22 annotated bibliographies AMA style

JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 58, NO. 5

Positive Changes in Perceptions and Selections of Healthful Foods by College Students After a Short-Term Point-of-Selection Intervention at a

Dining Hall

Sharon Peterson, PhD, RD; Diana Poovey Duncan, MS, RD; Dawn Bloyd Null, MS, RD; Sara Long Roth, PhD, RD; Lynn Gill, MS, RD

Abstract. Objective: Determine the effects of a short-term, multi- faceted, point-of-selection intervention on college students’ percep- tions and selection of 10 targeted healthful foods in a university din- ing hall and changes in their self-reported overall eating behaviors. Participants: 104 college students, (age 18–23) completed pre-I and post-I surveys. Methods: Pre-survey collected at dining hall in April 2007, followed by 3-week intervention then post-survey col- lected via email. Healthy choice indicators, large signs, table tents, flyers and colorful photographs with “benefit-based messages” pro- moted targeted foods. Response rate to both surveys was 38%. Results: Significantly more participants reported that healthful choices were clearly identified in the dining hall after the inter- vention. Over 20% of participants reported becoming more aware of healthful food choices in the dining hall after the intervention. Significant increases in self-reported intake were reported for cot- tage cheese and low-fat salad dressing, with a trend toward increased consumption of fresh fruit. Seven of the 14 assessed eating behaviors had significant changes in the desired direction. Increased aware- ness of healthful foods was the top reason for self-reported changes in overall eating behaviors. Conclusion: Short-term, multi-faceted, point-of-selection marketing of healthful foods in university dining halls may be beneficial for improving college students’ perceptions and selections of targeted healthful foods in the dining hall and may improve overall eating behaviors of college students.

Keywords: food choices, college students, point-of-selection, marketing, eating behaviors

Dr Peterson, Ms Bloyd Null, and Dr Long Roth are with the Department of Animal Science, Food and Nutrition at the Southern Illinois University Carbondale in Carbondale, Illinois. Ms Poovey Duncan is with the Department of Human Environmental Studies at Southeast Missouri State University in Cape Girardeau, Mis- souri. Ms Gill is with the Student Health Center at Southern Illinois University Carbondale, Illinois.

Copyright © 2010 Taylor & Francis Group, LLC

Entering college brings about numerous life changes,with many decisions involving food choice. Many oftoday’s college dining halls offer a large variety of food items presented in a self-service format, similar to an “all-you-can-eat” restaurant. Thus, it is well-established that college students need guidance on making healthful food choices.1–10 They typically consume high intakes of total fat, saturated fat, and cholesterol, and low fiber intake.6 Few col- lege students eat 5 or more servings of fruits and vegetables per day.3 Frequently, there is a disproportionate consumption of higher-fat foods at the expense of more healthful foods.5

Healthy People 2010 aims to increase the proportion of col- lege students who receive information on dietary practices, nutrition, and disease prevention.11 To meet these national objectives, action must be taken to increase education re- lated to food choice, nutrition, and disease prevention within the college setting.

Social marketing may be an effective environmental strat- egy to promote nutrition knowledge and awareness to college students. Whereas traditional marketing aims to satisfy con- sumer needs and wants, social marketing seeks to change the target group’s attitudes and/or behaviors, including thoughts, actions, or values. Social marketing attempts to influence the acceptability of an idea in a population. The goal of social marketing when applied to human health is to “change a spe- cific behavior by influencing voluntary health behaviors.”12

Nutrition labeling at the point of food selection is considered a type of social marketing, and has been used to promote healthful eating in various settings.13

When college students are provided with relevant informa- tion regarding benefits of healthy eating that are specifically catered to their values, while given clear indication as to

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which foods are considered “healthful” selections, it is as- sumed that students will become more aware of healthy food choices available to them. In fact, a recent study concluded first-year college students can be positively influenced by nu- trition information at point-of-selection.14 Two thirds of re- spondents reported they were aware of nutrition labels posted within the college dining hall, whereas one third reported using them to guide their food choices. A social marketing campaign designed to increase fruit intake among community college students reported increased awareness and increased fruit intake over a 10-week intervention period.15

