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1 ATTITUDES, KNOWLEDGE, AND BELIEFS OF ADOLESCENT GIRLS ABOUT THE BENEFITS OF EATING ORGA NIC FRUITS AND VEGETABLES By HOLLY L. MEADE A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNVERSITY OF FLORI DA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS IN MASS COMMUNICATION UNIVERSITY OF FLORIDA 2008
2 2008 Holly L. Meade
3 To the memory of my moth er, my life-long cheerleader.
4 ACKNOWLEDGMENTS The com pletion of this long-time goal required overcoming many challenges for me along the way. However, it is with the love, support, and encouragement of many people that this project has finally arrived. As a result, I would like to acknowledge thos e who helped make this study possible. I thank Dr. Debbie Treise, my advisor, chai r, and friend, who supported me throughout my graduate career. It is her influence in the Univ ersity of Floridas hea lth communication program that allowed me to pursue combining my education, experience, and passions. Drs. Julie Dodd and Youjin Choi were encouraging and helpful committee members. They each brought different perspectives and experiences to my table! I appreciate their friendships as well as our time in the classroom. Jody Hedge, Program Assistant in the Division of Graduate Studies and Research, also helped me in so ma ny ways with her unselfish and caring attitude. This qualitative study would not have been possible without the generous help of Cindy Gulledge and her precious sixth-grade girls. As a result of their partic ipation, I am encouraged by their knowledge and their openn ess to healthy lifestyles. I anticipate many more people will be motivated to pursue research re garding adolescents and organic food. There are many others who have been valuable cheerleaders to keep me going throughout this process. Alan Meade, Roland Hollowa y, Michelle Washburn, Susan Meade, and Kerry Meade are just a few of those people. I must also mention Diane Francar t, whose friendship and sacrificial typing of all my interviews, has been an invaluable gift to me. Finally, and most important, I tha nk my Lord and Savior, Jesus Christ. Without Him, none of this would have been possible.
5 TABLE OF CONTENTS page ACKNOWLEDGMENTS...............................................................................................................4 LIST OF FIGURES.........................................................................................................................7 ABSTRACT.....................................................................................................................................8 CHAP TER 1 INTRODUCTION..................................................................................................................10 2 LITERATURE REVIEW.......................................................................................................17 Adolescence and Diet.............................................................................................................17 Benefits of a Plant-based Diet................................................................................................19 Creation of Organic Labeling Standards ................................................................................22 Conventional Versus Organic Produce...................................................................................26 Theory of Reasoned Action and Theory of Planned Behavior............................................... 28 Theory of Reasoned Action.............................................................................................29 Theory of Planned Behavior............................................................................................30 The Media as a Source for Nutritional Information for Adolescents.............................. 33 Nutrition Coverage in Newspapers................................................................................. 35 Nutrition Coverage in Magazines.................................................................................... 36 Nutrition Coverage on the Internet.................................................................................. 38 Cumulative Study of Nutrition Inform ation in the Media............................................... 38 Impact of Media on Children.................................................................................................. 40 Implementing Nutrition in School................................................................................... 44 Role of Peers, Parents and Caretakers............................................................................. 44 Research Questions............................................................................................................. ....45 3 METHODOLOGY................................................................................................................. 46 Qualitative Versus Quantitative Research.............................................................................. 46 Types of Qualitative Research Interviews.............................................................................. 47 Methods Employed............................................................................................................... ..48 4 FINDINGS....................................................................................................................... .......52 Research Question 1: What do adolescent girls know about organic fruits and vegetables? ..........................................................................................................................52 Research Question 2: What are adolescent girls attitudes about consum ing organic fruits and vegetables?..........................................................................................................54 Research Question 3: Where do adolescent girls receive inf ormation from which to base their knowledge, attitudes, and beliefs about organic fruits and vegetables?............. 57 The Internet................................................................................................................... ..........57 Further Information about Orga nic F ruits and Vegetables..................................................... 60
6 Research Question 4: What are the significan t barriers or obstacles that would prevent adolescent girls from eating organic fruits and vegetables?............................................... 61 Research Question 5: What overall themes emerge f rom the interviews and the focus groups with the adolescent girls regard ing the consumption of organic foods?................. 62 5 DISCUSSION.........................................................................................................................65 The Theory of Planned Behavior............................................................................................ 65 Implications................................................................................................................... .........69 Limitations of the Study....................................................................................................... ..71 Future Research......................................................................................................................72 APPENDIX A INTERVIEW CONENT FORM............................................................................................. 75 B INTERVIEW QUESTIONS................................................................................................... 76 C SAMPLE TRANSCRIPT INDIVIDUAL INTERVIEW....................................................78 D SAMPLE TRANSCRIPT FOCUS GROUP........................................................................ 79 E SURVEY QUESTIONS.........................................................................................................81 REFERENCES..............................................................................................................................82 BIOGRAPHICAL SKETCH.........................................................................................................94
7 LIST OF FIGURES Figure page 1-1 Theory of Reasoned Action............................................................................................... 29 1-2 The Theory of Planned Behavior...................................................................................... 30
8 Abstract of Dissertation Pres ented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy ATTITUDES, KNOWLEDGE, AND BELIEFS OF ADOLESCENT GIRLS ABOUT THE BENEFITS OF EATING ORGA NIC FRUITS AND VEGETABLES By Holly L. Meade May 2008 Chair: Deborah Treise Major: Mass Communication Since poor dietary practices are a leading cont ributor to the development of obesity and chronic diseases, these issues could be effec tively addressed during adolescence by teaching and encouraging good nutritional habits to young people. Eating a plant-based diet consisting of primarily organic fruits and vegetables is an important nutrition recommendation for a healthy lifestyle. The purpose of this qua litative study was to examine a dolescent girls decision making and their diets, with the intent to determine their attitudes, knowledge and beliefs about the benefits of eating organic fruits and vegetables. In-depth indi vidual interviews and focus groups were used with 26 sixth-grade girls, ages 11 a nd 12, who were recruited fr om a private school in a suburban area of Orlando, Florida. This study s eems to indicate that in this cohort of sixthgrade girls, Ajzens Theory of Planned Behavi or may be a helpful framework to view their intention to consume organic fruits and vegetables. The participan ts in this study revealed they obtained their knowledge, attitude s, and beliefs about organic fr uits and vegetables primarily from media sources such as tele vision and Web sites as well as family members such as their mother. Most of the adolescent girls associated organic fruits and vegetables as a healthy food choice and believed that these foods were better for them than conventional fruits and vegetables. Participants percep tions of the benefits and challe nges of consuming organic fruits
9 and vegetables and the consumers of these produ cts are also discussed. The findings suggest a need for continued research to understand thor oughly and to determine how the media affect adolescents nutrition choices a nd dietary behavior. Results s how the need for media literacy curriculum specifically designed to reach adolescent girls.
10 CHAPTER 1 INTRODUCTION Am erica is a nation that abounds in the late st technology, information and opportunities for individuals to make wise decisions regarding their health. As a result, it seems people should be living essentially disease-free live s. However, this is not the case. America is experiencing a health crisis. The incidence of di sease is steadily increasing. Yet, it appears to be a crisis that is not only preventable, but also ha s a great deal to do with what people are putting on their forks. In fact, there appears to be a significant rela tionship between disease and diet. For example, heart disease, cancer, diabetes, and obesity are cu rrently the most outstanding health issues that people incur as a result of consum ing the standard American diet. Coronary heart disease and stroke are the firs t and third leading causes of death in America (AHA, 2001; CDP, 2004). Nearly 2,600 Americans die every day from some type of cardiovascular disease--thats an average of one death every 34 seconds (AHA, 2005). The number of sudden deaths from coronary heart disease among people ages 15 through 34 has also increased in recent years (AIC 2002; CDP, 2004), and overwhelming evidence indicates that is strongly related to poor diet. Ex cess calories leading to obesity, total fat, cholesterol, saturated fatty acids, sucrose, and fiber play a significant role in the devel opment in this disease (Slattery & Randall, 1988). An estimated 16.7 million deat hs result from the various forms of cardiovascular disease, many of which are preven table through a healthy diet (WHO, 2006). For example, studies indicate there is a lower instance of coronary heart disease among those people who have the highest intakes of fruit, vegetables, and grains (Shewmake, 2006). Incidences of cancer also continue to increase in America. One out of every four deaths, or 7.1 million annually (WHO, 2006), is the result of cancer (AIC, 2002; CDP, 2004). Dietary factors account for about 30% of all cancers in Western coun tries. Approximately 20 million
11 people currently suffer from cancer, and this figure is projected to rise to 30 million within 20 years (WHO, 2006). Not only are health issues like heart disease a nd cancer on the rise, but diabetes as well. The number of persons with diabetes in the Un ited States recently increased by approximately 50 percent from 10.1 million in 1997 to 15.2 million in 2004. Diabetes-related doctors visits have also increased by approximately 41 percent duri ng this period (CDC, 2006), reflecting a strong correlation with obesity (USDA, 2004). Approximately 3.2 milli on deaths every year, or six deaths every minute, are attribut able to complications of diab etes (WHO, 2006; Brunton, White, & Renda, 2005). In a country where fat-laden, fast food is av ailable on just about every street corner, obesity in adults and children has also become a definite part of Americas health crisis. In a testimony before the House Committee on Governme nt Reform, U.S Agricu ltures Eric Bost said, Mr. Chairman, we all know that America is experiencing an epidem ic of obesity with adults as well as children. About 60 million Am erican adults are obese and 64% of adults aged 20-74 are either overweight or obese. Overweight persons live an average of 3 years less; obese persons live an average 7 y ears less. Recent trends among children are alarming. In the past 20 years, the percentage of children who are overweight has doubled and the percentage of adolescents who are overweight has more than tripled. (USDA, 2004). U.S. Surgeon General Richard Carmona said, America's obesity epidemic will dwarf the th reat of terrorism if the country does not reduce the number of people who are severely overweight (The Guardian, 2006). The American Academy of Pediatrics has estimated that one in five teens, or 20 percent, in the United States is overweight. In addition, obese adolescents with a body mass index children at or above the 95th percentile have a greater risk of b ecoming obese adults (Petrillo & Meyes,1999; Dietz, 1998).
