants who reported that they were currently on a diet (six of 42 males, eleven of 70 females) the types of diets most frequently reported were low carbohydrate/low sugar (three of six males, four of 11 females), weight loss (five of 11 females) or high protein (three of six males). Only four of the 17 participants reporting they were currently on a diet were also classified as overweight or obese (BMI ≥25.0 kg m–2), with the remainder being classified as normal weight and two as underweight (BMI 18.1 kg m–2 and 18.2 kg m–2). Compared with those not currently on a diet, influences perceived as being significantly more important to participants reporting they were currently on a diet included helping them control their weight (U = 536.0, P = 0.021), making them feel good (U = 508.0, P = 0.010) and nutritional value (U = 464.0, P = 0.003), whereas tasting good (U = 606.5, P = 0.049) and good value for money (U = 552.0, P = 0.023) were perceived as being less important (Fig. 3). Keeping them healthy also appeared to be more important to those on a diet, almost reaching significance (U = 585.5, P = 0.054). Gender comparisons revealed that, among males on a diet, nutritional value (U = 15.0, P < 0.001), making them feel good (U = 45.0, P = 0.015) and keeping them healthy (U = 45.0, P = 0.016) were more important influ-
Figure 1 Perceived importance of influences on food selection among emerging adults by waist circumference category: 0 = Not important at all, 1 = A little important, 2 = Moderately important, 3 = Very important. Dark grey boxes, P < 0.01; Light grey boxes, P < 0.05; Circles indicate outliers.
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Figure 2 Perceived importance of influences on food selection among emerging adults by level of physical activity: 0 = Not important at all, 1 = A little important, 2 = Moderately important, 3 = Very important. Dark grey boxes, P < 0.01; Light grey boxes, P < 0.05; Circles indicate outliers.
Figure 3 Perceived importance of influences on food selection among emerging adults by dieting practice: 0 = Not important at all, 1 = A little important, 2 = Moderately important, 3 = Very important. Dark grey boxes, P < 0.01; Light grey boxes, P < 0.05; Circles indicate outliers.
ences than for males not on a diet. Alternatively, among females on a diet, tasting good (U = 219.5, P = 0.036) and good value for money (U = 175.5, P = 0.008) were less important influences than for females not on a diet. Participants’ mean (SD) perceived stress was similar in males and females [16.3 (5.5) and 17.6 (6.1), P = 0.259]. Compared with participants reporting a lower perceived stress (i.e. below the median), influences on food selection perceived as being more important to those reporting a higher perceived stress included helping them cope with stress (U = 1192.5, P = 0.020) and making them feel good (U = 1189.0, P = 0.021). Discussion The present study aimed to measure the relative importance of different influences on foods selected for consumption outside the home by emerging adults from a university setting. The resulting findings are relevant for ª 2015 The British Dietetic Association Ltd.
planning interventions to improve the food environment in similar tertiary education settings. Taste was found to have the most important influence on food selection, followed by convenience (availability), cost, nutrition and health value, as well as smell and stimulatory properties (alertness). These findings are consistent with earlier research available for young- to middle-aged populations, in whom sensory appeal (such as taste and smell), convenience, price and health were perceived as important influences on food selection (35–37). The findings also concur with limited earlier research for young adult populations with regard to taste (palatability) being more important than health considerations on the types of foods selected for consumption (38,39). This research showed emerging adults reporting a higher level of physical activity to perceive the nutritional and health value of foods as being more important influences on their food selection compared to less active participants. This supports the earlier findings of Georgiou 405
