Food choice as a multidimensional experience. A qualitative study with young African American women

Perspectives on Healthy Eating of Adult Populations in High-Income Countries: A Qualitative Evidence Synthesis

BACKGROUND

Understanding how individuals currently perceive healthy eating is essential for developing food policies and dietary recommendations that improve the health and well-being of populations. The purpose of this qualitative evidence synthesis was to systematically outline the views and understandings of healthy eating, focusing on how foods are classified as healthy and unhealthy and what meanings are attached to food and eating by the general adult population in high-income countries.

METHODS

A systematic search of four electronic databases was conducted and yielded 24 relevant primary qualitative studies of generally healthy, community-dwelling adults.

RESULTS

Thematic synthesis of the included studies identified three analytic themes: constructions of healthy and unhealthy eating, considerations on dietary recommendations, and meanings attached to food and eating. Study participants generally understood what constitutes a healthy and unhealthy diet which was in line with dietary recommendations, but those of lower socioeconomic status exhibited gaps in nutrition knowledge. Participants expressed diverse opinions on dietary recommendations, including skepticism and a lack of trust. Food and eating were associated with various meanings, including pleasure, stress relief, and feelings of guilt. Moral, health, and sociocultural considerations also played a role in dietary behaviors.

CONCLUSIONS

The findings suggest that improving population diet requires considering how dietary recommendations are phrased and communicated to ensure that healthy eating is associated with pleasure and immediate well-being. This review provides valuable insights for developing consumer-oriented, practicable, and acceptable food policies and dietary recommendations that effectively improve population health and well-being.

A qualitative exploration of food choice motives of urban indigenous food gatekeepers in Fiji: Implications for the use of the food choice questionnaire

Pacific Island Countries (PICs) have exceptionally high rates of obesity and non-communicable diseases. The causes are complex but one prominent factor is the notable shift from traditional plant and seafood diets to diets high in unhealthy processed foods. Literature is sparse on the motives behind food choice decisions of Pacific Islanders. The widely used Food Choice Questionnaire (FCQ) (Steptoe et al., 1995) is a multi-dimensional tool capturing nine potential food choice motives. This study used a hybrid thematic analysis. Fourteen in-depth semi-structured interviews with urban indigenous Fijian mothers were conducted to (1) explore how the nine FCQ motives impact food choice (2) to examine conceptual equivalence of the nine FCQ motives and (3) to identify additional food choice motives, not captured in the FCQ. Mothers identified seven of the nine FCQ motives (i.e., health, mood, convenience, sensory appeal, weight control and familiarity) and three new food choice motives (i.e., food that is filling, religious dietary restrictions and food quality) as important determinants of food choice. Moreover, while choosing foods that promote health and well-being was identified as an important food choice motive, mothers also identified four other motives, that they considered important, which lead to over-eating and unhealthy eating. Food choice is a complex, layered decision, driven by multiple considerations, some more important than others. These findings can inform diet-related interventions and policy within this community. Adapting the FCQ for broader PIC use through further qualitative exploration in PICs, and validating the adapted FCQ with larger samples will enhance its utility in measuring food choice motives in PICs.

Engaging with 'less affluent' communities for food system transformation: a community food researcher model (FoodSEqual project)

The UK food system is distorted by inequalities in access, failing the people most in need, yet it should provide access to safe, nutritious affordable food for all citizens. Dietary patterns are associated with socio-demographic characteristics, with high levels of diet-related disease mortality attributed to poor dietary habits. Disadvantaged UK communities face urgent public health challenges, yet are often treated as powerless recipients of dietary and health initiatives. The need for food system transformation has been illustrated within recent UK government policy drivers and research funding. The Food Systems Equality project is a research consortium that aims to 'co-produce healthy and sustainable food systems for disadvantaged communities'. The project focusses on innovating food products, supply chains and policies, placing communities at the centre of the change. Tackling the above issues requires new ways of working. Creative approaches in food research are known to empower a wider range of individuals to share their 'lived food experience' narratives, building relationships and corroborating co-production philosophies, thus promoting social justice, and challenging more traditional positivist/reductionist 'biomedical' approaches for nutrition and food studies. This review paper critiques the use of community-centric approaches for food system transformation, focusing on one, a community food researcher model() as an exemplar, to highlight their utility in advocating with rather than for less affluent communities. The potential for creative methods to lead to more equitable and lasting solutions for food system transformation is appraised, consolidating the need for community-driven systemic change to foster more progressive and inclusive approaches to strengthen social capital. The paper closes with practice insights and critical considerations offering recommendations for readers, researchers, and practitioners, enabling them to better understand and apply similar approaches.

