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Factors Influencing Healthy Eating Habits Among College Students: An Application of the Health Belief Model

Poor eating habits are an important public health issue that has large health and economic implications. Many food preferences are established early, but because people make more and more independent eating decisions as they move through adolescence, the transition to independent living during the university days is an important event. To study the phenomenon of food selection, the heath belief model was applied to predict the likelihood of healthy eating among university students. Structural equation modeling was used to investigate the validity of the health belief model (HBM) among 194 students, followed by gender-based analyses. The data strongly supported the HBM. Social change campaign implications are discussed.

Poor nutrition and obesity are among the most important health issues facing society today, not only in terms of health, but also health care expenses (Goel, 2006; Rashad & Grossman, 2004). There are a variety of predictors of obesity including genetics, physical activity, and food consumption (Goel, 2006). There are other outcomes of food choice and nutrition that also have an independent effect on health including some types of cancer, cardiovascular disease, and diabetes (Nicklas, Baranowski, Baranowski, Cullen, Rittenberry, & Olvera, 2001). For these reasons, food selection is an important consumer behavior with many long-term consequences to the individual in the form of health and longevity and to society in the form of health costs.

Some research has shown that the most important factors predicting food selection among adults are: taste, cost, nutrition, convenience, pleasure, and weight control, in that order (Glanz, Basil, Maibach, Goldberg, & Snyder 1998). Many studies have shown that people often establish these tastes and habits while they are relatively young (Birch, 1999). Evidence suggests early establishment of habits and preferences occurs for a variety of behaviors including media use (Basil, 1990) and music listening (Holbrook & Schindler, 1994), as well as food choice (Birch, 1999). Therefore it is advisable to begin establishing good eating habits when people are as young as possible. Importantly, however, for the very young many food decisions are controlled by parents and preschools (Nicklas et al., 2001). Therefore, food choice for the youngest age groups may be constrained by a number of factors. Get the most natural sleep aid without melatonin.

An especially important time of life for food choice is when people step out independently for the first time and begin to make all of their own food decisions. For many people, this is the transition to college life. The transition to college or university is a critical period for young adults, who are often facing their first opportunity to make their own food decisions (Baker, 1991; Marquis, 2005) and this could have a negative impact on students’ eating behaviors (Marquis, 2005; Rappoport, 2003).

Previous literature has extensively discussed factors that influence eating behaviors among college students. However, application of a behavioral model such as the health belief model (HBM) has received less attention. Only three studies were found that applied HBM in the college eating context (Garcia & Mann, 2003; Von Ah, Ebert, Ngamvitroj, Park, & Kang, 2004; Wdowik, Kendall, Harris, & Auld, 2001). These studies examined avoiding dieting, a combination of eating and exercise, and diabetic students, respectively. The present study provides valuable insights into how health beliefs impact eating behaviors for college students—a population at the crucial stage of transitioning into independent nutritional practices.

Numerous studies have shown that college students often have poor eating habits. Students tend to eat fewer fruits and vegetables on a daily basis and report high intake of high-fat, high-calorie foods (Brevard & Ricketts, 1996; Driskell, Kim, & Goebel, 2005; Racette, Deusinger, Strube, Highstein, & Deusinger, 2005). According to the American College Health Association (2006), a 2004 study revealed that only 7.3% of students ate five or more servings of fruits and vegetables daily. The transition to college life often worsens dietary habits among students (Grace, 1997) which could contribute to weight problems especially during the first year of college or university (Anderson et al., 2003) and continue during later years of life (Centers for Disease Control, 1997; Racette et al., 2005).

Determinants of Eating Behavior
Previous studies have shown a link between demographic and psychographic characteristics with dietary behavior of college students. Driskell et al. (2005) revealed few differences among lower and upper level students in terms of their dietary habits, suggesting that habits established in the first year or two likely carry forward into later college years. However, where a student lives seems to affect his or her dietary habits and diet-related health (Brevard & Ricketts, 1996). Students living off-campus reported a higher percentage of energy from protein. Similarly, serum triglyceride level and the ratio of total cholesterol to high-density lipoprotein were also higher among students living off-campus. The authors conclude that students living off campus are choosing different foods than those living on campus.

