Nutrition knowledge among college students

Chronic diseases are rapidly increasing worldwide. Non communicable diseases including cardiovascular diseases (CVD), diabetes, obesity, cancer and respiratory diseases account for 59% of the 57 million deaths annually and 46% of the global burden of disease (WHO, 2008). According to (WHO, 2002), the proportion of the burden of non communicable diseases is expected to increase to 57% by 2020. Obesity has become a public health concern in United States’ population (Polednak, 2006). Approximately 65% of Americans are overweight and nearly 35% of their college students are reported to be overweight (American College Health Association, 2008).

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In Malaysia, Third National Health and Morbidity Survey which was conducted in 2006 and based on the survey, among residents of Kuala Lumpur from 18 years old or older, the prevalence of diabetes was estimated to be 12.6% in 2006, with an additional 6.1% of the population having impaired fasting glucose. According to the same survey, the prevalence of hypertension in Kuala Lumpur (as defined by ≥140/90 mmHg) was 22.5% in 2006 (Clinical Practice Guidelines, 2008).

Diet rich in certain components, such as fat, sodium, sugar and other components can cause the increased risk of coronary heart disease, high blood pressure, high cholesterol and diabetes. (Lichtenstein et al., 2006, American Heart Association, 2006). Several heaths issues are due to nutrition habits which are inappropriate that can cause long term consequences to one’s health (Deshpande, Basil & Basil, 2009).

The nutrition scenario in the South-East Asian region has changed dramatically in the last two decades. Especially among the urban segments of the community, diet-related chronic diseases have been on the rise. The main cause of deaths in most of these developing countries in the region is coronary heart disease (Tee et al, 2002). With the increase in these diseases in the region, there has been greater focus on the role of nutrition in the disorders. Consumers are paying greater attention to the nutritional value of their diets (Tee et al, 2002).

A period of over 20 years of sustained economic growth and political stability has made Malaysia one of the most buoyant Southeast Asian countries. Such rapid advancements in the socio-economic situation in the country, as well as in many countries in Asia, has resulted in significant changes in the life-styles of communities, including food habits, and food purchasing and consumption patterns (Tee, 1999).

Increasing urbanisation puts further strain on the available health services and other facilities in the cities. There has been increased consumer awareness and sophistication among Malaysians. These changes have resulted in a definite change in the food and nutrition issues facing the communities in Malaysia over the past three decades (Tee, 1999).

Consumers have become more conscious of their health and weight control over the last few decades and they tend to be more aware of daily intake requirements and food nutrients (e.g. dietary fat) (Niva, 2007; Oakes, 2005; van Trijp & van der Lans, 2007). Nutrition labeling of food packaging has been a major instrument in Europe to providing consumers with information, in order for them to make nutritionally appropriate choices. (Josephine et al. 2009)

Based on a survey conducted by Nielsen in 2005 on consumer attitudes towards nutritional labels on food packaging, two in 10 consumers in Asia Pacific, Europe and North America ‘always’ check the nutritional labels on packaging whereas in Latin Americans the consumers are known as most label-minded where a third of consumers claim to ‘always’ check labels on packaged food. For an average of four in 10 consumers worldwide, the survey shows the consumers check the nutritional labels when trying a product for a first time (Nielsen, 2005).

Across Asia Pacific, Thailand (41%), India (32%) and Malaysia (29%) made the world’s top ten countries where the consumers claimed to ‘always’ check food labels However, Japanese (24%), followed by Finnish (15%) and Dutch (14%) claimed that they most likely ‘never’ check food labels (Nielsen, 2005).

Figure 1.1 Consumer checking the nutritional information on food labels

(Nielsen, 2005).

Statement of Problem

Although consumers are checking the food labels, it is not necessarily they understand what they are reading on the nutritional content. In the same study conducted by ACNielsen in 2005, 60% of Asia Pacific’s citizen leading the world in this lack of understanding of nutritional information provided on food labels, followed by Europeans (50%) and Latin Americans (45%). Half of the world’s consumers said they only understand ‘partly’ the nutritional labels on food (Nielsen, 2005).