When food is uncertain, how much does sustainability matter? A qualitative exploration of food values and behaviours among users of a social grocery store

A transition towards sustainable diets ensuring food security while preserving ecosystems is necessary, but remains challenging. Low-income consumers, particularly those experiencing food insecurity, require specific consideration since they face financial constraints when making food choices, leading to poorer diets. However, little is known about the place given to sustainability in their choices. This study thus aims to identify the role played by sustainability in the food values of food-insecure consumers in France. Twenty-nine semi-structured interviews with users of a social grocery store were conducted to investigate food values and actual behaviours, with a focus on the four dimensions of sustainable diets - health, economic, sociocultural and environmental. Verbatims were analysed through thematic analysis. Five core values were identified, namely health and nutrition, naturalness, trust and control, solidarity and frugality, and preferences. Participants valued all dimensions of food sustainability but notably valued less the environmental dimension. Despite various strategies, participants felt unable to adhere to their values in practice, mainly because of their socioeconomic vulnerability. They insisted on their lack of control over their food behaviour. These findings provide insights into the disempowerment experienced by consumers with low financial resources regarding more sustainable food choices. Our study calls for interventions addressing affordability issues and considering consumers' food values, while providing opportunities to make consumers feel involved in the transition of the food system.

Exploring Adolescent girls' Food-Talk in Kathmandu Valley, Nepal: A Qualitative Study

This study aimed to analyze how adolescent girls residing in Kathmandu valley, Nepal, talk about food within the context of their everyday experiences. We conducted 10 in-depth and four focus group interviews. Qualitative thematic analysis based on the constructivist paradigm was used to organize the interviews. The Utilitarian domain contained health statements using biomedical language and lay theories on health. Hedonic talk emphasized the taste of food, but notions about enjoyment were limited. Collective talk constructed an ideal family. In agency talk, the interviewees described their active role in achieving a slim body. Participants were not concerned about food insecurity but about eating too much.

Perceptions of dietary intake amongst Black, Asian and other minority ethnic groups in high-income countries: a systematic review of qualitative literature

BACKGROUND

Minority ethnic groups are a fast-growing population in many high-income countries, partly due to the increasing population of immigrants and second-generation migrants. The dietary practices of some of these minority ethnic groups might make them to be disproportionately affected by obesity and increase their risks of developing non-communicable diseases. Population-specific interventions and strategies are vital to addressing poor nutritional practices among this population. Thus, this study systematically reviewed the perceptions of dietary intake amongst Black, Asian and other minority ethnic groups in high-income countries.

METHODS

This systematic review was conducted in line with the guidelines of the Joanna Briggs Institute (JBI) methodology for systematic reviews, using a meta-aggregative design. This systematic review identified and synthesised qualitative literature on the perceptions of dietary intake amongst BlackAsian and other minority  ethnic groups in high-income countries. An extensive and comprehensive database search was conducted between January 2000 - May 2022 and included twenty (20) studies that met the eligibility criteria from six countries. The included studies were assessed for quality using the JBI qualitative assessment and review instrument. The JBI data extraction tools were used to retrieve relevant data from included articles, and the data were thematically analysed.

