Relationship of Attitudes Toward Fast Food and Frequency of Fast-food Intake in Adults

Transcription

1 nature publishing group Relationship of Attitudes Toward Fast Food and Frequency of Fast-food Intake in Adults Jayna M. Dave 1, Lawrence C. An 1, Robert W. Jeffery 2 and Jasjit S. Ahluwalia 1 The purpose of the study was to examine the association between attitudes toward fast food and the frequency of fast-food intake in adults. This study is a cross-sectional evaluation of random digit-dial telephone surveys to identify patterns of eating away from home and attitudes toward it. Participants included adults (94 white, 6 women, 7 married, 42 with college educated). Attitudes toward fast food was measured using an 11-item, 4-dimensional scale: perceived convenience of fast food (α =.6); fast food is fun and social (α =.); fast food perceived as unhealthful (α =.4); and dislike toward cooking (α =.2). Frequency of fast-food intake was found to be significantly associated with age (odds ratios (OR) =.981, P =.1), gender (men > women), and marital status of the participants (single > married/partnered and divorced/separated/widowed). Additionally, frequency of fast-food intake was also found to be significantly associated with perceived convenience of fast food (OR = 1.162, P <.1) and dislike toward cooking (OR = 1.119, P <.1) but not with perceived unhealthfulness of fast food (OR =.692, P =.7). These findings suggest public education regarding the unhealthfulness of fast food may not influence fast food consumption. Interventions targeting the issue of convenience and quick or efficient preparation of nutritious alternatives to fast food could be more promising. Obesity (9) 17, doi:.38/oby.9.26 Introduction Eating away from home is becoming increasingly common and visits to fast-food are growing even more rapidly. In 197, money spent on away-from-home foods represented of total food spending (1); by 199, it comprised of total food spending and by 1999 it reached a record 47. of total food spending (2). It is projected that, by, 3 of the food dollar will be spent on foods away from home (2,3). Fast food has been defined as food purchased in self-service or carry-out eating places without waiter service (4). Between 1977 and 199, the percentage of meals and snacks eaten at fast-food increased (ref. ). Americans have unprecedented access to fast food. Fast food has become an increasingly important part of the American diet and the frequency of fast-food intake has dramatically increased since the early 197s (ref. 6). Fast food pervades virtually in all segments of the society including local communities, public schools, and hospitals. These trends seem to be accompanied by massive advertising and marketing campaigns. A report by the National Restaurant Association indicates that 3 out of consumers report that meals from including fast-food are essential to their way of life (3). Several studies have examined the association of the frequency of fast-food intake with BMI, energy intake, and diet patterns (6 12). For example, Jeffery et al. reported a significant positive relationship between BMI and individuals who frequented fast-food once a week or more (11). In a subsequent study by Jeffery et al., a positively significant association was observed between fast-food intake and BMI only among women (). Many aspects of fast food are of concern specifically as they are related to obesity and related problems. Specifically, fast food tends to be energy-dense, poor in micronutrients, low in fiber, high in glycemic load, and excessive in portion size, thus causing many to exceed daily energy requirements (7,13,14). The expert panel of the World Cancer Research Fund and American Institute for Cancer Research recommend minimal fast-food consumption because of the possible association between fast-food intake and weight gain (1). Healthy People also recommends a decrease in the consumption of fast foods that are energy-dense high-sugar/high-fat foods with the goal of decreasing the prevalence of overweight and obesity in the United States (16). Despite these well-documented recommendations, fast-food consumption is common, is growing, and is a cause of public health concern. Although public education on health effects of fast food is a reasonable strategy, there has been little scientific study of the consumers attitudes toward fast food. Attitudes such as 1 Department of Medicine, Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA; 2 Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA. Correspondence: Jayna M. Dave (jayera@gmail.com) Received 1 October 8; accepted 18 January 9; published online 26 February 9. doi:.38/oby VOLUME 17 NUMBER 6 JUNE 9