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et al. (19) who showed the healthiness or nutritional value of foods to have a greater influence on food selection behaviour in emerging adults identifying as ‘exercisers’ compared to non-exercisers. However, a concept that has not been documented in the previous literature is the finding that dieters and highly physically active individuals placed less importance on taste, with dieters also placing less importance on value for money. When analysed by gender, it was only female dieters who were found to place less importance on taste and value for money. These findings illustrate that emerging adults who engage in more health or weight gain protective behaviours may sacrifice normative influences of taste and cost for foods that offer greater nutritional or health value, particularly young females. Functional properties of helping them cope with stress and making them feel good were perceived as being more important in those reporting a higher level of perceived stress. This effect of stress on food preferences is of concern because earlier research in young adults has indicated that the types of foods selected by those with higher stress tend to be less healthful (20,21,40). Because the studied sample was recruited for a nutrition-focused trial, this may be considered a limitation given that this would usually introduce sampling bias from attracting those who are more health or weight conscious than the general population. However, participants were also offered a material incentive of entry into a competitive draw to win a computer tablet in attempt to prevent this form of sample bias. Furthermore, comparing the study sample with the general population aged 18–24 years, a similar proportion of males and females reported sufficient physical activity for health (66% versus 59% and 59% versus 48%, respectively), and a similar proportion reported that they were currently dieting (14% versus 7% and 16% versus 11%, respectively) (41,42). However, only 9% of males and 12% of females in the studied sample had a WC in the increased health risk category (i.e. WC > 94 cm in males, >80 cm in females) compared to 26% and 43% in the general population (43). A further limitation was the small cell sizes in analyses for dieters (n = 6 males and n = 11 females) and those in the increased risk WC category (n = 12); thus, the results from these data should be interpreted with caution and may not be generalisable to other emerging adult populations. There are also inherent differences between young adults attending tertiary education institutions compared to the general population that must be acknowledged including higher SES and greater ethnic diversity, which may partly explain the lower WC of participants, with a lower proportion reporting speaking English at home (64% versus 84%) (44). Finally, consumer food behaviour is a complex phenomenon and, although the present study explored the importance of different 406
factors such as taste, cost and convenience on food selection behaviour, there are other environmental factors, such as marketing and promotion, that will also influence the foods that emerging adults ultimately select to consume from these environments. Future interventions addressing the immediate food environments of emerging adults should focus on ensuring the ready availability of tasty and nutritious foods for students to purchase at a low cost. Given that nutrition and health qualities of foods were also perceived to be of importance, the potential for nutrition labelling or labelling foods with nutrition or health-related claims may prove to be a successful strategy for encouraging selection of healthier foods in emerging adult populations. Health and research practitioners working in this field must also acknowledge the influences of intrinsic sensory, functional and nutritive or health values placed on foods, and extrinsic influences of cost and availability, on the types of foods emerging adults select for consumption. Conclusions Food selection is primarily influenced by taste in emerging adults: a unique population group at high risk for weight gain that has received very little attention in the health literature. Other important influences include convenience (availability), cost, nutrition and health value, as well as smell and stimulatory properties (alertness). Health promotion strategies addressing tertiary education food environments should focus on ensuring the ready availability of tasty and nutritious foods at a low cost, and potentially consider the use of nutrition or health related food labelling schemes to encourage selection of healthier foods. Conflict of interests, source of funding and authorship The authors declare that they have no conflicts of interest. We thank the following post-graduate dietetic students who assisted in the recruitment processes and data collection: Naomi Wu, Reem Bashour, Sarah O’Connor, Valentina Giannelli, Ki Wong, Lu Gao, Lara Pasternak, Wenqian Wang and Wei Ming Yap. The authors have no funding sources to declare. HNC managed recruitment processes and assisted in data collection. MAF, AN, LH and JCL developed the research protocol and survey tool with HNC. LH cleaned and analysed the data, and drafted the manuscript. All authors critically reviewed the manuscript and approved the final version submitted for publication.