12 Approximately 280,000 deaths a year are attributed to obesity among U.S. adults (Allison, et al., 1999; McHugh, 2006). There is a relation between higher childhood body mass indexes and disease as adults (Gunnell, Fr ankel, Nanchahal, Peters, & Sm ith, 1998; Guo & Chumlea, 1999; Tufts University, 1996; Goran & Gower, 1999; Nicklas, 1995). Moderately higher body fat at age 18 years is associated with increased rates of cardiovascular disease, diabetes (Dietz, 1998; Caprio, et al., 1995; Must, 1996) and premature death in younger and middle-aged U.S. women (Van Dam, Willett, Manson, & Hu, 2006). Aside from diseases, serious ps ychological and social consequen ces may also increase as a result of obesity. Obese adolescents often re port significant depression and lower self-esteem and impaired academic success (Kuczmarcki, 1993). Other psychological and social consequences among women who are obese during a dolescence include completion of fewer years of education, higher rates of poverty, and lower rates of marriage and household income (Dietz, 1998). Since poor dietary practices are a leading cont ributor to the development of obesity and chronic diseases, these issues could be effec tively addressed during adolescence by teaching and encouraging good nutritional habits to young people. Adolescents dietar y needs are greater during this period of rapid growth and high-energy expenditure. However, they need guidance in making healthy nutritional choices. When they l earn the importance of these choices, it can have a positive impact on the development and mainte nance of healthy eating habits throughout adulthood (Petrillo & Meyes, 1999). Since research has revealed a connection betw een the diets of children and adolescents and the diseases and premature death of adults, the diets of young people r ecently have started receiving more attention (Rocke tt & Colditz, 1997). For exampl e, children eat more food per
13 body mass than adults (Hood, 2003). Therefore, it is important to be concerned about the higher amount of toxic chemicals they may consume wh en eating conventional produce versus organic (National Research Council, 1993; Benbrook, 2003). Research ha s shown that organic diets provide protection against pesticide exposure in children (Mangels, 2006). Food that has been grown without artificial chemicals, additives, and pesticides is considered organic. The originally proposed food label for organic foods was a shield similar to the one that is displayed on m eat, eggs and other government-inspected foods. However, in response to the National Food Processors A ssociation, a trade group made up mostly of conventional food processors, the la bel was changed to either a brow n and green circle or a black and white circle (Burros, 2000; Neal, 2004). Source: http://www.ams.usda.gov/no p/Consumers/brochure.html The Agricultural Marketing Service of th e USDA specifies these descriptions and requirements for organic labels: % Organic Products must contain (e xcluding water and salt) only organically produced ingredients. Organic Products must consist of at least 95% organically produced ingredients (excluding water and salt). Any remaining i ngredients must consist of nonagricultural substances approved on the National List or non-organically produced agricultural products that are not commercially available in organic form. The USDA seal and the seal or mark of involved certifying agents may appear on product packages and in advertisements.
14 These foods cannot be produced using excl uded methods, sewage sludge or ionizing radiation. Made with Organic Ingredients Products contain at least 75% or ganic ingredients and can use the phrase made with organic ingredie nts and list up to three of the organic ingredients or food groups on th e principal display panel. They cannot be produced using excluded meth ods, sewage sludge or ionizing radiation. The percentage of organic conten t and the certifying agent seal or mark may be used on the principal display panel. However, the USDA seal cannot be used anywhere on the package (AMS, 2002). Certification is an important part of the Na tional Organic Program and this ensures that organic growers and handlers are following the la w. Certification is handled by agencies accredited by USDA. As of December 2002, more than 70 agencies were accredited. Anyone who wants to sell products labeled as organ ic and grossing over $5000 annually must be certified (OTA; Neal, 2004). This includes produ cers of organic livestock, food and fiber crops and anyone who receives, processes, packages or stores agricultural products (OTA; Keen, 2003). The certification process focuse s on three main requirements: 1 Methods and materials used in production must meet organic standards. 2 Clear and ongoing documentation of produc tion methods and materials must be provided. 3 There must be proper paperwork to trace a produ ct back to its production site in order to verify the production methods and materials (OTA). Organic farmers are responsible for creating a buffer zone to prevent drift of pollutants, pesticides and non-organic seeds or pollen onto their land when gr owing crops. Their fields may not have had pesticides or other prohibited subs tances applied for three years before planting. Seeds must be produced under the organic standard s and farming should maintain or improve the fertility of the soil, minimizing erosion and runoff. Crops should also be rotated to renew soil.
15 Farmers cannot use manure or sewage sludge fe rtilizers on crops for human consumption (OTA; New York Times, 2002). Pesticides, except for botanical and those approved on the National List, are not allowed (OTA, Neal, 2004). Farmers who are raising organic livestock must feed their animals organic feed. The feed may not contain plastic pellets (used experimentally for roughage ), urea (a synthetic protein), poultry litter (a mix of waste and bedding fed to ca ttle), manure or parts of slaughtered animals. Animals cannot receive growth drugs or hormone s and only approved vaccines may be used for sickness. Sick animals must be treated and medical treatment may not be withheld to maintain an animals organic status. If organic methods fail, further treatment must be given and the animal may be kept or sold on non-organic mark ets. The animals must have outdoor access for fresh air, freedom of movement, exercise, sunlig ht, shade and stress reduction (OTA; New York Times, 2002). As part of the Organic Foods Production Act of 1990, Congress mandated a uniform National List of materials th at can and cannot be used in organic production, processing and handling in the United States. The NOSB reco mmends the materials on an ongoing basis to the USDA Secretary and the Secretary makes the final decision. An advisory panel researches data and makes recommendations to the NOSB based on: Effect on human health. 2 Effect on the farm ecosystem. 3 Toxicity and mode of action. 4 Availability of gentler alternatives. 5 Probability of environmental contamination during manufacture, use and disposal. 6 Potential for interactions with other materials used. 7 Overall compatibility with a syst em of sustainable agriculture. (OTA) It is questionable how much adolescents typically know about the importance of eating organic fruits and vegetables. There is a co ntinued need to further examine the diets of
16 adolescents and educate and encourage them on the importance of establishing healthy dietary habits. Adolescents are beginning to make decisions that can have a significant impact on their health the rest of their lives. In particular, fe male adolescents are of particular interest as the primary caregivers and nutritional decision makers in their future families. Therefore, this study examines adolescent girls decision making and their diets, with the intent to determine their attitudes, knowledge and beliefs about the bene fits of eating organic fruits and vegetables.
17 CHAPTER 2 LITERATURE REVIEW Adolescence and Diet The period between adolescence and adulthood is a tim e of mental, physical and social change. Adolescents make decisions and develop habits that ofte n continue into adulthood. In fact, evidence indicates that dietary patterns esta blished during adolescen ce can be a significant predictor of food intake in adulthood (Lake, et al., 2006; Adamson, et al., 2004). Research has shown that when adolescents ages 13 -16 are equi pped with adequate information, they can make healthcare decisions as wisely as adults (Managed Care Weekly, 2004). Childrens decision-making influence as consumers of food and in the family food shopping process is still a relativ ely unexplored area. One study of 10 -13 year olds from 20 families, and surveys from 451 families, revealed that children participate in and influence family food decisions (Mikkelsen & Norgaard, 2004) However, some research has shown that childrens participation in the decision processe s about food choice can have an important effect on the familys meals and eating habits (Christensen & Romero, 2006). One study of 92 families which included adolescents between 12 and 18 years old, showed that families in which adolescents had more influence in the food purch asing tended to eat le ss healthier food choices (De Bourdeaudhuij & Van Oost, 1998). Adolescents have high nutritional require ments during this period of growth and development and consuming a diet rich in fruits and vegetables is particularly important (Neumark-Sztainer et al, 2003; St ory & Alton, 1996). Developing healthy eating patterns during adolescence also may lead to continued heal th eating patterns during adulthood (NeumarkSztainer et al, 2003; Kelder, Pe rry, Kelpp, & Lytle, 1994). Howeve r, studies have shown that
18 food choices for the population of a dolescents are not consistent w ith the Dietary Guidelines for Americans (Story, et al, 2002). Adults who regularly eat fruits and vegetabl es are those who often consumed these foods during childhood (Krebs-Smith, Co ok, Subar, Cleveland, & Ka hle, 1996). However, the percentage of children and adolescents who ar e regularly consuming fruits and vegetables appears to be low. Studies reveal that preschool children consume approximately only 80% of the recommended fruit servings per day and onl y 25% of the recommended vegetable servings per day. As a result, young peoples low intakes of fruits and vegetables cause inadequate intakes of vitamin A, vitamin C, and dietary fibe r and high intakes of total fat and saturated fat (Dennison, Rockwell, & Baker, 1998). A diet low in fruits and vegetables is not the only nutritional concern regarding adolescents. Adolescents consume a high intake of unhealthy fast foods. As a child becomes older his diet does not seem to improve. At leas t one-third of teens eat many of their meals away from home (Whitney and Rolfes 1999). Erratic eating behaviors, such as skipping meals, are also prevalent especially among girls (Story et al, 2002). The Centers for Disease Control and Prevention (2000a) provide the following statistics of the average adolescent diet: More than 84% of children and adolescents eat too much total fat on a daily basis. More than 90% eat too much saturated fat. On the average, young people get 33 34% of their calories from total fat and 12 -13% of their calories from saturated fat. Children and adolescents eat only 3.6 servi ngs of fruits and vegetables daily, and a significant portion of those vegetables are derived from fried potatoes. One in five children eat five servin gs of fruits and vegetables daily. 51% eat less than one serving a day of fruit, and 29% eat less than one serving a day of vegetables that are not fried.