2 perceived benefits (e.g., economizing, convenience, fun, and taste) and perceived concerns (e.g., unhealthfulness, high calorie, etc.) likely influence fast-food consumption. A greater understanding of consumers attitudes about fast food could help inform public health efforts to improve dietary practices. The purpose of this paper is to address this gap in the literature by exploring the relationship between attitudes toward fast food and frequency of fast-food intake in adults. This is the first study that we are aware of that examines the attitudes toward fast-food restaurant use among a community based sample of adults. Methods And Procedures Study participants and procedure The study was approved by the Institutional Review Board of the University of Minnesota. Participants in this investigation were 1,33 residents of the state of Minnesota identified in a random digit-dial telephone survey. Individuals were told that the survey was being conducted by the University of Minnesota to identify patterns of eating away from home and attitudes toward it. The survey took ~ min to complete. All adults over the age of 18 were eligible to complete the survey. Data collection procedures have been described in detail elsewhere (). Data on attitudes toward fast food were collected only from participants who reported at least one event of fast-food intake in the past week. Thus, for the purpose of this paper, data from the participants (1.3 of all respondents) who reported of eating at a fast-food restaurant at least once in the past week were considered. Measures Demographics. Demographic information was self-reported by the participants and included age, gender, ethnicity/race, education level, marital status, number of people in the, number of children in the. Frequency of fast-food intake. Frequency of fast-food restaurant use was estimated with the question During a typical week, how many times do you eat something from a fast food restaurant? The instructions included examples such as Burger King, Hardee s, Kentucky Fried Chicken, Pizza Hut, and similar. Frequency of fast-food intake was categorized into a dichotomous variable with 1 time = low and >1 time =high. Attitudes toward fast food. Attitudes toward fast food scale (AFFS) was a 13-item scale with response options ranging from 1 = strongly disagree to = strongly agree on a -point Likert scale. To characterize the factor structure of the AFFS, principal component factor analysis was conducted on the 13-items using an orthogonal (varimax) rotation. Examples of these items include I eat at fast food because they are easy to get to, I eat at fast food because it is a way of socializing with friends or family, I think fast food serve mostly high fat foods, and I eat at fast food because I don t like to prepare food myself. Psychometric properties including Eigen values, Cronbach s α, and descriptive statistics of each of the subscales are provided in the Results section. Statistical analysis Data analyses were performed using Statistical Package for Social Sciences (SPSS, version 16.; SPSS, Chicago, IL). Initial data analysis included descriptive statistics. Categorical variables were summarized by frequencies and percentages, and quantitative variables were summarized by mean and standard deviation. Spearman s correlation coefficients were calculated to determine the unadjusted associations of different demographic variables with AFFS factors and frequency of fast-food intake. Additionally, AFFS factors were each categorized into low, medium, and high using tertiles and χ 2 -tests were performed to show the nonadjusted relationship with frequency of fast-food intake. Tukey s post hoc test was performed to determine what levels of the AFFS factors differed for frequency of fast-food intake. Logistic regression analysis was used to determine the multivariate relationship of the dependent variable of frequency of fast-food intake with demographics, and the four factors of the AFFS (treated as continuous variables). Odds ratios (OR), P values, and confidence intervals were reported for each level of the variables. Unless indicated otherwise, an α level of. was used to determine statistical significance. Results Sample description The mean age of the participants was 42.3 ± 13. years. As shown in Table 1, the majority of participants were white (94), women (6), married (7), and ~ of the participants had a college or a university degree. Psychometric properties of AFFS As shown in Table 2, factor analysis on AFFS yielded four distinct factors (i.e., Eigen value >1). Perceived convenience of fast food, comprising of three items, demonstrated an internal consistency reliability of Cronbach s α =.6 (mean = ± 2.8; range = 3 1). Fast food being fun and Table 1 Characteristics of survey respondents (n = ) Respondent characteristics Mean ± s.d., median, range Age, years 42.3 ± 13., 41., No of people in 2.8 ± 1., 3., 1 No of children in 1.1 ± 1.2, 1., 8 BMI.7 ± 4.8,., Gender n () Women 34 (6.1) Men 18 (34.9) Ethnicity White (94.3) Other 28 (.3) Missing 2 (.4) Marital status Married/partnered 371 (7.) Divorced/widowed/separated 76 (14.3) Single 8 (1.1) Missing 3 (.6) Education school or less 8 (.4) Some postsecondary (37.7) College or university degree 2 (41.) Missing 2 (.4) obesity VOLUME 17 NUMBER 6 JUNE 9 116