RESULTS

We identified eight major themes across this database: (1) "Social and Cultural Factors," (2) "Availability and Accessibility," (3) "Family and Community Influences," (4) "Food Preferences", (5) "Home Country Food Versus Host Country Food" (6) "Dietary Acculturation" (7) "Health and Healthy Eating" (8) "Perception of Nutritional Information."

CONCLUSION

Overall, Black, Asian, and other minority ethnic groups individuals were found to be aware of the effects of unhealthy eating on their health, and some of them have nutritional knowledge, but social and cultural factors, including structural factors, were deterrents to their healthy eating behaviours. An important finding from this review is that some participants believed that nutritional information, based on bio-medical science, was intended for only White population groups and that it was antagonistic to their cultural and community well-being.

Transitioning food environments and diets of African migrants: implications for non-communicable diseases

Non-communicable diseases disproportionately affect African migrants from sub-Saharan Africa living in high-income countries (HICs). Evidence suggests this is largely driven by forces that include migration, globalisation of unhealthy lifestyles (poor diet, physical inactivity and smoking), unhealthy food environments, socio-economic status and population ageing. Changes in lifestyle behaviours that accompany migration are exemplified primarily by shifts in dietary behaviours from more traditional diets to a diet that incorporates that of the host culture, which promotes the development of obesity, diabetes, hypertension and CVD. The current paper presents a critical analysis of dietary change and how this is influenced by the food environment and the socio-economic context following migration. We used a food systems framework to structure the discussion of the interaction of factors across the food system that shape food environments and subsequent dietary changes among African migrant populations living in HICs.

"They Eat What They Eat, I Eat What I Eat": Examining the Perspectives and Experiences of African Americans Who Adopt Plant-Based Diets

Adopting a plant-rich or plant-based diet is one of the major recommendations for addressing obesity, overweight, and related health conditions in the United States. Currently, research on African Americans' food choices in the context of plant-based diets is limited. The primary aim of this study was to understand food-related experiences and perceptions of African Americans who were participating in the Nutritious Eating with Soul (NEW Soul) study, a culturally tailored dietary intervention focused on increasing the consumption of plant-based foods. The roles of gender and ethnicity were also examined to identify how eating patterns were chosen or maintained. Twenty-one African American adults in South Carolina, who were randomly assigned to either a vegan diet (n = 11) or a low-fat omnivorous diet (n = 10) in the NEW Soul study, completed one-on-one, qualitative interviews. Emerging themes included awareness, being in control, and identity. The study revealed that access to social support and coping strategies for addressing negative comments about plant-based food choices may be important components to include in future nutrition interventions focused on African Americans.

Exploring adults' motives for food choice of sustainable diet components: a qualitative study in Tehran Metropolis

BACKGROUND

Todays, due to the impact of human food choices on increasing greenhouse gas emissions, water consumption and environmental degradation, there is a new approach about changing the pattern of food production and consumption, including sustainable food and nutrition system related to consumption. This study aimed to explore the components of a sustainable diet among the factors that affect people's food choices.

METHODS

This qualitative study was carried out using an in-depth interview with 33 individuals aged 30-64 years old living in different areas of Tehran. Data collection, data analysis and theoretical conceptualization were performed simultaneously. MAXQDA 10 software was used for managing and organizing the data.

RESULTS

In this paper, the findings are categorized according to the key components of a sustainable diet in five themes: "Health and Nutrition", "Food and Agriculture Security", "Environment and Ecosystems", "Markets, food trade and production chains", "social, cultural, and policy factors" were categorized. Meanwhile, the components of the "Health and Nutrition" domain had the highest contribution and the components of the two domains "food and agriculture" and "environment and ecosystems" had the lowest role based on the participants' perception in this study.

CONCLUSION

Considering to the low importance of the components of a sustainable diet in food choices of the community, promoting the individual awareness of sustainable diet components, clarifying the importance of food choices in creating environmental impacts and leading the national macro policies in the field food and nutrition toward sustainable diet goals are essential.