19 The average calcium intake of adolescent girls is about 800 mg a day. (Recommended daily allowance for adolescents is 1,200 mg of calcium a day) (Whitney and Rolfes, 1999; Petrillo & Meyers, 2002, p.293). Benefits of a Plant-based Diet Substantial health benefits could result from encouraging adolescents to consum e organic fruits and vegetables as part of a plant-based di et. This could have positive implications for their health throughout their lives. T. Colin Cam pbell (1994), professor of nutritional sciences at Cornell University, and Chen Junshi, deputy dire ctor of the Institute of Nutrition and Food Hygiene in Beijing, conducted a comprehensive study of diet, lifestyle, and disease on 6,500 individuals living in 65 counties in rural and suburban China. Results revealed that Western diets, which include a higher intake of animal versus plant-ba sed food products, are related to greater incidences of obesity, high er levels of plasma cholestero l, and increased risk for cancer and heart disease. Campbell and Junshis recommendations were: Ignore the widespread dietary recommendations on the numbers of servings from each food group and the daily intake for grams of pr otein. Eat generous variety and amounts of roots, stems, leaves, flowers (such as broccoli florets), s eeds, and fruits, and eliminate animal products. Even small increases in th e consumption of animal-based foods was associated with increased disease risk (Henderson, 1994; Segelken, 2001). Atherosclerosis, the underlying cause of corona ry heart disease, currently threatens one of every two Americans and is predicted to beco me the number one global disease burden by the year 2020. However, atheroscleroti c disease does not discriminate by age and has been shown to be present even in young adults. For example, in one study 2,876 people between the ages of 15 and 34 who had died of external causes, were examined for signs of this disease. Lesions not only appeared in all the aortas and more than half of the right coronary ar tery in the youngest age group (15-19 years), but also increased in prevalence and extent with age through the group (3034 years) (Strong, Malcom, McMahan, Tracy, Newm an, Herderick, & Cornhill, 1999; Esselstyn, Jr., 2001). Participants from the Korean and Vietnam wars, the Bogalusa study, and the
20 Pathological Determinants of At herosclerosis in Yout h study, also have shown the widespread nature of the disease in young Americans. Howeve r, this disease is virt ually absent in cultures that eat plant-based diets, such as the Tara humara Indians of northern Mexico, the Papua highlanders of New Guinea, and the inhabitants of rural China and central Africa (Esselstyn, Jr., 2001). The American Heart Association and the National Cholesterol Education Program recommend that people consume no more than 30 % dietary fat and maintain cholesterol levels below 200 mg. Yet, numerous studies conf irm that people who adhere to these recommendations experience progression of the disease rather than arrest and reversal (Esselstyn, Jr., 2001; Jan, Jenkins, Jenkins, Kendall, Vuksan, & Vidgen, 2000). In 1990, The Lancet published the findings of Dean Ornish, M.D ., who demonstrated that heart disease can actually be reversed through eati ng a plant-based diet and without medicines (Ornish, Brown, & Scherwitz, 1990). A 28-day study of 120 men and women between th e ages of 30 and 65 revealed that adding fruits, vegetables, nuts and whole grains may reduce LDL cholesterol levels more effectively than focusing on lowering fat intake alone (Clinicians Publishing Group, 2005). Another study showed that people who adopt a ve getarian diet can reduce their sa turated fat intake by 26% and achieve a significant drop in cholesterol levels in just six weeks (Masarei, Rouse, Lynch, Robertson, Vandongen, & Beilin, 1984; Steffen, Jacobs, Jr., Stevens, Shahar, Carithers, & Folsom, A.R., 2003). A study from Stanford University School of Me dicine revealed a lo w-fat diet rich in vegetables, fruits, whole grains, and beans ha s twice the cholestero l-lowering power of a conventional low-fat diet (Consumers Medical Journal, 2004). Another study of 22 patients
21 also revealed that a diet of gr ains, legumes, lentils, vegetables, and fruit can reduce cholesterol levels to below 150 mg (Esselstyn, Jr., Ellis, Me dendorp, & Crowe, 1995). In fact, vegetarian diets can reduce serum cholesterol levels to a much greater degree than is achieved with the National Cholesterol Education Program Step Tw o diet (Cooper, Goldberg, & Trevisan, 1982; Cabral, Melo, Amado, & Santos, 1989; West & Hayes, 1968; Sacks, Ornish, Rosner, McLanahan, Castelli, & Kass, 1968; Burslem, Schonfeld, Howald, Weidman, & Miller, 1978). Eating a plant-based diet primarily of fruits and vegetables not only has a positive impact on the prevention and reversal of heart disease but also on cancer The World Cancer Report predicts that worldwide new cases of cancer will increase by 50% by 2020 (Nutrition & Food Science, 2006). A diet of raw fruits and vegeta bles has been tested and shown to suppress cancer growth (Robinson, Hunsberger, & Westall, 1994). In addition, can cer rates for vegetarians are 25% to 50% below population averages (ChangClaude, Frentzel-Beyme, & Eilber, 1992; Thorogood, Mann, Appleby, McPherson, 1994). In 1995, the American Cancer Society released new dietary guidelines which includ ed urging Americans to eat foods from plant sources (American Cancer Society, 1996; Welland, 1998). Researchers believe that fruits and vegetables help protect ag ainst cancer in several ways. They contain nutrients, such as vitamin C, vitamin E, and carote noids, which act as antioxidants to help reduce cellular damage caused by harmfu l free radicals (Jacob & Burri, 1996). Another benefit of fruits and vegetables is the fiber they provide to help move waste through the digestive tract, leaving less time for t oxic compounds to harm the colon and helping curb precancerous polyps. Fiber also helps eliminates excess estr ogen (Walsh, 2001). Plant-based diets also may encourage a later menarche for girls, which has been shown to be associated with the reduced risk of breast cancer (de Ridde r, Thijssen, Van 't Veer, van Duuren, Bruning, Zonderland, &
22 Erich, 1991). Thirteen case-control studies provided substantial evid ence that increased intake of fiber-rich foods, such as fruits, vegetables, ce reals, and legumes, may decease the risk of both colon, rectal, and pancreatic cancers (Howe, Bentino, & Cast elleto, 1992; Trock, Lanza, & Greenwald, 1990; Chan, Wang, & Holly, 2005). Encouraging adolescents to cons ume organic fruits and vegetabl es as part of a plant-based diet also could have positive implications for their health in regards to preventing obesity. Research has shown that those who consume a vegetarian diet maintain a lower body mass index (BMI) than non-vegetarians (Barnard, Scial li, & Turner-McGrievy, 2005; Ellis, Path, & Montegriffo, 1970). A study of 55,000 women who were either semi -vegetarians (who eat some meat, diary and eggs), lacto-vegetarians (w ho consume milk but not meat or eggs), vegans (who consume no animal products), and omnivores (who eat all foods), showed that all the vegetarian women had a lower risk of being overweight or obese than the omnivorous women (Bliss, 2006). In addition, a study of 2,909 18to 30-year-olds also revealed that consuming high-fi ber plant-based diets may protect against obesity by lo wering insulin levels (Ludwig, Pereira, Kroenke, Hilner, Van Horn, Slattery, & Jacobs, Jr., 1999). Creation of Organic Labeling Standards Many consum ers have an interest in knowing that their food is safe to eat. A November 1998 nationwide survey found that eighty-nine percen t of U.S. consumers think food safety is a very important national issue. In fact, they think its more important than crime prevention. A 1999 poll found that 81% of American consumers believe that genetically engineered food should be labeled. National surveys indicate that 80% of consumers also worry about pesticide residues on food, especially when it c oncerns their children (HEALL, 2000).
23 Even though organic foods account for only two percent of food sold in the United States (K. DiMatteo, personal communication, March 2 6, 2004), it has become a $22 billion dollar industry (Robbins, 2001). The total number of certified acres dedicate d to organic farming increased from 1,347 in 1997 to 2, 344 in 2001 (U.S. Census Bureau, 2003). Research reveals that the customers purchasing orga nic foods are not just represented by one ethnic group. In fact, Asian-American, African-Americans and Hispanic -Americans are all more likely to choose organics for food purchases than Caucasians. It is not necessarily wealthy consumers either. The average income is $43,280 (Lipson, 2003). As the organic industry has increased, requirements for strict, uniform standards also has increased. Only private and state agencies had previously been certifying organic practices and what constituted organic varied from state to state (OTA). Washingt on State became the first state to develop organic sta ndards and implement an organi c certification program in 1988. Colorado, Idaho, Iowa, Indiana, Kentucky, Mary land, New Hampshire, New Mexico, Nevada, Oklahoma, Rhode Island, and Texas followed (FAS, 2003). However, the organic industry lobbied to have the government implement a national policy for the labeling of organic foods. Orga nic farmers, anti-pesticide, environmental and other trade and consumer groups met with U.S. Senator Patrick Leahy of Vermont. These groups educated Leahy and his staff and helped to create a bill requiring the development of national organic standards. Congressman Peter DeFazio of Oregon presented it before the House as an amendment to th e 1990 Farm Bill. The House a nd Congress approved it and The Organic Foods Production Act of 1990 was created (USDA; Ingersoll, 1997; Greco, 2000; K. DiMatteo, personal communi cation, March 26, 2004).
24 The Organic Foods Production Act of 1990 author ized the formation of a National Organic Program to establish organic standards and to require and oversee manda tory certification of organic production (OTA). Un ited States Department of Agri culture Secretary Dan Glickman appointed a fifteen-member Natio nal Organic Standards Board (NOSB) to assist him in developing standards to be used in organic production (USDA) Members of the NOSB serve for five-year terms and must include: four farm ers; two handlers/proces sors; one retailer; one scientist; three consumers/public interest advocates ; and three environmentalists (OTA). At a meeting in Orlando, Florida in 1995 th e NOSB decided on the following standard definition of organic. Organic agriculture is an ecological production manageme nt system that promotes and enhances biodiversity, biological cycles and soil biological activit y. It is based on minimal use of off-farm inputs and on manage ment practices that restore, maintain and enhance ecological harmony. Organic is a labeling term that denotes products produced under the authority of The Organic Foods Production Act. The principal guidelines for organic production are to use materials and practices that enhance th e ecological balance of natural systems and that integrate the parts of the farmin g system into an ecological whole. Organic agriculture practices cannot ensure th at products are completely free of residues; however, methods are used to minimize polluti on from air, soil and water. Organic food handlers, processors and retaile rs adhere to standards that maintain the integrity of organic agricultural products. The primary goal of organic ag riculture is to optimize the health and productivity of interdependent co mmunities of soil life, plants animals and people (OTA). In 1997 the USDA released a proposed National Organic Program (FAS). However, this was not acceptable to those in favor of orga nic standards because it allowed irradiation, genetically modified foods, antibiotic-laced animal meat or sewage sludge-treated crops to be labeled as organic. Essentially, there woul d not be a difference between organic and nonorganic production. (Greco, 2000; Priest 2001; Robbins, 2001; DiMatteo, 2004).
25 Those in favor of strict organic standards su ch as The Organic Trad e Association, Organic Consumers Association and National Campaign for Sustainable Agriculture organized a grassroots campaign against the first proposal. They posted noti ce on the Federal Register, the official daily publication for rules, proposed rules, and notices of Federal agencies and organizations (Merrigan, 2004; DiMatteo, 2004; GPO Access). They placed information, postcards and petitions in stor es like Patagona Clothing, Whole F oods Market and Wild Oats. Working Assets, a long-distance company that gives proceeds to non-profit organizations, put inserts in its phone bills (D iMatteo, 2004; Merrigan, 2004). The media also played a significant role in this campaign. There we re articles in every major newspaper. Radio and television interviews were conducted. Katherine DiMatteo, Executive Director of the Organic Trade Association, was surprised by the amount of coverage since the organic industry is not a large industry and does not support the media through advertising. Kathleen Merrigan, pr ofessor at Tufts University, said it was the typical David and Goliath story that probably drew media attention. It was an unusual situation of the smaller organic industry fighting the government and larger agribusiness (DiMateo, 2004; Merrigan, 2004). As a result, concerned consumers res ponded. They contacted their congressional representatives and President Clinton (Priest, 2001; Robbins 2001). Various leaders of nonprofit organizations such as Fr iends of the Earth, Natural Res ources Defense Council, League of Conservative Voters, Physicians for Social Responsibility, etc., wr ote a letter to USDA Secretary Dan Glickman stating that the recentl y proposed National Organic Program threatened to undermine the significant ecological gains promised by passage of the 1990 Act (CFFS).