3 Table 2 Factor analysis of attitudes toward fast-food measure in adult respondents Item no. Item Factor 1 Factor 2 Factor 4 Factor 3 Factor 1: Perceived convenience of fast food 1. I eat at fast food because they are easy to get to. 2. I eat at fast food because they are quick. 3. I eat at fast food because they are inexpensive Factor 2: Fast food is fun and social 4. I eat at fast food because they are fun and entertaining.. I eat at fast food because other people in my life chose to eat there. 6. I eat at fast food because it is a way of socializing with friends or family Factor 3: Fast food perceived as unhealthful 7. I think fast food have many nutritious foods to offer. 8. I think fast food serve mostly high fat foods. 9. I think fast food serve unsafe foods Factor 4: Dislike toward cooking. I eat at fast food because I don t like to prepare food myself. 11. I eat at fast food because I/m too busy to cook Eigen value Variance Cronbach s α Entries are item loadings multiplied by and rounded to the nearest integer. For an item to be considered on a factor the loading score had to be in absolute value. social, comprising of three items, demonstrated an internal consistency reliability of Cronbach s α =. (mean = 7.14 ± 2.77; range = 3 1). Perceived healthfulness of fast food, comprising of three items, demonstrated an internal consistency reliability of Cronbach s α =.4 (mean = 7.94 ± 2.31; range = 3 1). Dislike toward cooking, comprising of two items, demonstrated an internal consistency reliability of Cronbach s α =.2 (mean = 6.1 ± 2.; range = 2 ). Of the total 13 items on the AFFS, 2 items were discarded because they did not load well (loading <. or that loaded on multiple factors) on any of the four factors. Items on each of the factors were summed to provide a total factor score and each of the factors was treated as a separate scale for analyses. Associations between frequency of fast-food intake, demographics, and AFFS Table 3 shows the unadjusted associations of the different demographic variables with AFFS factors and frequency of fast-food intake. Frequency of fast-food intake was found to decrease as the participants age increased. Additionally, men were more likely to eat at a fast-food restaurant than women. There was a significant positive association with participants marital status indicating that participants who were single were more likely to eat at a fast-food restaurant than participants who were married/partnered or separated/ divorced/widowed. Age was found to be significantly negatively associated with fast food perceived as unhealthful and dislike toward cooking. er education was positively associated with higher perception of fast food as being unhealthful. The number of people and children in the was positively associated with increased perception of fast food being fun and social. Additionally, fast food was perceived to be less unhealthful when the number of people and children in the increased. Additionally, as shown in Table 3, we also computed correlations of BMI with frequency of fast-food intake and AFFS. However, we did not find any significant associations between them. χ 2 -Test of independence helped determine the significant relationships of AFFS with frequency of fast-food intake (categorized as low, medium, and high using tertiles). As seen in Figure 1, perceived convenience of fast food and dislike toward cooking were two of the four AFFS factors that were found to be significantly associated with high frequency of fast-food intake. Tukey s post hoc test determined that there was a significant difference in the frequency of fast-food intake between low and high levels of convenience, and between low and medium, and low and high levels of dislike toward cooking. However, reporting fast food as being fun and social and perceived healthfulness of fast food were not associated with the frequency of fast-food intake in these bivariate comparisons. Results from the logistic regression model essentially confirm findings of these bivariate analyses. In the logistic model, gender, marital status, perceived convenience of fast food, and dislike toward cooking were significant predictors 1166 VOLUME 17 NUMBER 6 JUNE 9