Buscher et al reported improved food selections and rec- ommend use of “benefit-based messages” in college dining hall point-of-purchase interventions.16 Benefit-based mes- sages are positive phrases that address specific motivations of the target population such as taste, body leanness, having more energy, or overall health. Effectiveness was attributed to colorful graphics and a “professional look.” Because college students have grown up with flashy, high-quality marketing, it is essential that “marketing” of healthy food selections on a college campus compares to promotions they are accustomed to in other settings. Strategic placement of benefit-based mes- sages was also a key to success.16

Successful interventions must be attention-grabbing and visible to all persons entering the college dining hall. Thus, it appears routine exposure to nutrition information at point-of- selection during college years could have a positive impact on nutrition knowledge and eating behaviors of college stu- dents.8,14–17 However, current research on successful point- of-selection interventions for college students in dining halls is very limited.

A multifaceted approach using a variety of attention- grabbing approaches holds great promise for increasing in- take of healthful food choices among college students. There- fore, the purpose of this study was to evaluate the impact of benefit-based messages with a multifaceted approach (use of table tents, posters, flyers, and point-of-selection symbols) on college student’s perceptions and selections of healthful foods at a university dining hall. Our hypothesis was that participating students would report increased selection of the targeted foods and improved overall eating behaviors follow- ing the intervention.

METHODS This study was conducted at a large Midwestern public

university with a total student population of 19,878. The uni- versity’s undergraduate population is diverse, with 17.5% of undergraduates from self-reported minority groups (African American, Hispanic, Native American, Asian American, and/or Pacific Islander). The study design for this pilot study was a preintervention (pre-I)/postintervention (post-I) writ- ten survey, with a 3-week intervention at a campus dining hall. The dining hall serves approximately 900 people at any given lunch/dinner period. Students purchase a prepaid meal plan and choose foods from a variety of food stations, thus

cost of the individual food items would not be a factor in this study.

Survey Development To measure student perceptions and selections of healthful

food choices in the dining hall, a short survey was developed. Content validity was assessed by 4 Registered Dietitians who evaluated the survey for appropriate content and appropriate- ness for this university setting. Content validity was further assisted in a small pilot study (n = 29) with college stu- dents who indicated the items were appropriate and easy to understand.

The survey (see Appendix A) evaluated student’s percep- tions of availability of healthful foods in the targeted dining hall while also inquiring about their weekly dining frequency. A short food frequency questionnaire assessed student’s self- reported intake of the 10 targeted healthful foods that were available in the dining hall at lunch and dinner every day (see Table 3 for intake questionnaire items).

Recruitment This research was approved by the university’s Human

Subjects Committee (Institutional Review Board). Due to poor response rate (∼10%) received from this population by previous researchers who only used e-mail contact to collect data,18 it was decided pre-I surveys would be distributed in person. Pre-I surveys were distributed for 3 days by a team of researchers onsite (once during lunch hours and 3 times during dinner hours). Every person who entered the cafeteria was invited to participate in exchange for a chance to win a mountain bike or Ipod shuffle. By the 3rd day of recruitment, it appeared that most of the students who were interested in participating had been approached by the research team. E- mail addresses were collected upon completion of the pre-I survey and participants were informed that they would re- ceive a post-I survey via their e-mail account. Participants were required to be between the ages of 18 and 23, have a meal plan with residence hall dining, and consume at least 3 meals per week at the targeted dining hall to ensure they were adequately exposed to the intervention.

Intervention The 3-week intervention started 1 month after the pre-I

surveys were collected to avoid overlapping activities during National Nutrition Month in March. Due to the end of the semester in early May, 3 weeks was the maximum time frame that was possible for this intervention. Although this time frame was short, previous studies of college students have reported positive behavior changes following short-term interventions for alcohol abuse19,20 and for improved attitudes toward older adults.21

Healthy choice indicators at point-of-selection were used to increase perceptions of availability of healthy food choices and increase selection of the 10 targeted healthy foods. A colorful logo was created which featured a slogan describ- ing the targeted foods as “The Right Stuff!” All promotional