26 Postcards, letters and emails were sent to the USDA (Robbins, 2001). In fact, this was the first time that the public could send electronic responses to the USDA regarding a governmental rule. As a result, the USDA received over 275,000 responses from consumers and industry groups, the largest amount of responses to any regulation ever posted and the second largest for any federal agency (DiMatteo, 2004). Prior to The Organic Foods Production Act of 1990 the USDA was not involved in organic foods. After Congress passed the law, Arthur N eal, Agriculture Marketing Specialist for the USDA, said the USDAs main role was to create fair and consistent organic standards. People werent held accountable pr ior (A. Neal, personal communication, March 23, 2004). After more deliberations, the USDA released th e United States first official standards for organic labeling on December 20, 2000. After an 18-month certificat ion period the new government standards were to begin in June 2002 However, due to paperwork delays, the new organic labeling was enacted on October 21, 2002. As of that date producers and handlers must be certified by a USDA-accredited cert ifying agent to sell, label or represent their products as percent organic, organic, or made w ith organic (Keen, 2003; Robbins, 2001; Neal, 2004; AMS). The new standards apply to all or ganic food products imported into the United States (Keen, 2003). Conventional Versus Organic Produce Pesticides contam inate more than 94% of f oods, and studies have shown that continuous exposure to them can cause cancer and other degenerative diseases. In 1968, researchers found that patients who died from liver cancer, brain cancer, multiple sclerosis and other degenerative disease had significantly higher tra ces of pesticides in their brains and fatty tissues than those who died from other dise ases (Contreras, 2002).
27 According to the 2003 U. S. Census Bureau, a total of 511.1 million pounds of herbicides, insecticides, fungicides and othe r pesticides were used on vege tables and fruit in 2001. In a sampling of supermarket produce, conventional produce was more than three times as likely to contain residues of toxic pesticides than organic produce (HEALL, 2000; Baker, Benbrook, Groth, & Benbrook, 2002). Pesticides also have been shown not to help protect against E. coli and other pathogens. Research conducted at the University of Ma nitoba in Winnipeg shows that pesticide sprays actually encourage life-threatening bacteria to grow on crops. Numbers of E. coli could increase one-thousand fol d, said lead researcher Greg Blank, who found that the lifethreatening microbes flourished in many pesticides (Robbins, 2001). Children consume not only more food per kilogr am of bodyweight than adults but also a much less varied diet. As a re sult, exposure to a pesticide from consumption of a given food is greater per kilogram of infant/child bodyweight compared to adults (National Research Council, 1993; Benbrook, 2003). Nearly three-qua rters of the fresh fruits a nd vegetables consumed most frequently by children in the U.S. contain re sidues and almost half the fruit and vegetable samples tested from 1994-1999 in the pesticide Data Program contain two or more residues (Baker et al, 2002). In general, soft-skinned fru it and vegetables tend to contain residues more frequently than foods with thicker sk ins, shells, or peels (Benbrook, 2003). One study compared children who ate produce th at was at least 75% organic with those who ate at least 75% non-organic produce. Results of this study found that children who ate primarily organic produce and juice had one-sixth the level of pesticide byproducts in their urine compared with children who ate non-organi c food (Curl, Fenske & Elgethun, 2003). Adolescents are also aware of the risks of pesticides. One study surveyed 669 high school students in New York City and re vealed that more than 63% were worried that pesticides might
28 leak into the drinking water supp ly, and more than 54% were c oncerned that the way in which animals are raised for food damages the environmen t. Fifty-eight percen t also indicated it was important that foods be grown w ithout pesticides and herbicides (Bissonnette & Contento, 2001). In a study of high school seniors, more than 69% understood that conventional farming practices require the use of pestic ides or herbicides. More than 51% of the participants agreed that conventional farming practices are harmful to the environment and will need to change, more than 73% agreed that organic foods are be tter for the environment, and more than 74% believed consuming organic foods was better for their personal health. More than 55% also considered organic foods more e xpensive to purchase, but more th an 45% considered them better in taste. In addition, almost 70% of the seni ors indicated that more organic foods should be available (Bissonnett e & Contento, 2001). Studies have also revealed that organic crops contained significantly more vitamin C, iron, magnesium, phosphorus, chromium, iodine, potassi um, selenium, zinc and significantly less nitrates than conventional crops (Smith, 1993; Worthington, 2001). There also seems to be higher ascorbic acid content in organically gr own leafy vegetables and potatoes (Magkos, Arvaniti, & Zampelas, 2003). Theory of Reasoned Action and Theory of Planned Behavior The Theory of Reasoned Action and The Theory of Planned Behavior provide a fra mework from which to determine and analyze beliefs that impact health behaviors (Ajzen, 1989; Ajzen, 1991; Ajzen, 1987; Ajzen & Fishbein, 1980) Both theories focus on theoretical constructs that are concerned with motivational fact ors that determines individuals likelihood that they will perform a specific be havior (Glanz, Rimer & Lewis, 2002).
29 Figure 1-1 Theory of Reasoned Action Reprinted with permission from Fishbe in, M., & Ajzen, I. (1975). Belief, attitude, intention, and behavior : An in troduction to theory and research. Reading, Mass.; Don Mills, Ontario: Addison-Wesley Pub. Co. Theory of Reasoned Action The Theory of Reasoned Action was devel oped in 1967 and focused on the relationship between beliefs (behavioral and normative), at titu des, intentions, a nd behavior (Montano & Kasprzyk, 2002). The Theory of Reasoned Action asserts that a persons behavioral intentions are determined by his attitude to ward performing the behavior and his subjective norms, or belief about whether most people important to him appr ove or disapprove of th e behavior. Fishbein showed that attitude toward a beha vior is a better predictor of a behavior than the attitude toward the target of the behavior. Fo r example, according to this theory, a womans attitude toward breast cancer is expected to be a poor predictor of a woman getting a mammogram. However, a womans attitude toward actually getting a mammogram is determin ed to be the better predictor (Montano & Kasprzyk, 2002). The main constructs of the Theory of Reasoned Action include behavioral intention, attitude, and subjective norm. Be havioral intention is the per ceived likelihood of performing the behavior. It is an indication of how much effort a person will exert in order to perform the behavior. Behavioral intention is influenced by three components. The first component is a persons attitude toward performi ng the behavior. This is either a persons favorable or
30 unfavorable evaluation of the beha vior. Subjective norm also infl uences behavioral intention. Subjective norm is the individuals belief about whether most people important to him approve or disapprove of the behavior. The influence of social pressure that is perceived by the person (normative beliefs) is weighted by the individuals motivation to comply with those perceived expectation (motivation to comply). Figure 1-2 The Theory of Pla nned Behavior. Reprinted with permission from Eagly, A. H., & Chaiken, S. (1993). The psychology of attitudes. Fort Worth: Harcourt Brace Jovanovich College Publishers Theory of Planned Behavior The Theory of Planned Behavior is not an independent theory. Instead, this theory is an extension of the Theory of Reasoned Action (G lanz, Rim er & Lewis, 2002). The Theory of Planned Behavior includes an a dditional construct that influen ces behavioral intention called perceived behavioral control. This construct is the individuals belief about his control over the behavior and how easy or difficult it will be to perform (Montano & Kasprzyk, 2002; Brown, 1999). Ajzen observed that the Theory of Reas oned Action was valuable when describing behaviors in which the individua l can make a conscious choice. However, if adopting the behavior requires opportunities, reso urces, or skills, the person has a lack of control. The concept
31 of perceived behavioral contro l was added to the original Theory of Reasoned Action since perceived behavioral control can apparently in fluence intention (Godin & Kok, 1996). Perceived behavioral control is determin ed by control beliefs and perceived power. This construct indicates that a persons motiva tion is influenced by how difficult he perceived the behavior to be and if he can successfully perform the activity (Montano & Kasprzyk, 2002; Brown, 1999). Many factors often influence how adolescents make decision s (Fischhoff et al., 1999). According to the Theory of Planned Behavior, an adolescents decision may be predetermined by norms perceived to be held by a significant other or peer group. The effectiveness of this model has been demonstrated in a variety of health behavior studies, includ ing research on weight reduction (Sejwacz, Ajzen, & Fishbein, 1980; Sa ltzer, 1981) and cigarette smoking (Langer & Warheit, 1992; Chassin, et al, 1981), exercise behavior, and eating behavior (Godin & Kok). The Theory of Planned Behavior also has appeared useful for examining food choice among adolescents (Dennison & Sh epherd, 1995; Gummeson, et al ., 1997; Mesters & Oostveen, 1994). For example, this model was used to st udy Swedish schoolchildrens choices for milk types (low-, medium-, and full-fa t) and high-fiber bread for breakfast. It was found that attitudes were important predictors of intentions to consume each milk type and high-fiber bread. For all milk types, the beliefs about taste and health ma de the greatest contribu tion to the prediction of attitude. Those who ate high-fiber bread had a mo re positive attitude to ward high-fiber bread. The relationships between subjective norm and normative belief suggest that parents were important influences in the childrens choices for breakfast (Berg, Jonsson & Conner, 2000). A study of 780 high school students in San Bernardino, California was conducted to identify predictors for adolescents health di etary practices using the Theory of Planned Behavior. The results showed th at the intention to eat a healthful diet was a predictor of
32 healthful dietary behavior. Those with positive attitudes toward healthful eating believed they would like the taste of healthful foods, feel good about themselves, tolerate giving up foods they like to eat, and lose weight or ma intain a healthful weight. Mothers, siblings, and friends were identified as important influen cers in decisions about healthy eating. Knowledge about how to eat a healthful diet, availability of health ful floods, motivation, and access to enough money were also factors related to this behavior contro l. Attitude seemed to be a stronger determinant of intention than subjective norm and percei ved behavioral contro l (Backman, Haddad, Lee, Johnston & Hodgkin, 2002). One study examined how well the Theory of Pl anned Behavior predicted the consumption frequency of fruit and vegetables among adoles cents, and whether gender or socioeconomic status had any effects on the relationships be tween the constructs. More than 1400 seventhgrade students from eight middle schools were surveyed to measure how often they consumed fruit juice, fruit, green salad, potatoes, carrots, and other vegetables durin g the year. How often the children ate fruits and vege tables and frequency of attitude s, subjective norms, barriers, and intentions were measured. The results showed no significant direct eff ects of attitudes and subjective norms on behavior. Gender appeared to have moderating effects on the relationships between attitudes and intention a nd between intentions and behavi or in the model. However, large proportions of the variance in frequency of the childrens consumption of fruits and vegetables were unexplained. There appeared to be strong relationships between subjective norms or barriers and intentions as well as gende r differences that may have implications for future intervention methods or messages (Lien, Lytle, & Komro, 2002).