An exploratory study on the sociocultural consequences of food consumption patterns among African American girls

African American women, in particular, have learned to navigate through a food consumption landscape that purposefully, and often aggressively, limits their choices and stigmatizes their resulting physical appearance, and renders them collectively unattractive and unworthy. While American women are challenged to subscribe to traditional slim body standards, a faction of Americans have differing opinions. African American (AA) women celebrate larger body types and defy weight stigma. When African Americans make food choices, taste and cost are not the only factors influencing those choices; the cultural role of food is also considered. We conducted semi-structured interviews with 12 African American girls to identify some of the consequences of this consumption practice that challenges what we argue is a hegemonic taste regime surrounding body size. This work further elucidates the ways in which the African American community has operationalized the concept of cultural capital around the issues of body image to create what we suggest is a type of emotional well-being. In addition to uncovering marketing channels promoting anti-obesity campaigns that would be more likely to capture their attention, our findings also reveal that AA girls embrace shapely bodies, despite not necessarily having one themselves, and overall possess a more positive body image than their Caucasian peers. Having shapely bodies was deemed more attractive among romantic interests and acceptable overall in the AA community regardless of the associated health risks associated with consuming unhealthy foods.

Friend or foe? A qualitative study exploring the relationship of people with obesity and food consumption

BACKGROUND

Obesity is a major health problem worldwide, and one of its causes is unhealthy eating. A healthy diet should ensure that energy intake (calories) is in balance with energy expenditure, but in this paper a subjective experience of healthy eating will be discussed. Research has revealed many determinants of food consumption, but a more holistic view of food consumption is often overlooked.

AIM

The aim was to go beyond identifying determinants of eating by exploring the experience of (healthy) food for people with obesity.

METHODS

Semi-structured interviews were conducted with eight patients with obesity.

RESULTS

Interpretative phenomenological analysis identified four superordinate themes: ambivalence in the emotional relationship with food, an obesogenic environment where it is less acceptable to society to be obese, an experience of unfairness in the relationship to eating in comparison with other people, and the parental role as an existential motivation to eat healthier.

CONCLUSION

The relationship of people with obesity and food is highly complex and personal, and is influenced by the uncontrollability of the social and physical environment. These personal experiences of people with obesity should be taken into account in the psychological treatment of obesity. The current research adds to the mostly motivational determinants discovered with social cognition models, by showing the subjective experience of (healthy) food consumption for people with obesity.

Improving Lifestyle Behaviors After Breast Cancer Treatment Among African American Women With and Without Diabetes: Role of Health Care Professionals

BACKGROUND

Little is known about the effect of health professionals' advice on promoting healthy lifestyle behaviors (diet and exercise) among breast cancer patients.

PURPOSE

To identify predictors of receiving lifestyle advice from health professionals and its impact on healthy lifestyle behaviors.

METHODS

We used data from a randomized controlled trial of an interactive, cancer-communication video program using African American breast cancer survivor stories for newly diagnosed African American breast cancer patients (Stages 0-III). Participants completed five interviews over 2 years. This intervention did not significantly affect changes in quality-of-life outcomes. In secondary analysis, we examined differences in baseline variables between women with and without diabetes. Logistic regression models identified independent predictors of receiving advice from "a doctor or other health professional" to improve diet and exercise and of self-reported change in diet and exercise habits at 2 year follow-up.

RESULTS

Of 193 patients included (85% of 228 enrolled), 53 (28%) had diabetes. At 2 year follow-up, a greater proportion of women with (vs. without) diabetes reported receiving advice by a doctor/health professional to improve their diet (73% vs. 57%, p = .04,). Predictors of receiving dietary advice were obesity, diabetes, and breast-conserving surgery (each p < .05). Women receiving dietary advice were 2.75 times more likely to report improving their diet (95% confidence interval: 1.17, 6.46) at follow-up, but receiving physical activity advice was not significantly associated with patients reporting an increase in exercise.

CONCLUSIONS

Although receiving dietary advice predicted dietary improvements, receiving exercise advice did not lead to an increase in physical activity.

CLINICAL TRIAL REGISTRATION

Trial Number NCT00929084.