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materials featured “The Right Stuff!” logo to tie all compo- nents together. Ten different 12′′ × 18′′ signs hung above the 10 targeted food items on the tray line. These colorful signs used humor and benefit-based messages to draw attention to the 10 targeted food items. In addition, a 4′′ × 5′′ card with the same healthy choice indicator was placed directly in front of the targeted foods on the tray line and corresponding table tents were placed on dining tables. Flyers were distributed throughout the dining hall and a large sign was placed at the entrance to encourage selection of the 10 targeted foods identified by “The Right Stuff !” healthy choice indicators. All signage directly corresponded with the 10 targeted foods on the survey.

Procedures After the 3-week intervention, post-I surveys were dis-

tributed via e-mail, and were accepted for 10 days following the distribution. Researchers sent a reminder e-mail prior to the post-I survey distribution, and also sent 3 reminder e-mails to participants following distribution of the post-I survey. Upon return of the completed post-I survey, re- searchers matched it with participant’s pre-I survey and then she/he was entered into the drawing.

Data Analysis Data were analyzed using the Statistical Package for So-

cial Sciences (SPSS) version 15.0 for Windows, Student Ver- sion (2006; SPSS, Chicago, IL). Descriptive statistics were used to describe demographic information and Wilcoxon’s matched pairs test was used to measure participant responses when comparing pre-I surveys to the post-I surveys. The Wilcoxon test is the nonparametric model of the paired t test that evaluates differences between matched pairs/groups and determines the direction of difference between matched pairs.22

RESULTS Two-hundred eighty-eight students completed the pre-I

survey, which represents approximately 1/3 of those who entered the dining hall on a given day. However, 16 were excluded due to age disqualification. Of these 272 students, 107 returned the post-I survey. Three post-I surveys were excluded due to infrequent weekly meals at the dining hall, leaving the total post-I sample size at 104. Therefore, re- sponse rate for the post-I survey was 38%, which is over 3 1

2 times the response rate received when sampling the same population the previous year.18 This improved return rate may be attributed to face-to-face contact during the pre-I survey distribution, numerous reminder e-mails sent out to participants, and/or the chance to win a prize.

Demographics of student participants are presented in Table 1. Compared to other racial/ethnic backgrounds, the overall response rate from African American students de- clined by half for the post assessments. Of the 114 partici- pants who responded to the open-ended question about per- ceived barriers that could prevent them from selecting healthy

TABLE 1. Demographics of College Students Surveyed in a University Dining Hall Setting Preintervention (pre-I) and Postintervention (post-I)

Total pre-I survey

Both pre-I/post-I

survey (n = 272) (n = 104)

Demographics Mean SD Mean SD

Age (years) 19.58 1.365 19.97 1.882 Gender (%)

Male 63.8 56.7 Female 36.2 43.3

Race/ethnicity (%) Caucasian/White 60.5 68.3 African American 26.6 13.5 Hispanic American 3.0 4.8 Asian American 4.4 8.7 Native American 1.8 2.9 Other 3.7 1.9

Class rank (%) Freshman 55.9 53.8 Sophomore 18.6 16.4 Junior 15.9 17.3 Senior 9.6 12.5

Note. Pre-I/Post-I = participants who completed both the preinter- vention (pre-I) and postintervention (post-I) surveys.

foods in the dining hall, approximately 24% mentioned “lim- ited selection of healthy choices” (data not shown).

For the question: “Are healthy food choices easily identi- fied at the dining hall (such as labels, symbols, or signs)?” 44 participants’ responses significantly changed in a positive direction after the intervention (Table 2). Of the 104 post-I survey respondents, 83 indicated that healthy choices were easily identified at least some of the time. Of those, 52 par- ticipants successfully acknowledged some component of the intervention and 20 specifically identified materials promot- ing healthy foods as the “The Right Stuff!” A question on the post-I survey asked: “If your eating habits have changed

TABLE 2. Frequency of Self-Reported Changes for College Students’ Belief That Healthy Foods are Easily Identified (Symbols, Signs or Labels) at the College Dining Hall

Positive Change in Response

Negative Change in Response

No Change in Response

Observed 44 21 38 Expected 32.5 32.5 — Residual +11.5 −11.5 —

Note. n = 104. χ 2(df = 1) = 8.162, p = .004∗∗ ∗∗indicates that the correlation was significant at the .01 level.