33 The Media as a Source for Nutritio nal Information for A dolescents Adolescents are at a life stage where th ey are forming their personal identity and developing a personal system of beliefs a nd values (Bissonnette & Conteneto, 2001; Cobb, 1992), and most of them seem to be turning to the media for entertainment and information. Studies have found that 26% of children aged 6 to 14 are using a variety of media at one time. Sixty-nine percent have a television in their room and consume an average of 24 hours of digital cable per week. They also are using broadband on their computers for an average of 17 hours a week. Many adolescent have their own cell pho nes and are sending an average of 14.4 text messages and making 8.8 calls each day (Oser, K., 2005). The media, particularly advertising, can have such a powerful influence on children and adolescents. The American Psychological Associ ation has stated that children ages eight and younger lack the cognitive ability to recognize advertisings persuasive intent (APA, 2004). Therefore, most children older th an eight have at least an init ial understanding that advertising aims to sell products (Moore, 2004; Macklin, 1987; Roberts, 1982). However, researchers from the Nielsen Norman Group found that children in grades one through fi ve cannot distinguish between advertising and actual content on Web s ites, even when the ads are clearly marked (eSchool News, 2002). Research also showed that female adoles cents remembered more facts, made more inferences, reported stronger emoti onal responses, and detected th e explicit claim of the visual advertisements than males (Edens & McCormick, 2002). Another study was conducted to determine the difference between the abilities of teen agers and adults to recall and recognize advertisements. Results showed that teenager s 18 years and younger ha d greater brand recall and recognition than 18-to-34year-old young adults (Dubow, 1995).
34 Since the media have such a powerful influen ce on children and adolescents, they could be used as effective tools to educate and encourag e adolescent girls to c onsume organic fruits and vegetables. However, it may be helpful to ex amine what types of f oods are presented by the media and how they may be influencing adolescents dietary choi ces and behaviors. Television can provide food information in a variety of ways that include advertising, entertainment programming, and news. For example, one study examined television advertisements that aired during top-rated, prim e-time network programs. In a sample of 700 commercials, 42% contained food-related content in the form of verbal, written, or visual references. Advertisements promoting fast food sandwiches were shown most often which resulted in references to breads, cereals a nd proteinrich foods. Co mmercials showing low nutrient-density foods, along with foods in th e fats, sweets and alcohol group, exceeded the advertisements to both high and moderate nutri tion-density foods combined. There were 527 visual references, the most fre quent being vegetables. This wa s primarily due to salad dressing advertisements that showed a variety of salad ingredients and pizza advertisements featuring vegetable toppings. In addition, re ferences to fruits and dairy products almost never occurred (Byrd-Bredbenner & Grasso, 1999). Children ages 2 to 17 watch an average of 22 hours of television per week and are exposed to approximately 20,000 commercials a year. Studies have shown that 56% of these advertisements are for food (Boynton-Jarrett, Thomas, Peters on, Wiecha, Sobol & Gortmaker, 2003). In one study researchers analyzed programming on ABC, CBS, NBC, Fox and Nickelodeon between 7 a.m. and 10:30 a.m. on three different Saturdays in 1991 and 1992. Of the 997 total commercials, 11 of those advertisemen ts per hour were for food. More than 43% of the commercials were for foods belonging to the fats, oils, and sweet food group (candy; cereals
35 with sugar as main ingredient; soft drinks; ch ocolate products; whippe d topping; cakes, cookies and pastries; and flavored gelati n). Bread, cereals, rice and pasta represented more than 37% of the ads and more than 10% were fast-food restau rant ads. There were no advertisements for fruits or vegetables (Getty & Evers, 2004). It is interesting to note the type of nutrition information that African Americans may be receiving through television adve rtising and entertainment prog ramming. Studies have shown that African Americans watch more television and have a higher prevalence of obesity than the average American. Research also reveals they are more likely to watch shows with predominantly African American characters. In a study of the four mo st-watched situation comedy television shows among the general popul ation (general prime time) and among the African American population (black prime time), black prime time shows featured a greater number of overweight characters than programs intended for a general audience. Food advertisements, particularly those for candy and soft drinks, were also run more often during African American entertainmen t television programs than during other programs (Tirodkaar & Jain, 2003). Nutrition Coverage in Newspapers The second most popular m edia source among consumers for nutrition information is newspapers. In a study of newspaper coverage of childhood nutrition policies, a sample of news reports, editorials, letters and opinion pieces pr inted in California newspapers from July 1998 through August 2000 were analyzed. Almost one-third of the articles appeared on the front page of their section, and 14% appeared on A1 of the newspaper. The prominent placement of food and nutrition coverage in newspapers may indicat e a strong appeal and newsworthiness for these types of stories (Woodruff & Dorfman, 2001).
36 It is also interesting to examine which s ources newspaper reporters rely on for nutrition stories. This study showed that the most commonly quoted sources were advocates, which included nutritionists, researcher s or other public health professi onals, for various food policies and other professionals from the field. Nutritioni sts and dieticians were also quoted in 23% of the newspaper stories. This seems to indicate th at nutrition advocates and professionals are often well represented and are giving impor tant input regarding nutritiona l issues in newspaper stories (Woodruff & Dorfman, 2001). The largest single topic in this sample of ne wspaper articles was advi ce on what to pack in childrens lunch boxes a nd how to please finicky eaters. Food safety, including articles on pesticides and regulation of food processing plants that make foods that are served in school cafeterias, and milk pricing and other issues related to the regulation of the dairy industry in California followed in frequency. Other article s regarding new research on obesity and school breakfast programs and other food service issues ranked fourth and fifth in frequency of appearance in newspaper articles. One quarter of the stories in this sample had a specific local angle, such as stories about soda pouring contra cts in schools or organiconly policies for school food service. In general, smaller newspapers were more likely to use wire services such as Associated Press or Reuters, indi cating they may not have the staff to dedicate to researching and writing about nutrition issues (Woodruff & Dorfman, 2001). Nutrition Coverage in Magazines Another print m edium from whic h the public receives nutrition information is magazines. Four experts in nutrition and food science i ndependently judged th e quality of 200 nutrition articles in 20 top-circulating magazines be tween January 2000 and D ecember 2002. Articles were rated according to factual accuracy, presentation and re commendations. The magazines were ranked as excellent (100-90% ), good (89-90%), fair (79-70%), or poor (below 70%). Four-
37 fifths of the magazines included in the survey were rated good sources of nutrition information. Only one-fifth scored in the fair or poor range ; however, none of the ma gazines nutrition content was considered excellent (Meister, 2004). This study revealed that the quality of the nut rition articles in the consumer and home magazine categories (e.g. Parents, Consumers Reports, Cooking Light, Better Homes and Gardens etc.) was significantly better than that in the girls category (e.g. Ladies Home Journal, Redbook, etc). However, three of the four magazines that received fair or poor ratings were primarily aimed at male readers (e.g. Mens Fitness, Muscle and Fitness etc). These magazines had a tendency to exaggerate the signif icance of questionable scientific links between foods and health effects and to omit important he alth information regarding dietary supplements (Meister, 2004). Researchers found that the magazines with the highest scores included some articles with noticeable errors and weaknesses regarding heal th and nutrition topics. However, the lowestscoring magazines also included so me well-researched articles. Th e results apparently indicate that many of todays magazines are providing consumers with scie ntifically sound articles about nutrition. However, there seems to be need for improvement, particularly in magazines aimed at male readers (Meister, 2004). A content analysis of 30 issues of three popular teen magazines, Seventeen, Sassy, and Young Miss, each published during January 1988 to March 1989, revealed that 5% of the articles were health-related. The proporti on of advertisements in all the magazines was 46% with health and hygiene representing 4% of that total. Mi scellaneous ads for weight loss and fat camp services were also included in two of the magazines (Evans, 1991). Another study was conducted of 132 Seventeen magazines published in even years from 1970 to 1990. Articles over
38 one page in length where the primary subject wa s nutrition-related, focused either on weight loss plans, or on nutrition information such as vitamins fiber or fat. Brief highlights, columns, and advertisements primarily feat ured cooking tips and food inform ation, nutrition information, or career opportunities in foods or nutrition (Guillen & Barr, 1994). Nutrition Coverage on the Internet People seek ing nutritional information are also turning to the Internet. A recent research poll found that nearly 100 million American adults use this source to find health-related information (Bergeron, 2003). Sixty-six percent of In ternet users said they use the Internet to get health information (Madden & Rainie, 2003). One study conducted in 2001 revealed that the major media Web sites involved had partnered with other Web-based health news providers such as WebMD and Medscape, providing links to a wider array of reliable health information. Unfortunately, much of the health and nutrition information remains on the partner sites and not in the media Web site content. This indicates that reliable nutrition information is available but the consumer must search past the original Web site to find it (CMPA, 2002). Cumulative Study of Nutrition Information in the Media One particular scientific cont ent analysis that has been c onducted at twoyear intervals from 1995 through 2001 has revealed both consiste ncies and changes in media coverage of nutrition information. In 2001, 40 media outlets were examined including 10 major newspapers, two news wires, 12 national magazines, 13 na tional television news programs, seven local television news stations and five major media Web sites. Thirty-nine outlets were sampled in 1999, 38 in 1997 and 37 in 1995 (CMPA, 2002). Each time researchers have conducted this study, they have found important contextual information often was not included in nutrition articles. Five specific factors that were omitted
39 regarding nutritional information were: the amount of food consumed; the frequency of consumption; the cumulative effect of regular consumption; the difference of effects on particular groups; and the use of scientific evidence to reinforce an argument. Consumers ability to make sound nutrition decisions was hampered more by the lack of information than from misinformation (CMPA, 2002). The fluctuation in priority of topics that the media chose to address was also revealed as a result of these studies. In 1999, fiber was the mo st prominent nutrition subject in the media. However, that changed in 2001 when functional foods became the most covered nutritional topic. Functional foods include general advice to eat more fru its and vegetables containing vitamins, minerals and anti oxidants (CMPA, 2002). Coverage of genetically modified foods and organisms doubled in 2001 from 1999. This was a result of claims of allerg ic reactions to a genetically engineered corn called Starlink that was accidentally put into taco shells (CMPA, 2002; Jacobs, 2003). Biotechnology components in food, food labels and food allergens also became popular nutrition topi cs in 2001. Eggs were the most commonly discussed food allergen followed by peanuts, other tree nuts, shellfish, milk, and lactose intolerance (CMPA, 2002). Weight management and obesity were also si gnificant topics of food news in 2001. The angle of articles changed from 1999 to 2001, by a margin of almost three-to-one, from the benefits of losing weight to warnings about the dangers of being overweight. However, the most commonly mentioned causes of obesity were eating too much and eating poorly. These discussions were often linked to the oversized restaurant portions and poor nutrition control when eating at home. Consuming too much s ugar, carbohydrates, and fat also were cited as causes of weight gain (CMPA, 2002).