Gender differences also exist (Racette et al., 2005). Female college students tend to eat more fatty foods than male students, although their fruit and vegetable consumption tends to remain similar. As discussed earlier, according to Brevard & Ricketts (1996), residence on or off campus made a difference, but it also interacted with gender. Higher energy from protein was more prevalent among men living off campus than on campus. For women, higher serum triglyceride and ratio of total cholesterol to high-density lipoprotein was found among those who lived off campus. Horacek & Betts (1998) clustered male and female college students by dietary intake differences. Four clusters were found: students influenced by internal (hunger and taste) and external cues (friends and media), by budget, by health, and neither of the factors. Males tended to be equally represented in all the four clusters with a somewhat higher percentage in the cues group, while female students tended to cluster in the cues group (55%) followed by health factors (28%). In a study by Mooney & Walbourn (2001), females avoided certain foods for their concern for weight, health and ethical reasons (especially when avoiding meat) more significantly than males. Marquis (2005) similarly reported that females were more significantly motivated by convenience, pleasure, price, and weight concerns than male students. We can thus conclude that the dietary intake of male and female college students is influenced by different factors.

Motives influencing eating behaviors among college students have been studied as well. House, Su, and Levy-Milne (2006) investigated what benefits college students believed result from a healthy diet. In this study, students at a Canadian university reported healthy eating to be helpful in providing a healthy appearance (in terms of weight, skin, physique, and so forth), providing positive feelings, and preventing disease. Although the results in this study were based on a focus group finding with 15 students (9 students were studying to be dieticians) there are nonetheless similarities with studies conducted among general adults (Steptoe, Pollard, & Wardle, 1995). Horacek & Betts (1998) found that taste, time sufficiency, convenience, and budget influenced students’ eating habits in that order. These seem to act more as barriers to healthy eating as revealed from the focus group (House et al., 2006). One could assume that these barriers may be more influential than benefits given the prevalence of eating habits among college students.

Other factors associated with poor eating habits among college students include a higher perception of stress (Cartwright, Wardle, Steggles, Simon, Croker, & Jarvis, 2003), and low self-esteem (Huntsinger & Luecken, 2004). Previous studies have also reported a low level of nutrition knowledge (Barr, 1984; Van den Reek & Keith, 1984). Lack of indepth nutrition knowledge has been attributed to reliance on sources that provide inadequate information on nutrition (Thomsen, Terry, & Amos, 1987).

The Health Belief Model
Although studies have investigated demographic and psychographic characteristics of healthy eating among college students, research is lacking in terms of comparing the effectiveness of these predictors in a single model such as the HBM. The HBM, developed in the 1950s (Rosenstock, 1974), is a expectancy-value model. It has been employed in a variety of public health settings over the years. The HBM postulates that when an individual perceives a threat from a disease (measured by susceptibility to the disease and the severity of disease), and perceived benefits from preventive action exceed barriers then the individual is likely to take preventive action. In the HBM, demographic characteristics and cues to action moderate the effects of the above mentioned predictors.

While three studies were found to apply the HBM to eating among college students, their findings were less useful to the current study because of differences in the nature of the sample or the dependent variables. One study (Wdowik et al., 2001) applied HBM to understand how diabetic students manage their problem and did not address the general student population. The two student groups may differ from each other in their perceptions of healthy diet. For example, the diabetic student population may perceive benefits and barriers of healthy diet differently from general student population. A second study (Garcia & Mann, 2003) employed the model to understand how students resist dieting, not how they approach healthy eating. Finally, a third study (Von et al., 2004) investigated the influence of HBM variables on physical activity and nutrition behavior among other behaviors. Unfortunately, they combined physical and nutrition behaviors as a single measure, although the two behaviors conceptually differ.

The applicability of the HBM has been reported in predicting healthy eating among general adults (for example, Kloeblen & Batish, 1999; Sapp & Jensen, 1998), especially nutrition behaviors (see Chew, Palmer, & Kim, 1998). However, these findings may be less generalizable to the college student population given the differences between students and the general adult population in terms of lifestyle, income, social environment, and food choices available on the campus. The current study will attempt to extend the HBM’s applicability to predicting nutrition behavior among college students. In the present study, the HBM has been extended in accordance with the Sapp & Jensen (1998) study to include additional variables relevant to the eating behaviors of adults. These variables include perception of current dietary quality, perceived importance of eating a healthy diet, and environmental variables.