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TABLE 3. Frequency of College Students’ Self-Reported Changes in Various Eating Habits Following a Point-of-Selection Dining Hall Intervention (n = 104)

No Yes

“I’m eating more fast food” (n = 104) Observed 99.0 5.0 Expected 77.0 27.0 Residual 22.0 −22.0 χ 2(df = 4) = 24.276, p = 0.000

“I’m eating more junk food” (n = 104) Observed 95.0 9.0 Expected 67.0 37.0 Residual 28.0 −28.0 χ 2(df = 4) = 32.938, p = 0.000

“I’m drinking more soft drinks” (n = 104) Observed 98.0 6.0 Expected 81.0 23.0 Residual 17.0 −17.0 χ 2(df = 1) = 16.111, p = 0.000

“I’m eating larger portions” (n = 104) Observed 96.0 8.0 Expected 63.0 41.0 Residual 33.0 33.0 χ 2(df = 1) = 43.847, p = 0.000

“I’m eating one large meal a day” (n = 104) Observed 81.0 23.0 Expected 50.8 53.3 Residual 30.2 −30.2 χ 2(df = 4) = 35.126, p = 0.000

“I’m eating less junk food” (n = 104) Observed 76.0 28.0 Expected 86.0 18.0 Residual −10.0 10.0 χ 2(df = 4) = 6.732, p = 0.009

“I’m eating smaller portions” (n = 104) Observed 88.0 16.0 Expected 99.0 5.0 Residual −11.0 11.0 χ 2(df = 4) = 25.498, p = 0.000

since April 1st, what is the reason for this change?” The most common reason was: “I am now more aware of healthy food choices in the dining hall.” Thus, 22% of participants became more aware of healthy food choices in the dining hall, which led to a self-reported change in eating habits.

Seven of the 10 assessed eating behaviors had significant changes in the desired direction (Table 3). For example, a sig- nificant decrease in “I’m eating more fast food,” was found in the post-I survey responses. Significantly fewer participants also reported: “I’m eating more junk food,” as well as “I’m drinking more soft-drinks.” Eleven more participants in the post-I survey indicated they were eating smaller portions of food. These eating habits were combined into either “posi-

tive” or “negative” responses to determine whether responses had changed overall for the “positive” or the “negative” after the intervention. The post-I responses revealed significantly fewer participants were reporting “negative” changes in their eating behaviors than were previously seen (Table 4).

To assess whether the intervention increased self-reported selection of targeted healthful foods, the food frequency por- tion of the survey was analyzed. Self-reported use of cot- tage cheese and low-fat salad dressing increased significantly (Table 5) in the post-I surveys. Although it was predicted that students would significantly increase selection of deli sand- wiches, the opposite results were found. The analysis of fresh fruit did not reach significance; however, a trend was seen towards more frequent consumption of fresh fruit. No signif- icant results were found for self-reported changes in intake of steamed vegetables, chicken breast, tossed salad, or skim milk.

COMMENT It appears that specific food choices in the dining hall and

overall eating behaviors of college students can be improved through a short-term, multifaceted, benefit-based, point-of selection intervention in a dining hall setting. “Limited avail- ability of healthy foods within the dining hall” was the most common reason why these students said they did not choose healthful foods in the dining hall on the pre-I survey. Stu- dents’ top reason for why their eating habits changed since the beginning of the intervention was, “I am now more aware of healthy food choices within the dining hall.” Significantly more students in the post-I survey indicated that healthy choices were easily identified in the dining hall. Half of the post-I participants described some component of the inter- vention, whereas 19% specifically described materials pro- moting healthy foods as the “The Right Stuff!” These results are comparable to previous studies.14,16