4 Table 3 Unadjusted associations of the different demographic variables with AFFS factors and frequency of fast-food intake Age Age 1. Gender Marital status Education Table 4 Logistic regression: predictors of frequency of fast-food intake Variable Category Odds ratio 9 CI P value Age Gender Women Ref Men Marital status Single Ref Married/Partnered Divorced/Separated/Widowed Education Vocational/some college Ref school or less College/university degree Perceived convenience of fast food Fun and social Dislike cooking Perceived healthfulness of fast food Boldface values indicate that odds ratio is significant at the. level. CI, confidence interval. No of people in No of children in Perceived convenience of fast food Fast food is fun and social Fast food perceived as unhealthful Dislike toward cooking Frequency of fast food intake Gender.9* 1. Marital.3.9* 1. status Education No of.22**.*.. 1. people in No of.22** ** 1. children in Perceived convenience of fast food Fast food **.23**.11* 1. is fun and social Fast food.1**.6.8.*.1**.*.9*.1 1. perceived as unhealthful Dislike.9* **.. 1. toward cooking Frequency.19**.19**.13** ** ** 1. of fast-food intake BMI.9**.26**.1.11** AFFS, attitudes toward fast food scale. *Correlation is significant at the. level (two-tailed). **Correlation is significant at the.1 level (two-tailed). of frequency of fast-food intake, when adjusted for other variables in the model. As shown in Table 4, male participants were more likely to eat at fast-food than female participants. Within the age range of the participants in our study group, with every year increase in age, the odds of participants eating from fast-food restaurant decreased by.19. Participants who were married/partnered or divorced/ separated/widowed were ~ less likely to eat from fast-food obesity VOLUME 17 NUMBER 6 JUNE

5 a 4 1 frequency of fast food intake convenience of fast food (n = 193) Convenience of fast food 43.4 b 1 frequency of fast food intake fun and social (n = 192) Fun and social c 4 1 frequency of fast food intake dislike cooking (n = 193) d 1 frequency of fast food intake healthfulness of fast food (n = 191) Dislike cooking Healthfulness of fast food Figure 1 frequency of fast-food intake attitudes toward fast food. than participants who were single. Of the attitudes toward fast-food measures, only perceived convenience of fast food (OR = 1.162, P <.1) and dislike toward cooking (OR = 1.119, P <.1) were found to be significantly associated with frequency of fast-food intake. Additionally, we tested for effects of the interactions of significant demographic variables (age gender, gender marital status, age marital status) on frequency of fast-food intake. However, none of the interaction terms significantly contributed to the model. Discussion To our knowledge, this is the first study to examine the attitudes toward fast food. One of the most interesting finding of this study is that the frequency of fast-food intake was not found to be significantly associated with perceived healthfulness of fast food. Similar findings were demonstrated in the results of studies conducted among adolescents (17,18). This finding has important implications and suggests that public health messages aimed at healthfulness of foods would not be very effective and that the efforts to educate public about the health effects of fast food may not bring about the desired changes in dietary behavior. At a minimum, education alone about the health effects of fast food may not be sufficient to alter the frequency of fast food intake. Although no significant association was found between frequency of fast-food intake with perceived healthfulness of fast food, we did find strong and significant associations of frequency of fast-food intake with perceived convenience of fast food and dislike toward cooking. Although it is commonly suggested that convenience is an important factor for people to eat at a fast-food restaurant, there are very few studies that have empirically evaluated the association (6,17 21) and have found that convenience, in fact, is the most important factor influencing food choices in people. These results suggest that interventions seeking to decrease fast-food intake should focus on strategies to increase convenience of eating healthful foods. It may be feasible to increase the availability and accessibility of healthier food options at fast-food and provide those healthier food options at a lower price along with increasing prices of unhealthful food options. Studies have demonstrated that price reductions can be a successful approach to increase the purchase and intake of healthful foods (22,23). Thus, reducing prices on healthful foods is a public health strategy that should be implemented through policy initiatives and industry collaborations (). Another interesting finding of the study was that dislike of cooking was significantly and independently associated with the frequency of fast food. This finding suggests that one strategy to decrease fast-food intake would be to conduct interventions targeting food preparation through demonstrations, teaching cooking skills, as well as, emphasizing on the enjoyment aspect of cooking. Taste-testing has been proved to be effective with children (24 26). Our finding suggests that it may be interesting as well as important to have children learn some cooking skills during their formative years. These findings also have important policy implications. For example, if individuals are primarily eating fast food because of convenience and dislike toward cooking, as found in our study, then it may be important to target efforts to increase the proportion of fast-food offering healthier food options. In theory, expansion of providing healthier food options could be incentivized through subsidies 1168 VOLUME 17 NUMBER 6 JUNE 9