Food choice motives among two disparate socioeconomic groups in Brazil

Understanding the motives influencing food intake is indispensable for effective dietary recommendations aimed at promoting healthy eating in an integrative way. The objective of this study was to evaluate food choice motives across two socioeconomically different cities in Brazil. A cross-sectional study with a convenience sample (n = 473) of adults living in both places was evaluated. Food choice motives were assessed by The Eating Motivation Survey (TEMS) with 15 dimensions, and economic classifications were made according to the Brazilian Economic Classification Criteria (CCEB). Data analysis used both a general linear model (GLM) and a Structural Equation Model (SEM) adjusted for age, ethnicity, income and educational degree. Participants were mainly women (74.6%) with a mean age of 36.6 years. Cities were not invariant (Δχ2 = 314.165, p < 0.001) and two distinct prediction models for food choice motives emerged. Fit indices indicate acceptable model fit for both low (CFI = 0.911; TLI = 0.898; RMSEA = 0.041) and high socioeconomic status groups (CFI = 0.808; TLI = 0.717; RMSEA = 0.081). Although cities differ in the prediction models for food choice motives, we demonstrated that there are two main networks of predictors: one related to social context predictors of food choice motives and another related to hedonic-oriented ones. Particularly, hedonic-oriented motives (i.e., pleasure) were the most relevant predictors to the group of high socioeconomic status followed by social context predictors (traditional eating and sociability). On the other hand, the group of low socioeconomic status had most of its predictors related to social context (i.e., visual appeal, traditional eating, sociability, social norms and social image) and also price, but this last one was the least important among the most important predictors.

Understanding the food-family relationship: A qualitative research in a Chilean low socioeconomic context

Our life is comprised of, among other things, many food and eating decisions. Therefore, we are in a constant relationship with food. Although many health providers and researchers have recommended having a positive relationship with food for better health and well-being, what the human relationship with food entails is still unclear. The aim of this study is to explore the relationship with food among families in Chile, a country that has the highest rate of obesity among OECD countries. In this qualitative study, we conducted eight focus groups in three regions of Chile (North, Center, and South). We recruited women living with their partners and children who represented the family point of view. For data analysis, we used the Atlas.ti program and conducted a thematic analysis. We found that the family relationship with food had five dimensions: (1) An identity dimension that allowed families to describe themselves or some of their family members; (2) an emotional dimension in which family expressed feelings and emotions through food; (3) a social dimension in which family members got together through food; (4) a health dimension in which family related to food to obtain benefits from it or to avoid enemy food; (5) a practical dimension in which families were organized around food tasks. Our findings show that the relationship that Chilean families have with food is a complex phenomenon. All the dimensions should be taken in consideration to create or improve interventions that seek to improve eating habits or prevent nutrition-related diseases from a family perspective.

Changing food preferences among a former hunter-gatherer group in Namibia

The purpose of this study was to identify, describe and conceptualize the present drivers of food choices and preferences of the Khwe San indigenous peoples by considering influences of their historical and cultural contexts. Data were collected in Eastern Bwabwata National Park in Namibia using a range of qualitative methods: semi-structured and structured interviews and free listing. The various drivers of food choices have been clustered into four levels of the ecological conceptual framework. Key factors, found to be driving participants' food choices, were the following: taste, hunger, health, familiarity and body satisfaction at the individual level; culture and food taboos at the social level; access to food and food storage at the physical level, and; cost and seasonality at the macro level. Many of these factors are directly related to food insecurity and previous experiences of hunger. Current preferences towards traditional foods existed but were not prevailing among all the participants. Interviews with the elderly revealed the historical context of the increasing exposure to modern foods and a contested access to traditional foods and traditional knowledge transmission. Our findings exposed some substantial gaps in the nutritional knowledge of the Khwe that need consideration by future health promotion strategies along with the current perceptions of local food choices. Ensuring access and promoting sustainable management of traditional foods would not only contribute to the health of the Khwe people but also help to maintain a nutritional safety net in their current situation of extreme poverty.