Increased awareness of healthy foods appears to have prompted some students to report improved overall eating behaviors. Students reported significantly fewer “negative” eating behaviors and significantly greater “positive” ones af- ter the intervention. There was also a significant increase in self-reported consumption of cottage cheese and low-fat salad dressing, with a trend for increased reports of consump- tion of fresh fruit after the intervention. Drawing attention to nutrition and health in a dining hall surrounded with abundant food choices appears to have positively impacted students’ food behaviors. This is consistent with previous research that has shown healthy choice indication at point-of-selection to be moderately effective in improving selection of targeted foods.14,16

Just as businesses, products, and concepts must be mar- keted in today’s world to succeed, nutrition and health mes- sages must receive the same marketing vigor if expected to gain attention in a college population. The success of this intervention can be attributed to the abundance of marketing materials placed within the dining hall, including colorful graphics, sign placement, and relevant messages specifically

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TABLE 4. Self-Reported Changes in College Students’ “Positive” and “Negative” Eating Behaviors From Pre-I to Post-I Surveys (n = 104)

Mean SD t df Significance (2-tailed)

Pre-I “negative” eating behaviors versus post-I “negative” behaviors

1.106 2.038 5.533 103 .000∗∗∗

Pre-I “positive” eating behaviors versus post-I “positive” behaviors

−.279 1.830 −1.554 103 .123

Post-I “negative” behaviors versus post-I “positive” behaviors

−.202 1.375 −1.498 103 .137

Note. Pre-I = preintervention survey response. Post-I = postintervention survey response. ∗∗∗The correlation was significant at the.001 level. “Positive” behaviors included eating smaller portions, eating more vegetables, drinking fewer soft drinks, eating less “junk” food, eating less fast food, eating 5 to 6 small meals/day, and skipping fewer meals. “Negative” eating behaviors included eating less fruits and vegetables, eating larger portions, drinking more soft drinks, eating more fast food, eating more “junk” food, eating one large meal/day, and skipping more meals.

designed to appeal to college students. These messages pro- moted taste, satiety, body leanness, energy value, and overall health as reasons to select our targeted foods and improve eating habits.

These results may not be indicative of the full impact of the intervention. Participants could have experienced non-

TABLE 5. Frequency of Self-Reported Changes for College Students From Pre-I to Post-I for Targeted Healthful Foods at a College Dining Hall

Positive change in response

Negative change in response

No change in response

Cottage cheese Observed 26 8 67 Expected 17 17 — Residual 9 −9 — n = 104. χ 2(df = 4) = 10.253, p = 0.001 (the correlation was significant at the p ≤ .001 level)

Low-fat salad dressing Observed 34 19 45 Expected 26.5 26.5 — Residual 7.5 −7.5 — n = 104. χ 2(df = 1) = 3.876, p = 0.049 (the correlation was significant at the p ≤ .05 level)

Deli sandwiches Observed 27 51 22 Expected 39 39 — Residual −12 12 — n = 104. χ 2(df = 1) = 6.959, p = 0.008 (the correlation was significant at the p ≤ .01 level)

Fresh fruit Observed 34.0 23.0 46 Expected 28.5 28.5 — Residual 5.5 −5.5 — n = 103. χ 2(df = 1) = 3.65, p = 0.056

measurable changes such as a more positive attitude towards healthful eating to move them closer to an actual behav- ior change. For students who were already making healthful food choices, the intervention may have helped to maintain or reinforce their healthy behaviors. A review by Glanz et al proposed that providing nutrition information to target pop- ulations has benefits even if there is no measurable behavior change.23 It is well known that knowledge and awareness of healthy foods does not always translate into healthful eat- ing behavior. Awareness created by the marketing materials may have encouraged students to select at least some of the targeted foods and direct them towards improved eating be- haviors.

Although the celebration of National Nutrition Month (NNM) in the dining hall did not occur simultaneously with this intervention, it is possible that participant responses could have been impacted by having NNM between the pre-I and post-I surveys. Specifically, increased awareness of healthful food choices in the dining hall might have be related to NNM; however, it is important to note the NNM efforts made no attempt to identify healthy food choices in the dining hall.

A significant limitation of this study was the short length of the actual intervention period (3 weeks). Ideally, the inter- vention would last longer and would occur at the beginning of fall semester to avoid National Nutrition Month in March. However, the intense nature of our graduate program is not conducive to data collection during the fall semester. Another weakness was the inability to collect food production data to substantiate self-reported food frequency intake.