40 These studies also revealed that scientists, dieticians, and other experts are the sources most often quoted to substantiate informati on used in food and nutrition coverage. In 2001, approximately two-thirds of these references were unnamed scientists. Food producers and culinary groups followed in frequency due to th e prevalence of article s about functional foods and debates over food biotechnology Federal government sources, environmental and consumer groups were also often cited as sources (CMPA, 2002). The results of this study seem to indicate that improvement is needed in the nutrition information that television, print media and the Internet provide consumers. Although the media primarily rely on health and nutrition experts as sources in their nutrition articles, they collectively choose to focus on a na rrow range of topics. The me dia apparently also need to provide consumers with more information to help them make s ound nutrition choices. Impact of Media on Children It is also interesting to e xamine the infl uence of media on childrens behavior. Since children often copy behavior that is modeled for them, it is possi ble to posit that there is a strong relation between childrens exposure to media and their behavior. Ted Baehr, president of the Christian Film & Television Commission states, Children learn in part by teachers presenting information and/or behavior, repeating the information and/or behavior and rewarding the accurate feedback of the information and/or behavior (1998, pg. 16). Baehr also states that media occupies more of a childs time, deliver s more information per second than parents or teachers, and children find it more entertai ning, exciting and captivating (Baehr, 1998). Children can also learn behavior at an early age. A recent Tufts University study showed that 10-month-old and 12-month-old infants could make decisions based on the emotional reactions of adults around them The infants were shown a 20-second videotape of an actress reacting to a toy with a positiv e or negative emotion. When th e actress responded to a toy with
41 fear, the babies avoided playing with it and were more likely to appear worried, frown, scowl or cry. When the actress was enthusiastic, the infa nts usually played with the toy (Tufts, 2003; Baehr, 1998). Research has also shown that children younger than six can sing commercial jingles and correctly identify company logos and trade charac ters (Borzekowski & Robinson, 2001; AAP, 2004). Research has also shown that food advertisemen ts have an immediate effect on childrens short-term food preferences. In one study, 46 two to six-year-olds from a Head Start program in California viewed a videotape of a popular childrens cartoo n either with or without commercials. The children were exposed to only one or two 10to 30-se cond food commercials. The advertisements were for popular brands of juice, doughnuts, sandwich bread, remote-control toy cars, breakfast cereal, snack cake, fast-food chicken and candy. All the commercials were 30 seconds long, except for one juice commercial whic h lasted only 10 seconds. After viewing the cartoon, the children identifie d their preferences from pairs of similar products, one of which was advertised in the videotape with embedded commer cials. As a result, the children who watched the videotape with commercials were significan tly more likely to choose the advertised items than the children who were not exposed to the commercials (Borze kowski & Robinson, 2001; AAP, 2004). Even though the participants were from lowincome households, the majority had several televisions and other media technology in their homes. Sixty-two percent had a television on most of the morning, 46% during dinner, 81% during most of the evening, and 12% during all these time periods. Forty-six per cent of parents said their child occasionally ate or drank while watching television. Thirty percent said their ch ild often or always ate or drank while watching
42 television. Thirty-two percent watched television during breakfast and 30% during dinner four or more days per week (Borzekowski & Robinson, 2001; AAP, 2004). During the week after the ch ildren watched the videotape, 49% requested a food item advertised on television and 56% requested to go to a store or restau rant advertised on television. Children who made these requests did not usually watch significantly more television than the other participants. Only one-third of the pa rents surveyed thought their children knew that advertisements were to make people buy things (Borzekowski & Robinson, 2001; AAP, 2004). It is also apparent there may be a relationship between childr ens and teenagers exposure to media and their poor dietary choices and obesity. A National Health and Nutrition Examination Survey revealed that children who watched five or more hou rs of television a day also consumed more calories, higher dietary fat, less nutrient-rich food, and were more likely to be obese (Iowa State, 2002; Boynton-Jarrett et al., 2003). According to the U.S. Department of Hea lth and Human Services, most children and youth do not meet Healthy Peopl e 2010 objectives and the USDAs Dietary Guidelines of consuming five or more fruit and vegetables a da y. In fact, surveys have found that only one in five children meet the guidelines and one-quart er of the vegetables consumed reportedly are French fries (Krebs-Smith, S., Cook, A., Suba r et al., 1996; Boynton-Jarrett et al., 2003; AAP, 2004; Kaiser, 2004). Studies also show that a ch ild who watched three hours of television per day consumed fewer servings of fruits and vege tables per week than those who did not watch television (Boynton-Jarr ett et al., 2003). Ninety-one parent-child pair s from suburbs adjacent to Washington, DC, were studied from September 1993 through June 1995 to examin e relationships between the presence of television during meals and childrens food consump tion. The children were in the fourth, fifth
43 or sixth grades. In this analysis, the children who viewed television frequently consumed six percent more meats; five percent more pizza, sa lty snacks and soda; and nearly five percent less fruits, vegetables and juices than children from families with low television use. The children from high television-use families also consumed twice as much caffeine as children from low television-use families (Coon, Goldberg, Rogers & Tuckers, 2001). According to another study, the two minutes of daily advertising targeted to students in their cl assrooms through Channel One exposed them to fast foods, candy, soft drinks and snack chips in 7 out of 10 commercials (Kaiser, 2004). One study found that students in 7th through 12th grades who frequently ate fast food watched more television than other students (French, Story, Neumark-Sztainer, Fulkerson and Hannan, 2001; Kaiser, 2004). Fast food companie s spend billion of do llars advertising to children, and marketing executives anticipate that children unde r 12 will spend $35 billion of their own money and influence their parents to spend $200 billion in 2004. Fast food companies often have promotions that include toys th at are included with the meal based on media characters. In fact, one study found that about one in six food commercials aimed at children promise a free toy. Many commercials use carto on characters, which research has shown to be effective in helping children to identify the product (Kotz & Story,1994; Kaiser, 2004). Media advertisements may also contribute to childrens perceptions about nutrition. One study found that 70% of six-to-eight-year-olds believed that fast food was more nutritious than home-cooked meals (Donahue, Meyer & Henke, 1978; Kaiser, 2004). Another study of fourthand-fifth-graders revealed that children who wa tched more television indicated that the less healthy food choice was healthie r when shown a pair of food ite ms (Signorelli & Staples, 1997; Kaiser, 2004).
44 Implementing Nutrition in School Research has shown that rais ing nutritional standards in schools also m ay have an important impact on childrens health and dietary choices. Appleton Centra l Alternative Charter High School in Appleton, Wisconsin is an example. Students struggling with severe disciplinary problems were sent to Appleton from twelve ar ea schools. However, A ppleton did not have a kitchen, lunchroom or tables and chairs for students to sit and eat. The only food and beverages available were from vending machines. These items included sodas, candy bars, chips and other snacks. Then Appleton received a grant, teamed up with a local business, and implemented a Nutrition and Wellness Program. The importan ce of proper nutrition wa s included throughout the students course work. A kitchen was instal led and healthy food choices were provided for breakfast and lunch each school day. Whole-grai n breads, fresh fruits and vegetables, and a salad bar were served. Fresh entres with only na tural spices and flavors, and free of additives and chemicals, were never fried. As a result, students disruptive behavior and health complaints diminished substantially. Negative behaviors such as vandalism, drug and weapons violations, dropout and expulsion rates, and suicide attempts became virtually nonexistent. Students also seemed to concentrate better (Michael Fields Agricultural Institute, 2004; Good News Network, 2002). Role of Peers, Parents and Caretakers Researchers have noted a num ber of important factors that influence childrens dietary choices. Food acceptance, or the appearance, textur e and flavor of food is one factor. Childrens knowledge and beliefs about food, such as whic h foods are thought to be good for you, also influence food choice. Another factor is social pressure. Researchers have shown that peers and teachers food choices influence the choices ma de by children. Family structure is also an important factor. The types of foods selected for children who live in single-parent households
45 and homes with two working parents where time is often limited may also be a consideration in the kind of nutrition they rece ive (Bordi et al., 2002). Ther efore, parents and childrens caretakers play an important role in their food choices. However, if children are not receiving quality time and sound nutrition information from these role models, then perhaps they are learning more negative nutrition in formation from the media. According to a recent survey approximately 9 out of 10 parents believe that todays media negatively affect their children (Kaiser, 2003). However, even though The American Academy of Pediatrics recommends no television or videos for children under age two, and suggests limiting all other childrens media time to one to two hours of quality programming a day (Kaiser, 2004), most children have plenty of me dia available to them, of ten without supervision. In a recent poll, 65% of parents admitted they could do a be tter job of supervising their childrens media use (Kaiser, 2003). These issues suggest a need for continued research to understand thoroughly and to determine how the media affect adolescents nutr ition choices and dietary behavior. A further analysis of adolescents exposure to television, print media and In ternet advertis ements, articles and programming, and how their attitudes and beha viors are affected, could be helpful. Research Questions Research Q uestion 1: What do adolescent girl s know about organic fr uits and vegetables? Research Question 2: What are adolescent girl s attitudes about consuming organic fruits and vegetables? Research Question 3: Where do adolescent girl s receive information from which to base their knowledge, attitudes, and beliefs about organic fruits and vegetables? Research Question 4: What are the significan t barriers or obstacles that would prevent adolescent girls from eating organic fruits and vegetables? Research Question 5: What overall themes regarding consumption of organic food emerge from the interviews and the fo cus groups with the adolescent girls?
46 CHAPTER 3 METHODOLOGY Qualitative Versus Quantitative Research This study employs a qualitative approach. The purpose of qualitative research is prim arily to put information into context, to establish interpretations and to better understand peoples perspectives. Qualitative research ends with hypotheses and grounded theory, is inductive, and makes minor use of nume rical indices (Glesne & Peshkin, 1992). The purpose of quantitative research is primarily to draw general conclusions, predictions, and causal explanations. The approach begins with hypotheses and theories, uses formal instruments, experimentation, and reduces data to numerical indices (G lesne & Peshkin, 1992). One of the most important differences between qualitative and quantitative research is the role of the researcher. The qua ntitative researchers role is detached, objective and impartial (Glesne & Peshkin, 1992). In qualitative research there is a more complex relationship between investigator and respondent (McC racken, 1988). The researcher is personally involved (Glesne & Peshkin, 1992). Metaphors that could describe the qualitative researcher are th at of an intelligent homing device, a cultural detective and a professional stranger (Bingham & Moore, 1959). Researchers are the primary instrument for da ta collection and analys is in a qualitative study (McCracken, 1988). The researcher physically goes to the people to observe or record behavior in its natural setting. The resear ch is descriptive and the investigator is interested in process, meaning, and understanding gained through word s or pictures (Merriam, 1988; & Creswell, 1994).