Understanding the nutrition information correctly on food label is very important for people to make decisions about which food they choose to eat. Studies indicated generally, people gives small attention to this type of information, although they often say they do (European Heart Network, 2003; Higginson, Kirk, Rayner, & Draper, 2002a; Higginson, Rayner, Draper, & Kirk, 2002b). According to European Heart Network (2003) and Grunert & Wills (2007), they do not understand the information is one of the reason people have given for not reading the nutrition label. Even though a majority of consumers have knowledge on nutrition and can use nutrition labels when prompted, only a small amount of consumers seem to look at the nutrition labels when shopping (Black & Rayner, 1992; Grunert, 2008; Steenhuis, van Assema, Reubsaet, & Kok, 2004).

Colleges are potentially important targets for the promotion of healthy lifestyles of the adult population. It represents the final opportunity for nutritional education of a large number of students from the educator’s perspective (Sakamaki et. al, 2005). Nutritional habits of college students are an interesting research arena since college is often the transition from parental control to freedom of food choice (Desphande, Basil & Basil, D., 2009). To make the right food choice, college students often lack of nutrition knowledge (Kolodinsky, et al 2008).

To help people to make the right selection of food, reading nutrition information on products’ label is essential. Research shows students are not looking at this information correctly although reading food labels when purchasing items for the first time (Kolodinsky, et al 2008). Few researches have been conducted in the past in evaluating the nutritional knowledge, eating habits and obesity indices of college students (Malinauskas, Raedeke, Aeby, Smith, & Dallas, 2006; Osaka, Nanakorn, Sanseeha, Nagahiro, & Kodama, 1999; Sakamaki, Toyama, Amamoto, Liu, & Shinfuku, 2005).

As for adult population, college students are the important targets for the promotion of healthy lifestyles. Due to that, it is important to study the label ready behavior among college students and how their nutrition knowledge and attitude influence their label reading for their food choice.

1.3 Research Objectives

To examine the effect of nutrition knowledge towards label use among college students.

To examine the effect of attitude towards label use among college students.

To examine the relationship between nutrition knowledge and attitude towards label use among college students.

Research Questions

To what extend does nutrition knowledge influence label use among college students?

To what extend does attitude influence label use among college students?

Does nutrition knowledge influence attitude towards label use among college students?

Theoretical Framework

The proposed theoretical framework is adopted from model of food label reading behavior developed by Misra (2007) in her previous study.

Independent Variables Dependant Variables

H1

Nutrition

Knowledge

H3

Label Use

Among College Students

H2

Attitude

H

Figure 1.2. Proposed Theoretical Framework to study the effect of Nutrition Knowledge and Attitudes towards label use among College Students (Adopted from Misra (2007))

1.6 Research Hypotheses

H1: Higher nutritional knowledge would increase the label use among college students.

H2: Positive attitude would increase label use among college students.

H3: The higher the nutritional knowledge would improve attitude towards food label use among college students.

Significance of the Study

The findings from this study would provide useful information to Ministry of Health (MOH) and Ministry of Education (MOE) to plan for nutrition and label-reading education programs for students as one of the syllabus in college. The findings would also be useful for MOH and various stakeholders to take into consideration when designing a nutrition label for better public understanding and use nutrition information on labels.

1.8 Definition of Terms

1. Label: means any tag, brand, mark, pictorial or other descriptive matter, written, printed, stencilled, marked, embossed or impressed on, or attached to, a container of food (FAO/WHO, 2001)

2. Nutrition education: is most commonly delivered using the didactic model, in which the educator provides information and direction to the participant in a traditional teacher-student relationship. Although didactic approaches are generally successful at conveying information and increasing participant knowledge about nutrition, they have been less successful in motivating participants to translate this knowledge into the adoption of healthful behaviour (Nielsen, 2005); Higginson et al, 2002; Rayner, 2001)

3. Nutrition knowledge: means knowledge of nutrients and nutrition (Anthony, 2002)

4. Consumer: means persons and families purchasing and receiving food in order to meet their personal needs (CODEX, 1985)

5. Nutrition supplement: Nutritional supplements include vitamins, minerals, herbs, meal supplements, sports nutrition products, natural food supplements, and other related products used to boost the nutritional content of the diet. Nutrition supplements come in a variety of forms: pills, capsules, powders, liquids, and even in gel form (Brown University, Online Source)

5. Food: means any substance, whether processed, semi-processed or raw, which is intended for human consumption, and includes drinks, chewing gum and any substance which has been used in the manufacture, preparation or treatment of “food” but does not include cosmetics or tobacco or substances used only as drugs (CODEX, 1985)

.