6 while provision of unhealthful foods could be disincentivized through higher taxes. Alternatively, Kwate et al. also suggest use of conditional use permits to encourage to improve the availability of healthful foods, and displace outlets that do not improve (27). The overall goal of these strategies would be to increase the number of healthy options available in the fast-food restaurant market. Age, gender, and marital status were the three demographic variables that were found to be independently associated with frequency of fast-food intake. With increasing age, the frequency of eating at fast-food restaurant decreased. Additionally, the frequency of fast-food intake was found to be higher in men than in women. These findings are consistent with findings from other studies (12,28). Marital status was also found to be independently associated with the frequency of fast-food intake with adults who were single having greater odds of eating more frequently from a fast-food restaurant than the adults who were married/lived with a partner or divorced/separated/widowed. This finding is supported by results found by Satia et al. (12) who reported that participants who were single (never married) ate at fast-food more often than participants who were married/lived with a partner and divorced/separated/widowed. Authors of prior studies have speculated that convenience and dislike to cooking may be associated with gender. It is interesting to note that we observed these associations even after controlling for gender in our multivariate model. There are several limitations to the study. First, data on attitudes toward fast food were collected only for participants who reported at least one event of fast-food intake in the past week. This means that we are only able to examine how attitudes toward fast food are related to the frequency of intake among those already eating some fast food. Associations between attitudes toward fast food and the decision whether or not to ever eat fast food could differ. Second, the use of cross-sectional data does not allow for causal interpretations. With respect to this perspective, future studies employing a longitudinal study or quasi-experimental design would be informative. Third, data were self-reported and are therefore subject to response and social desirability bias. Fourth, perceptions of fast-food may vary among the participants and also that their responses to the fast-food questions may have been affected by question priming. Although our survey did provide examples of some fast-food, individuals perceptions of what constitutes fast food may differ. These perceptions should be explored in greater detail in future studies. Fifth, these results may not be generalizable to all adult population. The majority of the participants of this study were from middle or high SES (most had college or university degree) and were predominantly White. More studies are needed among low-income and minority populations that often report higher fast-food consumption (29). Fast food has become an important part of the American diet. Although more research needs to be conducted specifically in regards to the effect of attitudes toward fast food and fast-food intake, our study provides preliminary evidence for the association. Further research should be conducted to elucidate the potential associations of fast-food intake with some of the important psychosocial and attitudinal aspects of an individual. Our study results suggest that it may not be as effective to target the unhealthfulness of fast food as it would be to target issues related to availability of healthier menu options and facilitating healthier menu selection from a fast-food restaurant without exceeding the caloric recommendation (), realizing that convenience and time issues are important aspects to consider with the fast paced American lifestyle. Disclosure The authors declared no conflict of interest. 9 The Obesity Society References 1. Lin B, Guthrie J, Frazao E. Nutrient contribution of food away from home. In: Frazao E (ed). America s Eating Habits: Changes and Consequences. USDA: Washington, DC, 1999; pp Clauson A. Spotlight on national food spending. Food Rev ;23: Association NR. Restaurant Industry Pocket Factbook. National Restaurant Association: Washington, DC, Association NR. Frequently Asked Questions. vol 8, 3.. Association NR. 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