47 Types of Qualitative Research Interviews Because question craftin g lies at the core of conducting qualitative research, researchers often use interviews as a primary means of colle cting data. Interviews can be in-depth, semistructured, intensive, collabor ative, and ethonographic (study of human culture) interviews. Qualitative researchers interview people to better understand their individual, interpersonal, or cultural perspectives. Interviews can retrieve past experiences, gain personal insight, obtain descriptions of events, foster trust, understand sensitive relationships, and create a record of discourse for analysis (Lindlof & Taylor, 2002; Bingham & Moore, 1959). The qualitative interview is a remarkably adaptable method and can be done most anywhere two people can talk in relative privacy. It is sometimes called a conversation with a purpose. There are several types of interviews in qualitative research. One of these is the respondent interview (Bingham & Moore, 1959). Th e purpose of the respondent interview is to elicit open-ended responses. Res pondents are usually asked to expr ess themselves on an issue or situation, or to explain what they think or how they feel about th eir social world. They help the interviewer view the interaction of an individuals internal stat es (social attitudes and motives) with the outer environment (Lindlof & Taylor, 2002). Paul Lazarsfeld (1944) described five goals of this interview type: 1) to clarify the meanings of common concepts and opinions; 2) to distinguish elements of an expressed opinion; 3) to determine what influenced a persons opinion or to action; 4) to cl assify complex attitude patterns; and 5) to unders tand the interpretations th at people attribute to their motivations for action (Lindlof & Taylor, 2002). Not only are respondent interviews used in qualitative research, but also there are situations that call for interviewing several people at once. This type of method is known as focus groups. The interviewer plays a major role in the success of focus group interviews.
48 Interviewers try to achieve a fine balance betw een enfranchising indivi duals to speak out and promoting good group feeling (Lindlof & Taylor, 2002). A focus group discussion usually consists of eight to ten participants and lasts approximately 90 minutes. Discussions in focus groups provide direct evidence about similarities and differences in the participants opinions and experiences. Focus group interview structure varies between either giving control to the group an d possibly hearing less about the topic of interest or taking direct contro l over the group guiding a free-flowing discussion (Morgan, 1997). Methods Employed For this study, 26 sixth-grade girls1, ages 11 and 12, were recruited from a private school in a suburban area of Orlando, Florida. The a nnual tuition for a sixth-grade student is $8,135. These participants were interviewed during re gular school hours over a three-day period. A teacher sent the twenty-six consent forms home to parents and all of them were signed and returned. This teacher also assisted with coor dinating the schedules for the interviews and focus groups. Sixth-grade girls were selected because nutri tion is generally taught in the fifth grade according to the Sunshine State Standards. The Sunshine State Standards were established by the State Board of Education to provide expectati ons for student achievement in Florida schools. The Standards approved in 1996 were written in se ven subject areas and e ach divided into four separate grade clusters (PreK-2, 35, 6-8, and 9-12). Topics such as health behaviors and disease prevention, health habits, and the nutritional value of various foods are included in the curriculum for grades third through fifth (Florida Department of Health, 2008). 1 girl Applicable until 18th birthday is reached according to AP Stylebook, 2000.
49 The Sunshine State Standards are mandated in the public school curriculum and not required for private schools. Since this study was done in a privat e school, research was done to determine what kind of nutrition is taught in that school in the fifth grade. According to the elementary school principal, a new curriculum had ju st been implemented in the science classes. The principal said the material included referen ce to the importance of exercise and eating right; however, there were no specific un its which included specifics about nutrition (Brenda Oliver, personal communication, March 24, 2008). The physical education teacher, who teaches the students twice a week, said he discusses the five basic food groups, appropriate meals, and healthy snacks during grades kindergarten through second gr ade (Mark Rickard, personal communication, March 24, 2008). A monthly cafet eria menu from this school also was provided. Entres such as Salisbury steak with gravy, spaghetti with meat sauce, macaroni and cheese, teriyaki chicken and pizza were served du ring a week. Rice and/or vegetables and bread accompanied the entre. Fruit and/or a side salad was included once or twice a week and a dessert once a week. This research study involved a triangulati on of various methods. Triangulation involves comparing two or more approaches to enhance th e credibility and authenticity of findings in investigative research. The most familiar kind of triangulation is multiple methods (Lindlof & Taylor, 2002). In order to interact with adoles cent girls and better asce rtain their attitudes, knowledge and beliefs about the benefits of eatin g organic fruits and vegetables, this study will employ triangulation through the methods of focus groups and in-depth interviews. The first method used was individual in-depth interviews conducted on school premises with six individual girls for approximately 30 minutes each. This method elicited open-ended responses with greater detail from a sample of diverse participants. The second method used
50 consisted of three focus groups of five, eight, and seven adolescen t girls. The ideal size of a focus group consists of six to 12 participants. Fewer than six people in a group may lead to a less diverse range of comments, and more than twelve people may limit participation and feedback (Lindlof & Taylor, 2002). These focu s groups lasted for approximately one hour. An interview guide was used as the basis for the in-depth interviews and for the focus groups. The purpose of the questionnaire in the qual itative interview is to ensure all participants are asked the same questions and in the same or der. The questions establish direction for the interviews as well as allow the interviewer to give attention to the participants testimony. Prompts within questions also create an open-en ded nature to allow the participants to give details (McCracken, 1998). The interview guide for this study (Appendix B) consisted of 20 questions. The types of particip ant questions concerned issues su ch as what they typically eat during a day, how their food choices are made, wh at types of media they use, where they get health, diet and nutrition information, and thei r knowledge and attitudes of organic fruits and vegetables. The participants also were given an indivi dual written survey to complete after the interviews and focus groups. Surveys can be a va luable exploratory method used in qualitative interviews. Surveys and depth interviews can be used in a two-stage design in which the survey provides public normative opinions about a topic while the qualitative study yields data about actual practices and processes (Lindlof & Taylor, 2002, p.119). The survey in this study (Appendix E) consisted of 13 statements. A scal e with choices ranging from strongly agree to strongly disagree followed each statement. In this survey, the statements questioned the participants opinions about the advantages a nd disadvantages of eati ng organic fruits and
51 vegetables, and whether they would pursue further informati on about organic fruits and vegetables. Because adolescents may not have much control over family food purchases, the Theory of Planned Behavior was used as a basis in this study. Using the perceived behavioral control construct, adolescent gi rls were interviewed to examine how difficult they perceive consuming organic fruits and vegetables to be, as well as how successfully they coul d perform it on a regular basis. A simple explanation of organically grown produce was clarified during each focus group and interview. Each participant wa s first asked to define organic foods. Then organic fruits and vegetables were described as t hose fruits and vegetables which are grown without the use of any artificial chemicals or fertilizers a nd treated without any pesticides. In an attempt to encourage adolescent girls to consume a plantbased diet of primarily organic fruits and vegetables, measuring the attitudes and subjective norms th at affect adolescent girls food choice behaviors could be a positive st ep toward this goal. Determining what girls perceive about healthy eating a nd organic produce is an important factor in this study. In addition, since the media, parents, and peers may influence adolescent girls eating behavior, this information was helpful for this study as well as have implications for further research in these areas.
52 CHAPTER 4 FINDINGS Twenty-six adolescent girls, ages 11 and 12, participated in this research study. Twentytwo of the girls were Caucasian, three were Hisp anic, and one was African Am erican. All of the girls attended the same private school in Orlando, Florida. Through focus groups and individual interviews, the researcher f ound substantial information about how these young girls perceive organic fruits and vegetables a nd where they receive health, diet and nutrition information. The names of the girls have been changed in this stud y to protect their privacy. Results of this study address the following five research questions: 1. What do adolescent girls know a bout organic fruits and vegetables? 2. What are adolescent girls attitudes about consuming or ganic fruits and vegetables? 3: Where do adolescent girls receive inform ation from which to base their knowledge, attitudes, and beliefs about organic fruits and vegetables? 4. What are the significant barriers or obst acles that would preven t adolescent girls from eating organic fruits and vegetables? 5. What overall themes regarding consum ption of organic food emerge from the interviews and the focus groups with the adolescent girls? Research Question 1: What do adolescent gi rls know about organic fruits and vegetables? When this group of adolescent girls was asked the definition of organic food, the answers varied. However, most participants associated organic food as a hea lthy food choice. Seven girls commented that it was food that was grown without pesticides or chemicals. Twelve-yearold Ally said living things, and Becky, 12, noted just healthy food like fruit and vegetables. Debbie, 12, commented, When I think of organi c food I think of things to help your body grow. Three girls described organic food as w ithout any artificial stuff; while Carol, 12, said organic food grows in the ground and then you put it on your plate.
53 Three participants associated organic food with milk that did not contain bad stuff. For example, Elizabeth, 12, said, I dont think they give these cows like spray or something like that. Eleven-year-old Francie also defined organic food as like healthy without sugar and stuff and Gayle, 12, said something thats natura l and doesnt have any aci ds in it. Heidi, 12, commented fruit and vegetables and Jenna, 12, noted food thats good for the organs. Twelve-year-old Lisa was the only part icipant who said, I have no idea. The participants were then shown the US DA seal for organic food and given a brief explanation that is it food th at is grown with only natural fertilizers and treated without chemicals or pesticides. Seven girls said they had knowingly eaten organic fruits and vegetables like apples, strawberries, bananas and cucumber s. Three participants mothers regularly purchase organic fruits and vegeta bles at Whole Foods Market or in the organic section at Publix supermarkets. Twelve-year-old Mary said, Everything in my refrigerator and pantry is organic and Elizabeth, 12, commented, My mom gets all organic fruits and vegetables. Shes told me, I try to get all organic fruits. Becky stated, We used to have a garden that wed eat out of and Nikki, 12, said, I mean I eat fruits and vegetables but my mom hasnt really told me like, Oh, this is organic. Nine girls mentioned they eat other organic foods such as dairy products, meat, cookies, salsa, pasta, and tortilla chips. The remaining part icipants stated they had not or were not sure if they had eaten organic fruits and vegetables. However, according to the survey given after the interviews, 35% of the participants strongly agree d, and 31% agreed that th ey were interested in knowing more about organic fruits and vegetables.