Perspectives on diet and physical activity among urban African Americans with serious mental illness

African Americans are burdened by high rates of obesity that contribute to chronic disease and early mortality. To tailor a weight loss intervention to meet the needs of African Americans with serious mental illness, a community-based participatory research (CBPR) team comprised primarily of African Americans with serious mental illness guided qualitative research to understand factors that affect weight and interventions that may diminish obesity. Data from five focus groups (n = 55) were analyzed to better understand this group's needs. Participants voiced individual, social, and structural barriers to maintaining and achieving a healthy weight and provided perspectives on potential solutions.

Food Choices of Young Adults in the United States of America: A Scoping Review

Understanding food choice is critical to developing effective health promotion efforts to counter the leading causes of morbidity and mortality in the United States. Although physiologic, environmental, and social factors influence the development of health conditions, routine decisions, such as food choice, also contribute substantially over time. Behavioral scientists believe that these routine decisions represent a key opportunity to improve population health. We conducted a scoping review of both health and business literature to identify themes in the food choices of young adults aged 19-24 y in the United States. Informed by the Joanna Briggs Institute processes for scoping reviews, we conducted a structured search of 8 health and business databases on 18 April 2017. The databases were PubMed, Business Source Complete, PsycInfo, Cochrane Library, CINAHL, Web of Science, SCOPUS, and ABI/Inform Collection. Eligible literature captured real-world dietary choices of the general population of young adults between 1 January, 2007 and 31 December, 2017. Records were screened in Covidence. Data was extracted into Excel and key findings thematically analyzed. The search returned 9085 records. Ninety-nine records met the eligibility criteria. Themes identified in the foods chosen by young adults include inadequate fruit and vegetable consumption, choosing international flavors and food formats, convenience foods, frequent snacking, the selection of healthy foods based on perceptions of what is healthy rather than the nutrient or calorie content of foods, an interest in sustainable production methods, the desire to customize/tailor foods, foods young people find interesting, and regional foods. This research identified common food choices that can help inform the tailoring of health promotion efforts; however, more research is needed to understand the underlying mechanisms and principles shaping these choices.

Comparison of motives underlying food choice and barriers to healthy eating among low medium income consumers in Uruguay

Abstract: Interventions aimed at changing dietary patterns should be designed based on the main motives underlying the food choices of specific target populations. The aim of the present study was to identify motives underlying food choice and barriers to healthy eating among consumers in two socioeconomic levels in Uruguay. Eleven focus groups were carried out with a total of 76 participants. Six of the groups involved low income participants and the others were conducted with middle income participants. Discussions were held around frequently consumed products, motives underlying food choices and barriers to healthy eating. Results confirmed the strong influence of income level on motives underlying food choice and barriers to the adoption of healthy eating. Low income participants described their choices as mainly driven by economic factors and satiety, whereas convenience was the main determinant of food selection for middle income participants. Implications for the design of public policies targeted at each group are discussed.

¡Cocinar Para Su Salud! Development of a Culturally Based Nutrition Education Curriculum for Hispanic Breast Cancer Survivors Using a Theory-Driven Procedural Model

We developed a theory-based dietary change curriculum for Hispanic breast cancer survivors with the goal of testing the effects of the intervention on change in dietary intake of fruits/vegetables and fat in a randomized, clinical trial. Social cognitive theory and the transtheoretical model were used as theoretical frameworks to structure curriculum components using the Nutrition Education DESIGN Procedure. Formative assessments were conducted to identify facilitators and barriers common to Hispanic women and test the degree of difficulty and appropriateness of program materials. Focus groups provided valuable insight and informed preimplementation modifications to the dietary program. The result was a systematically planned, evidence-based, culturally tailored dietary intervention for Hispanic breast cancer survivors, ¡Cocinar Para Su Salud! (Cook for Your Health!). The methodology described here may serve as a framework for the development of future dietary interventions among diverse and minority populations. Short- and long-term study results will be reported elsewhere.