LITERATURE REVIEW

2.1 Food Label

According to (Kotler, 2001), a label might carry only the brand name or a great deal of information. These food labels have become increasingly complex, particularly as products move from the status of basic commodities to highly processed, value-added products (APO, 2002). The whole concept of healthy eating can be simplified by nutritional labels and it helps to keep track of the amount of nutrients such as fat, sugar, sodium, fibre, protein, carbohydrates and other nutrients. By using nutritional labeling, it will also allow consumers to make an informed judgement of a product’s overall value (APO, 2002). There are lots of interests in nutrition labels on food packages and it is designed to promote and protect public health by providing nutrition information for consumers to make informed dietary choices. However, nutrition labelling is not mandatory to all countries, in some countries it is still voluntary (Hawkes, 2004).

Nutritional labeling is a method to provide nutritional information and it reduces information search costs to consumers while retaining consumer freedom of choice (Grunert & Wills, 2007) and it help consumers to aware on their dietary choices (Roalands and Hoadley, 2006) and encouraging consumers to make healthier choices when shopping for food (Baltas, 2001; Cheftel, 2005).

2.2 Label use among consumer

A huge number of studies have been conducted to analyze the relationship between consumers and the different nutrition information labels on food products. However, most of the studies focused on the use of nutritional information, health and nutrition claims on the labels and the consumer understanding towards it. Only small studies have been conducted to assess the effect of different nutrition and health labels and/or claims on consumer food choice and/or how much consumers value their provision.

According to National Health and Nutrition Examination Survey (NHANES) in 2005-2006, the authors found that 61.6% of participants who comes from U.S adults reported using the nutrition facts panel, 51.6% used the list of ingredients, 47.2% read the serving size, and 43.8% reviewed health claims at least sometimes when deciding to purchase a food product. Roe et al.(1999), Garrestson & Burton (2000), Kozup et al. (2003) and Basil et al. (2005) studied the effect of two different nutrition and health information labels (facts panels and claims) on consumer food product evaluations, consumer attitude towards products and purchase intentions.

According to Nielsen (2008), an average of 37% of Latin Americans always checks the nutritional contents before purchasing and 42 % claiming to check when purchasing a product for the first time. Based on same survey, 73% of consumers from South East Asia claimed they always reading the nutritional panel or when purchasing a product for the first time. The research found that Chinese consumers seem a little less inclined, with 58% claimed always reading the nutritional panel or when purchasing a product for the first time. For countries open to fast food and generally without a strong culinary history such as New Zealand, Australia and England, six out of ten (56%) shoppers always read nutritional panels or when purchasing a product for the first time. Modern trade has long dominated the retail landscape in these markets and their consumers are familiar with packaged grocery products and therefore more likely to take their health cues from visual references rather than nutritional labels.

However, Nayga (2000) found that knowledge about nutrition was not significantly related to the extent of label use and he made a hypothesis that people who know more may ignore the label. Grunert and Wills (2007) mentioned an interesting observation from a think-aloud study. Because people held the belief that yoghurt is healthy, they disregarded the nutritional label. BMRB and University of Surrey (2008; Malam et al.,2009) specifically excluded items that would allow nutrients levels to be guessed from the name of the food alone, so that the label format per se was being tested. However, to the extent that people do apply prior beliefs, this would represent merely a special case. Research conducted by Malam et al. (2009) reported that a subgroup of health conscious consumers who claimed they did not use nutritional labels as they were confident that they knew which foods were healthy

Another research conducted by Roe et al. (1999) found that the effect of ten different nutrition and health claims on consumer health evaluations and intention to purchase for three food products indicate that when a food product carries a health and nutrition claims, consumers view the product as healthier and state they are more likely to purchase it.