Use of 24-hour dietary recalls may have better captured the impact of the intervention and would have strengthened the study design. In addition, survey questions may have been misunderstood. Some students may have difficulty remem- bering how many times a week they consumed the targeted foods. Because the pre-I survey was given to participants in the dining hall, they may have been distracted or rushed, leading them to misreport their answers. Moreover, the sea- son in which this research took place may have affected the

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results because early spring is a time when some students may attempt to eat healthier in anticipation of summer.

Future research efforts should incorporate 24-hour dietary recalls into the study design and use a control group with randomly selected participants. Further evaluation of gender and racial/ethnic differences may provide insight into why some college students respond and others do not to point- of-selection promotions. Future studies should provide for a longer intervention period and also attempt to measure “un- intended consequences” resulting from the intervention. For example, in a college dining hall population, when certain foods are promoted as “healthy,” researchers should con- sider how the rest of the food choices may be perceived by participants. Those who are prone to categorizing foods as “good” or “bad” (such as those with disordered eating pat- terns) might use the point-of-purchase labels as an excuse to restrict/avoid certain foods or the labels may trigger a set-back in those recovering from an eating disorder.

Development of a close partnership with food service staff would increase the likelihood of adding more health- ful choices to the cycle menu. Improving variety, taste, and visual appearance of healthy food choices within the dining hall could improve results of point-of-selection interventions. By incorporating taste testing of the “new” healthy choices, their selection may be further increased. Rearranging the food service area to highlight healthful choices could also improve healthful food selection. Placement of visually ap- pealing, healthful choices near the entrance and relocating less healthful options away from the entrance may have ben- eficial results. Seeing healthful items first may entice students to choose these foods instead of less healthful items.

ACKNOWLEDGMENTS This research was supported by the Illinois Soybean As-

sociation, and was completed in partial fulfillment of the re- quirements for a Masters Degree in Nutrition from Southern Illinois University Carbondale.

NOTE For comments and further information, address correspon-

dence to Sharon Peterson, PhD, RD, Assistant Professor, Department of Animal Science, Food and Nutrition, 875 S. Normal Avenue, Mail code 4317, Southern Illinois Uni- versity Carbondale, Carbondale, IL 62901, USA (e-mail: [email protected]).

REFERENCES 1. Matvienko O, Lewis DS, Schafer E. A college nutrition

science course as an intervention to prevent weight gain in female college freshman. J Nutr Educ. 2001;33:95–101.

2. Driskell J, Meckna, BR, Scales NE. Differences exist in the eating habits of university men and women at fast-food restaurants. Nutr Res. 2006;29:524–530.

3. Davy S, Benes BA, Driskell J. Sex differences in dieting trends, eating habits, and nutrition beliefs of a group of Midwestern college students. J Am Diet Assoc. 2006;106:1673–1677.

4. Butler SM, Black DR, Blue CL, Gretebeck RJ. Change in Diet, Physical Activity, and Body Weight in Female College Fresh- man. Am J Health Behav. 2004;28:24–32.

5. Silliman K, Rodas-Fortier K, Neyman M. Survey of dietary and exercise habits and perceived barriers to following a healthy lifestyle in a college population. CA J Health Promot. 2004;2:10–19.

6. Cason KL, Wenrich, TR. Health and nutrition beliefs, at- titudes, and practices of under-graduate college students: a needs assessment. Top Clin Nutr. 2002;17:52–70.

7. Lowry R, Galuska DA, Fulton JE, Wechsler H, Kann L, Collins JL. Physical activity, food choice, and weight management goals and practices among U.S. college students. Am J Prev Med 2000;18:18–27.

8. Conklin MT, Lambert CU, Cranage, DA. Nutrition informa- tion at point-of-selection could benefit college students. Top Clin Nutr. 2005;20:90–96.

9. Anderson DA, Shapiro JR, Lundgren, JD. The freshman year of college as a critical period for weight gain: an initial evaluation. J Eat Behav. 2003;4:363–367.