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adults: a comparison of nomothetic and idiographic analytic approaches. Aust NZ J Public Health 22, 547–551. Stewart B & Tinsley ANN (1995) Importance of food choice influences for working young adults. J Am Diet Assoc 95, 227–230. Bennett J, Greene G & Schwartz-Barcott D (2013) Perceptions of emotional eating behavior. A qualitative study of college students. Appetite 60, 187–192. Australian Bureau of Statistics. Australian Health Survey: Physical Activity, 2011-12, cat. no. 4364.0.55.004, Table 4: Sufficient physical activity measure by selected population characteristics, Persons aged 18 years and over, http:// www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent {00AMP00}Table%204%20Sufficient%20physical% 20activity%20measure%20by%20selected%20population% 20characteristics,%20Persons%20aged%2018%20years% 20and%20over.xls{00AMP00}4364.0.55.004{00AMP00}Data %20Cubes{00AMP00}608504AB99CC2643CA257BAC0 015F815{00AMP00}0{00AMP00}2011-12{00AMP00} 19.07.2013{00AMP00}Latest (accessed 27 November 2014). Australian Bureau of Statistics. Australian Health Survey: Nutrition First Results - Foods and Nutrients, 2011-12, cat no. 4364.0.55.007, Table 13: Whether currently on a diet and type of diet, http://www.abs.gov.au/ausstats/ subscriber.nsf/log?openagent{00AMP00}Table%2013% 20Whether%20on%20diet%20and%20type%20of% 20diet.xls{00AMP00}4364.0.55.007{00AMP00}Data% 20Cubes{00AMP00}CF3D1D6E403E8070CA257CD200147 2D8{00AMP00}0{00AMP00}2011-12{00AMP00}09.05.2014 {00AMP00}Latest (accessed 27 November 2014). Australian Bureau of Statistics. Australian Health Survey, 2011–2012, ‘Table 16.3 Waist circumference(a), Proportion of persons’, data cube: Excel spreadsheet, cat. no. 4364.0.55.001, http://www.abs.gov.au/AUSSTATS/ subscriber.nsf/log?openagent{00AMP00} 43640do016_20112012.xls{00AMP00}4364.0.55.001 {00AMP00}Data%20Cubes{00AMP00} 7FCB5E7BA12B3E9DCA257AA30014C43E{00AMP00}0 {00AMP00}2011-12{00AMP00}29.10.2012{00AMP00} Previous (accessed 29 January 2015). Australian Bureau of Statistics. 2011 Census of Population and Housing, http://www.abs.gov.au/ (accessed 29 January 2015).
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NUTRITIONAL SCIENCE You are what you choose to eat: factors influencing young adults’ food selection behaviour L. Hebden, H. N. Chan, J. C. Louie, A. Rangan & M. Allman-Farinelli School of Molecular Bioscience, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
Keywords food labelling, food preferences, food services, obesity, young adult. Correspondence L. Hebden, Level 4 East, Building D17 – Charles Perkins Centre, The University of Sydney, John Hopkins Drive, Camperdown, NSW 2006, Australia. Tel.: +61 2 8627 1690 E-mail: [email protected] How to cite this article Hebden L., Chan H.N., Louie J.C.Y., Rangan A. & Allman-Farinelli M. (2015) You are what you choose to eat: factors influencing young adults’ food selection behaviour. J Hum Nutr Diet. 28, 401–408 doi: 10.1111/jhn.12312
Abstract Background: Young or ‘emerging’ adulthood (ages 18–24 years) is a lifestage characterised by rapid weight gain, particularly among those born in recent decades, when environments have become saturated with cheap, highly palatable, processed foods. Although intervening in the immediate food environments of emerging adults is indicated, little is known about the factors influencing their food selection. The present study aimed to: (i) measure the relative importance of different influences on foods selected by emerging adults for consumption from a tertiary education setting and (ii) examine whether these influences differ according to gender, adiposity status, perceived stress and dieting or physical activity behaviours. Methods: An online survey was administered with 112 emerging adults aged 19–24 years assessing demographics, perceived stress, dieting, physical activity and influences on food selection. Adiposity indicators (body mass index and waist circumference) were measured. Analyses compared the importance of influences on food selection by gender, adiposity, perceived stress, dieting and physical activity. Results: Taste was the most important influence on food selection, followed by convenience (availability), cost, nutrition/health value, smell and stimulatory properties (alertness). Participants with an elevated waist circumference selected foods to help them cope with stress and control their weight. Those reporting a higher level of physical activity placed greater importance on nutritional/health value of foods but less importance on taste. Female dieters also placed less importance on taste and value for money. Conclusions: Health promotion strategies addressing tertiary education food environments of emerging adults should ensure the ready availability of tasty and nutritious foods at a low cost.
Introduction Young adulthood is a life-stage characterised by rapid weight gain and a subsequent increased risk for the incidence of being overweight and associated cardiometabolic risk factors (1–3). Data from high-income countries have consistently shown a greater risk for weight gain among young adult cohorts born during the last few decades (4–7). This has coincided with the development of modern obesogenic environments saturated with cheap, highly ª 2015 The British Dietetic Association Ltd.