Garretson & Burton (2000) studied the effects of nutrition facts panel and health claims on nutritional labeling towards consumer attitude and purchase intention whereas Kozup et al. (2003) carried out the same type of analysis to distinguish food products and restaurant menus. Based on the finding, it is indicated that a health claim can have a favourable effect on product attitude and purchase intention in both cases. The use of heuristics to understand nutritional information is the subject of the study by Basil et al. (2005). They analyze the effect of specific health and nutrition labels on consumer food decisions in Canada concluding that when individuals use a heuristic to read a nutrition label, they make more accurate food decisions. In other words, consumers prefer using shorter nutrition and health information when they take the final food product decision reducing the time spent on food choices.

Finally, Bond et al. (2008) use a choice experiment to estimate the willing to purchase for a number of health and nutrition claims and some production process attributes for a packaged red leaf lettuce. Results showed that specific health claims were more valued by consumers than general health claims. Label use is affected by education, gender, age and time pressure, i.e., consumers search for nutrition-related information as long as the costs (time and/or price) will not outweigh the benefits (Drichoutis et al, 2006).

2.3 Relationship between nutrition knowledge and label use

Nutrition knowledge has a statistically positive significant effect on nutrition facts panel use but a non significant effect on the claim use. These results indicate that consumers with higher nutrition knowledge are more likely to use the nutrition facts panel when shopping, while they show no difference with regards to the frequency of claim use (Drichoutis et al, 2006). The impact of nutrition knowledge on facts panel use is consistent with previous studies (Guthrie et al., 1995; Szykman et al., 1997; Kim et al., 2001b; Drichoutis et al., 2005; Drichoutis et al., 2006 and Gracia et al., 2007),

Education has been found to positively affect label use. (Drichoutis et al, 2006). Lacking in nutrition knowledge can limit consumers’ abilities to understand or evaluate a health claim (Health Canada, 2000) and this lack of understanding can diminish the credibility of claims food label. According to (Drichoutis et al, 2006), consumers who are more concerned about nutrition and health are more likely to use nutritional labels (Drichoutis et al, 2006). Consequently, consumers on a special diet, organic buyers, and those aware of the diet-disease relation are more likely to search for on-pack nutrition information than others.

Nutrition knowledge may facilitate label use by increasing its perceived benefits and by increasing the efficiency of label use, thereby decreasing the cost of using labels. Early studies of label use found a relationship between nutrition knowledge or self perception of knowledge and the use of specific nutrients (Bender and Derby, 1992). Moorman and Matulich (1993) showed that the higher the health knowledge among consumer, it will give a positive effect on information acquisition from media sources which include nutrition label reading. Later, Guthrie et al. (1995), Szykman, Bloom, and Levy (1997), and Kim, Nayga, and Capps (2001b) found evidence supporting a positive relationship between label use and knowledge, even though Nayga (2000) found no evidence supporting this relationship. Moorman (1998) also found that consumers with more knowledge were less sceptical toward nutritional information.

In addition, Levy and Fein (1998) revealed the positive effect of knowledge on consumer’s ability to perform nutrition label use tasks. Although it is reasonable to expect that nutrition knowledge can affect nutritional label use, it is also possible that label use can affect nutrition knowledge. For example, consumers can gain more knowledge as they read more nutritional labels from the products they purchase. In fact, (Drichoutis et al, 2005) found that label use in general and use of vitamins/minerals and ingredients information improve consumer’s nutrition knowledge.

2.4 Relationship between attitudes and label use

Studies conducted by Misra, (2007) shows

2.5 Relationship between label use and healthy diets

Studies show a positive effect of current diet status on search for nutrition information. It appears that consumers with a special interest in diet, use nutritional labeling as a means to an end. Consumers who follow a special diet may not necessarily do it because of a special medical situation, but because of their general diet-health awareness (Drichoutis et al, 2006). Awareness of the diet-disease relation may also positively affect the likelihood of consumers paying attention to the caloric content of foods (Drichoutis et al, 2005).

Therefore, in close relation with these results, consumers aware of the diet health and/diet-disease relation or consumers who perceive diet as important to their lifestyle, are more likely to use on-pack nutrition information and/or health claims (Kim et al, 2001; Nayga, 2000; Shine et al, 1997; Szykman et al, 1997; Wang et al, 1995). There is some research on people with high cholesterol levels, and they were more likely to look for saturated fat and cholesterol on labels as compared to those with normal or low levels (Jordan et al. 2004).