10. Debate RD, Topping M, Saragent RG. Racial and gender differences in weight status and dietary practices among college students. J Adolesc. 2001;36:819–833.

11. Office of Disease Prevention and Health Promotion. 2006. Healthy People 2010. Washington, DC: US Department of Health and Human Services.

12. Maibach EW, Rothschild ML, Novelli WD. Social mar- keting. In: Glanz K, Lewis FM, Rimer BK, eds. Health Behav- ior and Health Education. San Francisco, CA: Jossey-Bass; 2002: 439–440.

13. Holdsworth M, Haslam C. Review of point-of-choice nutri- tion labeling schemes in the workplace, public eating places and universities. J Hum Nutr Dietet. 1988;11:423–445.

14. Conklin MT, Lambert CU, Cranage DA. College students’ use of point of selection nutrition information. Top Clin Nutr. 2005;20:97–108.

15. Shive S, Morris M. Evaluation of the Energize Your Life! So- cial marketing campaign pilot study to increase fruit intake among community college students. J Am Coll Health. 2006;55:33–39.

16. Buscher LA, Martin KA, Crocker S. Point-of-purchase mes- sages framed in terms of cost, convenience, taste, and energy im- prove healthful snack selection in a college foodservice setting. J Am Dietet Assoc. 2001;101:909–913.

17. Evans AE, Sawyer-Morse MK. The Right Bite Program: a theory-based nutrition intervention at a minority college campus. J Am Dietet Assoc. 2002;102:S89–S93.

18. The National Association of College & University Food Services 2006 Customer Survey (unpublished data).

19. Oswalt SB, Shutt MD, English E, Little SD. Did it work? Examining the impact of an alcohol intervention on sanctioned college students. J Coll Student Dev. 2007;48:543–557.

20. Lederman LC, Stewart LP, Russ TL. Addressing college drinking through curriculum infusion: a study of the use of experience-based learning in the communication classroom. Com- mun Educ. 2007;56:476–494.

21. Nutrition students improve attitudes after a guided ex- periential assignment with older adults. J Nutr Educ Behav. 2008;40:279–287.

22. Howell DC. Statistical Methods for Psychology. 5th ed. Bel- mont, CA: Thompson Wadsworth; 2002.

23. Glanz K, Hewitt AM, McCann K. Consumer behavior and nutrition education: an integrative review. J Nutr Educ. 1992;24:267–277.

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Appendix A. Survey Instrument

1. How many days per week do you typically eat LUNCH at this dining hall?

(please circle one) 0 1 2 3 4 5 6 7

2. How many days per week do you typically eat DINNER at this dining hall?

(please circle one) 0 1 2 3 4 5 6 7

3. Please put an “X” by the THREE MOST IMPORTANT factors that influence your food choices when eating at this dining hall?

� Appearance of food � Convenience � Calorie content � Taste � Nutrient content/health � Food cravings � Safety of food � Hunger level � Other?

4. Do you think this dining hall offers a variety of healthy food choices for Lunch and/or Dinner?

� Yes � No � Sometimes

5. Is it possible for you to select healthy food choices at this dining hall for Lunch and/or Dinner?

� Yes � No � Sometimes 6. What are your barriers, if any, to selecting healthy food choices at this dining hall?

7. Are healthy food choices easily identified at this dining hall (such as labels, symbols, or signs)?

� Yes � No � Sometimes

8. When you eat at this dining hall, how often do you choose each of the following? (Put an “X” by the answer that best suits each food choice)

Food Item Almost Daily 2–4 X’s/week Once/wk Once/month Never Deli Sandwiches Grilled chicken breast Tossed salad Low-fat salad dressing Steamed vegetables Fresh fruits Yogurt Fat-free (skim) milk Cottage cheese Whole grain bread

Let’s talk about YOU: How old are you? Gender? � Male � Female What is your class rank? � Freshman � Sophomore � Junior � Senior Which of the following best describes your ethnicity/racial background?

� African American/Black � Hispanic American � Other? � Asian American/Asian � Caucasian/White � Native American � Pacific Islander/Native Hawaiian

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