palatable, processed foods. Approximately 40% of young adults’ eating occasions occur outside the home (8). This raises concerns, given that foods procured and eaten away from home are often of poorer nutritional quality compared to foods prepared and brought from home, as well as there being evidence for a positive association between eating away from home and obesity (9–11). Emerging adulthood is defined in the health and medical literature as individuals aged 18–24 years and represents a life-stage of transitioning to independence (12). 401
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This life-stage is characterised by the consumption of a poorer quality diet and a period of significant weight gain (13–17) . Understanding the factors influencing food selection behaviour among emerging adults is essential to inform the tailoring of interventions to address their immediate food environments, including retail food outlets within tertiary education settings or workplaces. Despite this, research on influences on food selection outside the home specifically in emerging adult populations is lacking. From the literature available internationally, it is well recognised that food selections away from home are influenced by taste, cost and convenience (18). Food selection behaviour, however, has also been shown to differ according to gender (18), dieting and physical activity behaviours (18,19), level of perceived stress (20,21), and adiposity status (22). For example, young adults with greater perceived stress are more likely to select energy-dense snacks and ready-to-eat foods for consumption (20,21), whereas Georgiou et al. (19) showed the nutritive or health value of foods to have a greater influence on food selection behaviour in young adults identifying as ‘exercisers’ compared to ‘non-exercisers’. Thus, it was hypothesised that emerging adults would place the greatest importance on taste, cost and convenience when selecting foods for consumption outside the home and, in addition, the importance that they place on such influences might differ according to their gender, adiposity status, level of perceived stress and dieting or physical activity behaviours. Hence, the present study aimed to (i) measure the relative importance of different influences on foods selected by emerging adults for consumption from a tertiary education setting and (ii) examine whether these influences differ according to gender, adiposity status, perceived stress and dieting or physical activity behaviours. Materials and methods The present study comprised a cross-sectional analysis of baseline data from a prospective intervention trial aimed at modifying the university food environment (i.e. retail food outlets available on university campuses) because approximately 82% of emerging adults are enrolled in tertiary education studies in Australia (23). Ethical approval for this research was received from the University of Sydney Human Research Ethics Committee (Project no. 2014/136). Participants University students were recruited to participate in this intervention trial aimed at modifying the university food 402
environment using print and online advertising. Printed poster advertisements were distributed across the main University of Sydney campuses and email advertisements were sent in three bursts during March and April 2014 to 12 400 enrolled students (24). All advertisements provided a weblink to an online survey to screen for eligibility criteria: age 19–24 years and a regular consumer (i.e. at least twice per week) at retail food outlets available on university campuses. All participants went into a lottery draw to win a computer tablet in attempt to increase participation rate from males in this nutrition-focused study. Procedure Eligible participants were contacted by the researchers to schedule an appointment at a university clinic. At this appointment, participants (i) provided their informed consent to participate in the trial; (ii) completed a brief online survey; and (iii) had anthropometric measurements [body weight, height and waist circumference (WC)] recorded by trained post-graduate nutrition students. Clinic appointments were conducted during March to May 2014. Measures The online survey comprised questions on (i) demographics including gender, residential postal code, living arrangement and cultural background (i.e. language spoken at home); (ii) adiposity-related factors including dieting and physical activity behaviours; (iii) level of perceived stress; and (iv) influences on food selection behaviour. Residential post-code was used to categorise participants’ socio-economic status (SES) into deciles, with 10 being the highest SES decile, using the Socio-Economic Index for Areas (SEIFA) index of relative socio-economic advantage and disadvantage (IRSAD), commonly used in Australia to inform the SES profile of tertiary education students (25). Dieting was assessed using the question ‘are you currently on a diet to lose weight or for other health reasons’, based on that used in the 2011–12 Australian Health Survey (26). Physical activity in the previous 7 days was self-reported using the validated International Physical Activity Questionnaire (IPAQ), which asks about time spent in vigorous, walking and other moderate intensity activities (27). Physical activity was categorised into levels of high [daily activity in the last week totalling ≥3000 metabolic equivalent of task (MET)-min], moderate (daily activity in the last week totalling ≥600 MET-min) or low (neither high, nor moderate activity level), in accordance with IPAQ scoring protocols (28). Perceived stress was measured using the validated 10-item perceived stress scale (29). ª 2015 The British Dietetic Association Ltd.