These results are amplified when one considers the fact that consumers buying organic products are more likely to use nutrition information (Govindasamy and Italia, 1999) and that placing importance on following dietary guidelines or healthy dietary practices positively affects nutritional label use ( Nayga, 2000) or specifically, the use of fat and sugar content information (Drichoutis et al, 2005; Lin and Lee, 2003). Major grocery shoppers were found more likely to use nutritional labels (Drichoutis et al, 2005; Kim et al, 2001), but meal planners were found less likely to use calories and/or cholesterol information (Drichoutis et al, 2005) perhaps because they assign greater value to taste (Drichoutis et al, 2007).

3.0 RESEARCH METHODOLOGY

This part of the study will discuss and lay out the methodology that is going to be used in the next stage of the research. The research design, unit of analysis, population and sample size, data collection method and instrumentation are also discussed.

3.1 Research Design

This study will employ the use of quantitative research design with a structured questionnaire as the research instrument. A descriptive research design and cross-sectional survey will be used in this study as data will be gathered just once at the same point of time for each participating consumer.

Population and Sample Size

Based on Table for Determining the Random Sample Size from a Determined Population (Krejcie & Morgan (1970), survey questionnaire will be distributed to 384 respondents based on 100,000 students from Hotel and Tourism Management Faculty, University Technology Mara, Shah Alam. The instruments will be pilot tested with 20 students and for instruments validity and reliability, Cronbach alpha will be applied.

TABLE FOR DETERMINING SAMPLE SIZE FROM A GIVEN POPULATION

N

S

N

S

N

S

N

S

N

S

10

10

100

80

280

162

800

260

2800

338

15

14

110

86

290

165

850

265

3000

341

20

19

120

92

300

169

900

269

3500

246

25

24

130

97

320

175

950

274

4000

351

30

28

140

103

340

181

1000

278

4500

351

35

32

150

108

360

186

1100

285

5000

357

40

36

160

113

380

181

1200

291

6000

361

45

40

180

118

400

196

1300

297

7000

364

50

44

190

123

420

201

1400

302

8000

367

55

48

200

127

440

205

1500

306

9000

368

60

52

210

132

460

210

1600

310

10000

373

65

56

220

136

480

214

1700

313

15000

375

70

59

230

140

500

217

1800

317

20000

377

75

63

240

144

550

225

1900

320

30000

379

80

66

250

148

600

234

2000

322

40000

380

85

70

260

152

650

242

2200

327

50000

381

90

73

270

155

700

248

2400

331

75000

382

95

76

270

159

750

256

2600

335

100000

384

Note: “N” is population size

“S” is sample size.

Krejcie, Robert V., Morgan, Daryle W., “Determining Sample Size for Research Activities”, Educational and Psychological Measurement, 1970.

Instrumentation

Questionnaires will be used for data collection method based on ‘Label Reading Survey’ developed by Marietta et. al, 1999. For nutrition knowledge, multiple-choice questions will be used to determine students’ knowledge of facts useful to consumers when using the food label. The purpose of the questions are to test their ability to gather information from the food labels and their knowledge on the meaning of certain terms or phrases that usually stated on label and their basic nutrition knowledge.

Attitudes will be measured with questions on a Likert scale (where 1: strongly disagree and 5: strongly agree) regarding the usefulness, accuracy and truthfulness of food labels. For label use, Questions (using a Likert scale where 5: never and 1: always) will be used to assessed the general use of food labels.

Regarding the use of specific items on the label, 17 items that are usually appear on a Nutritional Facts label (eg. Serving size, protein, carbohydrate) will be asked to the students to indicate if they used each of the items when looking at the label. A higher score will represent higher use of specific items from the Nutrition Facts panel. The students need to score 0 (no) and 1 (yes).

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3.4 Plan for Data Analysis

As the survey is handed out on paper, the answers will be manually entered into the statistical program SPSS 19.0 for analysis. Entering data in SPSS requires the separate questions and variables to be defined. The Cronbach alpha will be used to test the reliability. This is the most common accepted and widely used measure of reliability. Pearson Correlation Coefficient (r) will be used to compute and describe the nature, strength, direction and inter-correlations among the variables. Regression Analysis will be used to test the research hypotheses.

3.5 Timeframe

Based on Gantt chart, this project is predicted to be completed in 12 months.