Motives Underlying Food Choice for Children and Perception of Nutritional Information Among Low-Income Mothers in a Latin American Country

OBJECTIVE

The aim of the present study was to investigate the influence of nutritional information on how low-income mothers select food for their children.

DESIGN

Five focus groups, each consisting of 5-10 participants, were conducted.

PARTICIPANTS

Women, older than 18 years, mothers of young children who were beneficiaries of one of the national food stamps programs in Uruguay.

PHENOMENON OF INTEREST

Focus group discussions were held around motives underlying food choices for children and perception of labeling systems.

ANALYSIS

Transcripts of the focus group discussions were analyzed using inductive coding.

RESULTS

Forty-two women, aged between 18 and 40 years, participated in 5 focus groups. Results showed that low-income mothers do not consider nutritional information when selecting food their children. Traditional nutritional labeling was perceived as complex, difficult to find, and difficult to understand. Participants stressed that they relied on the nutrition claims included on labels for assessing the healthfulness of food products. Semi-directive and directive front-of-pack labels were positively evaluated in terms of ease of interpretation. Participants preferred the traffic light system over other alternatives.

CONCLUSIONS AND IMPLICATIONS

Results suggest the need to implement simplified nutritional labeling and to regulate the use of nutrition claims on products targeted at children.

Consumers' willingness to pay for nutritional claims fighting the obesity epidemic: the case of reduced-fat and low salt cheese in Spain

OBJECTIVES

The aim of this study was to investigate consumers' willingness to pay (WTP) for cheeses bearing reduced-fat and low salt claims in Spain.

STUDY DESIGN

An experiment with 219 cheese consumers was conducted in the period March-May 2015. We used different versions of cheese bearing reduced-fat and low salt claims.

METHODS

A choice experiment was used to estimate WTP for reduced-fat and/or low salt cheeses. Participants faced eight choice sets, each consisting of two packages of cheese with different combinations of two claims. Individuals chose one of the two packages of cheese in each choice set, or decided not to choose either. Moreover, to consider possible heterogeneity in WTP across consumers, a random parameters logit model (RPL), a Chi-squared test, and analysis of variance tests were used.

RESULTS

Spanish cheese consumers were willing to pay a positive premium for packages of cheese with reduced-fat claims (€0.538/100 g), and for cheese with reduced-fat and low salt claims (€1.15/100 g). Conversely, consumers valued low-salt content claims negatively. They preferred to pay €0.38/100 g for a conventional cheese rather than one low in salt content. As there was heterogeneity in consumers' WTP, two different consumer segments were identified. Segment 1 consisted of normal weight and younger consumers with higher incomes and levels of education, who valued low salt cheese more negatively than those individuals in Segment 2, predominantly comprising overweight and older consumers with low income and educational level. This means that individuals in Segment 1 would pay more for conventional cheese (€1/100 g) than those in Segment 2 (€0.50/100 g). However, no difference between the two segments was found in WTP for reduced-fat cheese.

CONCLUSIONS

The findings suggest that consumers are willing to pay a price premium for a package of cheese with a reduced-fat claim or cheese with reduced-fat and low salt claims appearing together; however, they are not willing to pay for a package of cheese with only a low salt claim. In comparison with overweight people, normal weight consumers would prefer to pay more for conventional cheese than low salt cheese. Finally, the results of this study contribute to insights in the promotion of healthier food choices among consumers. In this regard, outreach activities promoted by food companies could drive consumers to increase their knowledge of the benefits of eating reduced-fat and low salt food products in relation to their health status.