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Importance of different influences on food selection was assessed using a modified version of the Food Choice Questionnaire (30), which measures the perceived importance of a range of influences on food selection on a four-point Likert scale. The question used in the present study asked ‘The question in the scale below asks you about your reasons for choosing the foods that you purchase to eat. Please indicate your response by choosing the box representing how important each reason is to you’, with response options coded as 0 = not important at all, 1 = a little important, 2 = moderately important, and 3 = very important. The range of influences examined in the present study included ‘tastes good’, ‘is familiar to me’, ‘is nutritious’, ‘is easily available’, ‘is good value for money’, ‘is cheap’, ‘helps me cope with stress’, ‘helps me control my weight’, ‘looks nice’, ‘makes me feel good’, ‘keeps me healthy’, ‘keeps me awake/alert’, ‘is what I usually eat’, and ‘smells nice’. Anthropometric measurements were performed with participants in light clothing, without footwear, adopting methods consistent with the National Health and Nutrition Examination Survey anthropometry procedures (31). Body weight was measured to the nearest 0.1 kg using digital scales, height to the nearest 0.5 centimetres (cm) using a portable stadiometer, and WC to the nearest 0.5 cm using a tape measure. Body mass index (BMI) was then calculated using the formula [weight (kg)]/ [height (m)2] to categorise participants into underweight (80 cm in females) health risk categories, also developed by the World Health Organization (33). Statistical analysis Complete data were available for all participants except for three participants who were excluded from physical activity data as a result of missing data for the number of days that vigorous or other moderate activities were performed. Descriptive statistics were computed to describe participants’ demographic and anthropometric characteristics as median with associated interquartile range (IQR) or number and percentage (%) of sample (Table 1). These characteristics were compared between genders using chi-square tests for categorical indicators (i.e. living arrangement, language spoken, as well as BMI and WC health risk categories) and nonparametric Mann–Whitney U-tests for SES decile as data presented non-normal distributions. The outcome variable of interest was perceived ª 2015 The British Dietetic Association Ltd.
Factors influencing young adults’ food selection Table 1 Participant anthropometric and demographic characteristics by gender (n = 112) Males (n = 42) Socio-economic status decile Body mass index category Underweight (80 cm) Living arrangement At home with family University accommodation Off campus Language spoken at home English Other
Females (n = 70)
Median (interquartile range) 9 (7 – 10) 9 (6 – 10) n (%) 2 (5) 9 (13) 30 (71)
51 (73)
10 (24)
10 (14)
n (%) 38 (90)
62 (89)
4 (9)
8 (12)
n 28 3 11 n 32 10
(%) (67) (7) (26) (%) (76) (24)
50 (71) 3 (4) 17 (24) 53 (76) 17 (24)
importance of influences on food selection, which was compared across binary explanatory variables of gender (male versus female), BMI category (underweight or normal weight versus overweight or obese), WC category (low risk versus increased risk), level of perceived stress (below versus above median), level of physical activity (low-moderate versus high) and dieting behaviour (not on a diet versus currently on a diet) using nonparametric Mann–Whitney U-tests because the outcome variable was ranked categorical data that followed a non-normal distribution. These analyses were then also stratified by gender (other than gender itself), given previous evidence that influences on food selection differ by gender (18,21). Data for participants’ perceived stress were normally distributed and hence is reported as the mean (SD) with independent sample t-tests performed to compare genders. All analyses were conducted in SPSS, version 22 (IBM Corp., Armonk, NY, USA). P < 0.05 was considered statistically significant. Results Participant characteristics Table 1 presents participants’ anthropometric and demographic characteristics by gender. Participants resided in higher socio-economic areas, with the average IRSAD decile for New South Wales being 5.5 (25). The majority of participants also reported speaking English at home, 403
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with approximately half of other languages spoken at home being Chinese (n = 14/27). Most also lived at home with their family and were classified within the normal weight range on the basis of BMI (Table 1). Note that approximately two-thirds of Australian tertiary education students live at home with their parents or partner (34). Influences on food selection Taste was the most important influence on food selection in both males and females, with a median (IQR) score of 3.0 (2.0–3.0) reflecting taste to be a ‘very important’ perceived influence. This was followed by moderately important influences of ‘is easily available’ 2.0 (2.0–3.0), ‘is good value for money’ 2.0 (2.0–3.0), ‘is cheap’ 2.0 (1.0–3.0), ‘is nutritious’ 2.0 (1.3–3.0), ‘keeps me healthy’ 2.0 (1.0–3.0), ‘makes me feel good’ 2.0 (1.0–2.0), ‘smells nice’ 2.0 (1.0–2.0), as well as ‘keeps me awake/alert’ 2.0 (1.0–2.0). Comparing males and females, there were no significant differences in the perceived importance of any of the examined influences. Comparing results across category of BMI, no significant differences were found in perceived importance of influences on food selection. However, comparing across category of WC (Fig. 1), influences perceived as being significantly more important to participants in the increased health risk category (i.e. WC > 94 cm in males, >80 cm in females) included helping them cope with stress (U = 281.0, P = 0.001) and controlling their weight (U = 365.5, P = 0.021). Participants reporting a high level of physical activity (i.e. daily activity in the last week totalling ≥3000 METmin) perceived nutritional value (U = 983.5, P = 0.008) and keeping them healthy (U = 1086.5, P = 0.049) as being more important influences on their food selection compared to those reporting less physical activity (Fig. 2), whereas tasting good was perceived as being less impor-
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tant (U = 962.0, P = 0.001). Gender comparisons revealed that among males reporting a high level of physical activity, keeping them healthy (U = 126.0, P = 0.020) was a more important influence, whereas tasting good (U = 139.5, P = 0.032) was a less important influence on food selection, compared to males reporting less physical activity. Similarly, among females, reporting a high level of physical activity tasting good (U = 349.5, P = 0.029) was a less important influence compared to less active females, whereas nutritional value was perceived to be a more important influence (U = 299.0, P = 0.009), which was not found among males. Among participants who reported that they were currently on a diet (six of 42 males, eleven of 70 females) the types of diets most frequently reported were low carbohydrate/low sugar (three of six males, four of 11 females), weight loss (five of 11 females) or high protein (three of six males). Only four of the 17 participants reporting they were currently on a diet were also classified as overweight or obese (BMI ≥25.0 kg m–2), with the remainder being classified as normal weight and two as underweight (BMI 18.1 kg m–2 and 18.2 kg m–2). Compared with those not currently on a diet, influences perceived as being significantly more important to participants reporting they were currently on a diet included helping them control their weight (U = 536.0, P = 0.021), making them feel good (U = 508.0, P = 0.010) and nutritional value (U = 464.0, P = 0.003), whereas tasting good (U = 606.5, P = 0.049) and good value for money (U = 552.0, P = 0.023) were perceived as being less important (Fig. 3). Keeping them healthy also appeared to be more important to those on a diet, almost reaching significance (U = 585.5, P = 0.054). Gender comparisons revealed that, among males on a diet, nutritional value (U = 15.0, P < 0.001), making them feel good (U = 45.0, P = 0.015) and keeping them healthy (U = 45.0, P = 0.016) were more important influ-
Figure 1 Perceived importance of influences on food selection among emerging adults by waist circumference category: 0 = Not important at all, 1 = A little important, 2 = Moderately important, 3 = Very important. Dark grey boxes, P < 0.01; Light grey boxes, P < 0.05; Circles indicate outliers.
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Figure 2 Perceived importance of influences on food selection among emerging adults by level of physical activity: 0 = Not important at all, 1 = A little important, 2 = Moderately important, 3 = Very important. Dark grey boxes, P < 0.01; Light grey boxes, P < 0.05; Circles indicate outliers.
Figure 3 Perceived importance of influences on food selection among emerging adults by dieting practice: 0 = Not important at all, 1 = A little important, 2 = Moderately important, 3 = Very important. Dark grey boxes, P < 0.01; Light grey boxes, P < 0.05; Circles indicate outliers.
ences than for males not on a diet. Alternatively, among females on a diet, tasting good (U = 219.5, P = 0.036) and good value for money (U = 175.5, P = 0.008) were less important influences than for females not on a diet. Participants’ mean (SD) perceived stress was similar in males and females [16.3 (5.5) and 17.6 (6.1), P = 0.259]. Compared with participants reporting a lower perceived stress (i.e. below the median), influences on food selection perceived as being more important to those reporting a higher perceived stress included helping them cope with stress (U = 1192.5, P = 0.020) and making them feel good (U = 1189.0, P = 0.021). Discussion The present study aimed to measure the relative importance of different influences on foods selected for consumption outside the home by emerging adults from a university setting. The resulting findings are relevant for ª 2015 The British Dietetic Association Ltd.