A Systematic Review of Literature on Culturally Adapted Obesity Prevention Interventions for African American Youth

Obesity and overweight prevalence in African American (AA) youth continues to be one of the highest of all major ethnic groups, which has led researchers to pursue culturally based approaches as a means to improve obesity prevention interventions. The purpose of this systematic review was to evaluate culturally adapted obesity prevention interventions targeting AA youth. A search of electronic databases, limited to multicomponent culturally adapted obesity prevention controlled trials from 2003 to 2013, was conducted for key terms. Eleven studies met inclusion criteria. We used the PEN-3 model to evaluate the strengths and weaknesses of interventions as well as to identify cultural adaptation strategies. The PEN-3 model highlighted the value of designing joint parent-youth interventions, building a relationship between AA mentors and youth, and emphasizing healthful activities that the youth preferred. The PEN-3 model shows promise as an overarching framework to develop culturally adapted obesity interventions.

Knowledge is (not) power: healthy eating and physical activity for African-American women

African-American women are more likely to be overweight or obese as compared to other ethnic groups. The purpose of this Qualitative Interpretive Meta-Synthesis (QIMS) was to explore the experiences that African-American women encounter when trying to eat healthily and maintain physical activity to inform practice and research. The QIMS included studies from various disciplines to understand the experiences of African-American women with eating healthily and being physically active. Five themes were identified: family; structured support; translating knowledge into behavior modifications; barriers to physical activity; and God is my healer. These themes enhance understanding of what African-American women know, their support system(s), and how cultural barriers impact nutrition and physical activity.

Interest of functional foods for low-income countries

PURPOSE OF REVIEW

To understand the interest of functional food in low-income countries by analyzing various necessary factors.

RECENT FINDINGS

Being on a low income would appear to relate most often to an unbalanced diet, both qualitatively and quantitatively, which may be damaging to health in the long term. Most chronic diseases of concern today are multifactorial in origin. For control, an approach in which medicines and nutrition are considered together and complement each other may produce most successful and cost-effective management of health risk factors and chronic diseases. Functional food may become an important player at the interface between pharma and nutrition, and merit attention from both public health and a marketing perspective.

SUMMARY

In general, the health benefit of functional food is well established and the attitude both to functional food and to their low socioeconomic consumers is positive.

Role of expendable income and price in food choice by low income families

The public health literature suggests that the cheapness of energy-dense foods is driving the obesity epidemic. We examined food purchases in low-income families and its relationship to the price of food and availability of funds. In-depth interviews were conducted with 22 parents with children less than 15 years of age whose major source of income was a government pension. A photo taxonomy, where participants sorted 50 photos of commonly purchased foods, was used to explore food choice. The most common food groupings used by the participants were: basic, emergency, treat and comfort. The process of food purchase was described by participants as weighing up the attributes of a food in relation to price and money available. Shoppers nominated the basic unit of measurement as quantity per unit price and the heuristic for food choice when shopping as determining "value for money" in a process of triage relating to food purchase decisions. Participants stated satiation of hunger to be the most common "value" relative to price. Given that the foods nominated as filling tended to be carbohydrate-rich staples, we suggest that public health initiatives need to acknowledge this triage process and shape interventions to promote nutrition over satiation.

Food choice, eating behavior, and food liking differs between lean/normal and overweight/obese, low-income women

The higher rate of obesity among low-income women has widely been attributed to environmental barriers; however, many low-income women are still able to maintain a healthy weight despite obesogenic environments. To better understand personal and behavioral attributes related to food choice and weight, overweight/obese women and lean/normal weight women living in similar low-income environments, participated in focus groups, and taste testing sessions to investigate food liking (n=83). During focus groups, lean/normal weight participants reported that health was influential in food choice, while overweight/obese participants expressed cost as being more of a factor. Both BMI (kg/m(2)) groups reported that taste was of greatest importance. Personal factors, like emotional eating, and overeating were also discussed with differences noted between BMI (kg/m(2)) groups. Quantitative data also showed cost to be more important for overweight/obese women. Taste testing results revealed that overweight/obese participants had a higher overall liking for both healthy and less healthy foods, as well as other food categories. Additionally, these women had a higher liking of fat in the context of spreadable fats. Our results show that a variety of complex factors interact to influence eating behavior and present weight status of women living in similarly impoverished environments. However, findings from this exploratory study should be confirmed through further research.