planning interventions to improve the food environment in similar tertiary education settings. Taste was found to have the most important influence on food selection, followed by convenience (availability), cost, nutrition and health value, as well as smell and stimulatory properties (alertness). These findings are consistent with earlier research available for young- to middle-aged populations, in whom sensory appeal (such as taste and smell), convenience, price and health were perceived as important influences on food selection (35–37). The findings also concur with limited earlier research for young adult populations with regard to taste (palatability) being more important than health considerations on the types of foods selected for consumption (38,39). This research showed emerging adults reporting a higher level of physical activity to perceive the nutritional and health value of foods as being more important influences on their food selection compared to less active participants. This supports the earlier findings of Georgiou 405
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et al. (19) who showed the healthiness or nutritional value of foods to have a greater influence on food selection behaviour in emerging adults identifying as ‘exercisers’ compared to non-exercisers. However, a concept that has not been documented in the previous literature is the finding that dieters and highly physically active individuals placed less importance on taste, with dieters also placing less importance on value for money. When analysed by gender, it was only female dieters who were found to place less importance on taste and value for money. These findings illustrate that emerging adults who engage in more health or weight gain protective behaviours may sacrifice normative influences of taste and cost for foods that offer greater nutritional or health value, particularly young females. Functional properties of helping them cope with stress and making them feel good were perceived as being more important in those reporting a higher level of perceived stress. This effect of stress on food preferences is of concern because earlier research in young adults has indicated that the types of foods selected by those with higher stress tend to be less healthful (20,21,40). Because the studied sample was recruited for a nutrition-focused trial, this may be considered a limitation given that this would usually introduce sampling bias from attracting those who are more health or weight conscious than the general population. However, participants were also offered a material incentive of entry into a competitive draw to win a computer tablet in attempt to prevent this form of sample bias. Furthermore, comparing the study sample with the general population aged 18–24 years, a similar proportion of males and females reported sufficient physical activity for health (66% versus 59% and 59% versus 48%, respectively), and a similar proportion reported that they were currently dieting (14% versus 7% and 16% versus 11%, respectively) (41,42). However, only 9% of males and 12% of females in the studied sample had a WC in the increased health risk category (i.e. WC > 94 cm in males, >80 cm in females) compared to 26% and 43% in the general population (43). A further limitation was the small cell sizes in analyses for dieters (n = 6 males and n = 11 females) and those in the increased risk WC category (n = 12); thus, the results from these data should be interpreted with caution and may not be generalisable to other emerging adult populations. There are also inherent differences between young adults attending tertiary education institutions compared to the general population that must be acknowledged including higher SES and greater ethnic diversity, which may partly explain the lower WC of participants, with a lower proportion reporting speaking English at home (64% versus 84%) (44). Finally, consumer food behaviour is a complex phenomenon and, although the present study explored the importance of different 406
factors such as taste, cost and convenience on food selection behaviour, there are other environmental factors, such as marketing and promotion, that will also influence the foods that emerging adults ultimately select to consume from these environments. Future interventions addressing the immediate food environments of emerging adults should focus on ensuring the ready availability of tasty and nutritious foods for students to purchase at a low cost. Given that nutrition and health qualities of foods were also perceived to be of importance, the potential for nutrition labelling or labelling foods with nutrition or health-related claims may prove to be a successful strategy for encouraging selection of healthier foods in emerging adult populations. Health and research practitioners working in this field must also acknowledge the influences of intrinsic sensory, functional and nutritive or health values placed on foods, and extrinsic influences of cost and availability, on the types of foods emerging adults select for consumption. Conclusions Food selection is primarily influenced by taste in emerging adults: a unique population group at high risk for weight gain that has received very little attention in the health literature. Other important influences include convenience (availability), cost, nutrition and health value, as well as smell and stimulatory properties (alertness). Health promotion strategies addressing tertiary education food environments should focus on ensuring the ready availability of tasty and nutritious foods at a low cost, and potentially consider the use of nutrition or health related food labelling schemes to encourage selection of healthier foods. Conflict of interests, source of funding and authorship The authors declare that they have no conflicts of interest. We thank the following post-graduate dietetic students who assisted in the recruitment processes and data collection: Naomi Wu, Reem Bashour, Sarah O’Connor, Valentina Giannelli, Ki Wong, Lu Gao, Lara Pasternak, Wenqian Wang and Wei Ming Yap. The authors have no funding sources to declare. HNC managed recruitment processes and assisted in data collection. MAF, AN, LH and JCL developed the research protocol and survey tool with HNC. LH cleaned and analysed the data, and drafted the manuscript. All authors critically reviewed the manuscript and approved the final version submitted for publication.
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