54 In summary, most of the adolescent girls in this study associated organic fruits and vegetables as a healthy food choice. Many of them knew specifically that organic fruits and vegetables were grown without the use of chemicals or pestic ides, and believed that organic fruits and vegetables were better for them than conventional fruits and vegetables. Research Question 2: What are adolescent gi rls a ttitudes about consuming organic fruits and vegetables? For 18 of the participants in this study, th eir mother or both pare nts were the primary decision-makers regarding the food purchases for the home. However, 22 of the girls regularly participated in the food shopping. Even at their young ages of 11 and 12, these adolescent girls seemed to have establis hed particular attitudes about food. These participants expressed specific opi nions about the benefits of a nd consumers of organic fruits and vegetables. This group of adolescent girl s expressed how they would visualize someone who often purchases these products. Most of the study participants chose the 20to 30-year-old as the mean age range of this type of consumer. Pe ggi, 11, said it could be like an older person, probably 20 or older cause us ually kids under like 18 would rather have junk food. Jenna, 12, associated someone who purchases organic fruits and vegetables with her grandmother cause she always eat healthy f oods, and Debbie related to her 50-year-old neighbors who run five miles lite rally every single day. Rachel, 12, imagined a really fat guy like in his 40s running on a treadmill watchi ng TV. Elizabeth, 12, pictured a normal lady thats about 40, short and skinny just a normal person. Fourteen participants pictured a female as regularly purchasing organic fruits and vegetables. Two girls visualized a male and the remaining participants said it could be either
55 female or male. Eleven-year-old Sally said, I picture both and proba bly any age because if youre like my age I can eat a lot of fr uits and vegetables and organic stuff Eleven girls mentioned that someone who purch ases organic fruits and vegetables would be thin. Tara, 12, commented, Shes really qui et but has long hair and shes really skinny and tall and Lisa, 12, said, Shed be normal, maybe a little skinnier. Seven participants mentioned that a person who purchases organic fruit and vegetables would be healthy. Heidi, 12, stated they woul d be really healthy and Vanna visualized someone healthy and fit. Eleven-year-old Yoll y stated they could do a lot of activities and have more healthy things in their body. Six girls also pictured an athletic pe rson as someone who buys organic fruits and vegetables. Nikki, 12, co mmented, They would be kind of athl etic and female cause girls are more concerned about what they eat and guys just think its f ood. Twelve-year-old Michelle said, They can be athletic so they like want to look good and Yolly, 11, said They would probably be athletic and are really in shape. Three participants associated a hippie image with someone who purchases organic fruits and vegetables. Chris, 12, said, Id picture a female, and shed al ways be wearing a T-shirt with a peace sign on it. Mary, 12, commented, Shes kinda like a hippie and likes to meditate and is a vegetarian. Cindy noted, She probably does yoga or palates and has a little bandana on her head and shes probably meditating while walking. Just real peaceful. This group of adolescent girls not only expre ssed their visual per ception of an organic fruits and vegetables consumer; they also ac knowledged positive benefits to consuming these foods. In fact, according to the survey given after the interviews, 46% agreed, 23% strongly agreed and 23% somewhat agreed that it is importa nt to eat organic fruits and vegetables every
56 day. In addition, 42% strongly agreed, 35% agre ed and 19% somewhat agreed that it is important to eat organic fruits and vegetables when ever I can. As a resu lt of the interviews and surveys, the participants reveal ed their attitudes about specific benefits from consuming organic fruits and vegetables. A prominent benefit this group of adolescent girls associated with consuming organic fruits and vegetables was having more energy. Ma ny of the girls were involved in sports and communicated this as an important benefit. In fact, 50% of the girls surveyed strongly agreed and 31% agreed that eating organic fruits and ve getables would give them more energy. Sally, 11, stated, The most important one would be en ergy cause I do volleyball and you like need a lot of energy to run on the court and stuff. Leah, 12, commented, Youd have more energy and not be tired. Fourteen of the 26 participants volunteered the belief that or ganic fruits and vegetables would make them healthier. Vanna, 11, said, Like you might be a little bit more healthy and Peggi, 11, stated, Longer life maybe from healthie r choices instead of fa st food all the time. Jeannie, 12, commented, You wouldnt have all those chemicals in you. Being thinner or skinny was also another impo rtant benefit to the participants. In fact, the survey results revealed th at 50% strongly agree d, 26% somewhat agreed, and 19% agreed that eating organic fruits and vegetables will he lp their bodies be thin. Twelve-year-old Lisa commented, You wouldnt be fat. Gayle, 12, pointed out, You dont have more of a chance of gaining extra weight and Cindy, 12, said, Youd be skinny. The adolescent girls in this study also consider ed having clearer skin as a benefit. Survey answers showed that 46% agreed and 23% strongly agreed that your skin would be better as a result of eating organic fruits and vegetables.
57 The girls in this study also considered the pr evention of disease as a benefit of consuming these types of foods. From this group of adolescent girls su rvey results, 38% agreed, 31% strongly agreed, and 19% somewhat agreed that eating organic fruits and vegetables would prevent disease. Having better concentration was another be nefit these adolescent girls considered important. Five of the participants in this study specifically stated that they believed that eating organic fruits and vegetabl es would help them concentrate more effectively. In summary, these participants had specific at titudes about consuming organic fruits and vegetables. Their perception of someone who consumes these foods was typically a female in her 20s to 30s. They perceived this female to be thin, healthy, athl etic, and in good physical shape. The participants agreed that eating these foods daily w ould give them more energy, make them healthier, help their bodies be thin, give them cl earer skin, prevent disease, and help them concentrate more effectively. Research Question 3: Where do adolescent gi rls receive information from w hich to base their knowledge, attitudes, and beliefs about organic fruits and vegetables? The 26 adolescent girls in this study re vealed they obtained their knowledge, attitudes, and beliefs ab out organic fruits and vegetables from various sources. Primarily the information they received came from the media and from individuals. The Internet Every participant in this study regularly spent time using th e Internet. These adolescent girls m ainly used the Internet for entertainmen t purposes such as watchi ng music videos, playing games, virtual shopping, or creating fashion de signs. Eight girls said they often visited YouTube.com, 10 regularly visited DisneyChan nel.com., and two visited (Nickelodeon) nick.com. Three participants often visite d addictinggames.com a nd seven girls visited
58 webkinz.com. In addition, four a dolescent girls in this study often visited MySpace.com. Other sites mentioned by the participants were neopets.com, millsbury.com, kiddonet.com, Abercrombie.com, OldNavy.com. One girl also said that she visited a so ftball Web site but did not mention the site address. When the participants were asked if they have ever used the Internet to find health, diet or nutrition information, 11 stated they had looked up information for a class project, or for personal reasons such as finding a healthy snack or researching types of exercises. Web sites such as WeightWatchers.com, RachaelRae.com, HealthCare.com, Oprah.com, DrPhil.com were mentioned in these interviews. Magazines Eight of the 26 participants in this study did not regularly read magazi nes. Ten girls read celebrity magazines like People or Teen People and 11 girls read teen magazines like Seventeen PB Teen Girls Life, and Teen Vogue The participants stated the main reason they read these magazines is for the gossip or fashion and decorating ideas. Only 5 girls stated they have read magazine articles on health, diet and nutrition. Finding information about healthy snacks was one topic mentioned. For example, Chari, 12, said, Every once in a while youll find a page that has some like diet snacks or just snacks that are kind of healthy. Jeannie, 12, mentioned she has used magazines to find information about what you eat when you go to the movies popcorn without butter was better than popcorn with butter and gummy worms was better cause it takes a while to eat because its chewy. Sally, 11, had read a magazine by Rachael Rae and said its all about food and healthy diets and stuff. Two girls also stated they had read mag azine articles about a norexia and bulimia. Michelle, 12, said, Just like how to be healthy and how to eat healthy you can still be skinny
59 without going anorexic or bulimic. Jenna, 12, said her mother did not allow her to read celebrity magazines caus e theres too much stu ff about crash diets. Television The most popular television pr ograms among the participants in this study were viewed on the Disney Channel, Nickelodeon, MTV, The Learning Channel, and the Cartoon Network. American Idol and Animal Planet also were two popular programs mentioned. Twenty of the adolescent girls have watc hed a television program on health, diet, or nutrition. Some of these programs were on the Health Channel, Discovery Health, Nickelodeon, and Dr. Phil. Thirteen have watched either th e Food Network or a cooking program. Maureen, 12, said, This guy was making a sculpture out of pi neapples and all these fruits and vegetables and it all fell. Nikki, 12, stated, Theres a show like Rachael Rae. They like give you tips to be healthy and stuff you can eat and still be healthy. Peggi, 11, said I just watch them designing those cakes and the big sugar sculptures. Family Members Twenty-two of the 26 adolescent girls in this study stated they have received information about health, diet, and nutrition from a family member. Twelve girls mentioned their mother, four their father, three their aunt, three th eir sister and one mentioned both parents. Jeannie, 12, stated that her aunt is a vegetarian and eats rea lly healthy and has told her to eat organic food and stuff like th at. Lisa, 12, said that her da d has influenced her to exercise and eat healthy. We normally eat stuff thats heal thy and its unusual if we get a plate with a pie, ice cream cup or cupcake on the side. Heidi, 12, cited her mother as a source of information. Heidi stated, We usually have mixe d vegetables at home so if we dont like them she still makes us eat them because she knows it good for us.
60 Vanna, 11, cited her sister as a source of nut rition information. Vanna said, Shell buy like organic foods sometimes and she really like s to stay healthy and fit and eat good foods. Michelle, 12, stated that her da d was a source. Michelle said, Hes on a diet right now and he asked my mom to cook special stu ff for his diet and so he tells me its good for me. Peggi, 11, stated her mom was a source of nutrition informa tion because She says we need to stop eating so much crap around the house and we need to eat mo re fruits and vegetables and stuff like that. Mary, 12, who also cited her mother, said, Shes a health nut and she really likes to eat healthy things so shes got me to kind of get used to organic stuff. Now my taste buds arent like whoa when I eat like healthy stuff. Further Information about Organic Fruits and Vegetables When the participants in this study were as ked where they would seek infor mation about organic fruits and vegetables, the media, family members, and health professionals were their choices. Forty-six percent of the girls said they would use the Internet to find this information. In addition, 35% somewhat agreed, and 19% agreed that they would read an article about organic fruits and vegetables on the Intern et. Participants were asked in the survey if they would watch a television program about organic fruits and vege tables, 19% strongly agre ed and 19% agreed. When participants were asked whether they woul d read a magazine article about organic fruits and vegetables, 31% agreed, and 15% strongly agreed that they w ould probably read it. Forty-six percent of the partic ipants also said they would seek out family members for more information about organic fruits and vegetables. Fathers, mothers, aunts and sisters were mentioned in this category. In addition, 8% of the girls mentioned they would seek a health professional for more information about organic fruits and vegetables. In summary, the participants in this st udy revealed they obtained their knowledge,
61 attitudes, and beliefs about orga nic fruits and vegetables primaril y from media sources such as television and Web sites. Most of the 26 adolescent girls also st ated that they have received information about health, diet, and nutrition from a family member such as their mother. Research Question 4: What are the signific a nt barriers or obstacles that would prevent adolescent girls from eating or ganic fruits and vegetables? A dolescent girls may believe there are many be nefits to consuming organic fruits and vegetables. However, it may be important to cons ider any significant barriers or obstacles that would prevent them from eating these foods. Afte r interviewing and survey ing the 26 adolescent girls in this study, severa l factors were revealed. According to the survey used in this study, mo re than 50% of the adolescent girls thought that cost is a disadvantage of eating organic fruits and vegetabl es. Peggi, 11, said, They are kind of expensive but thats bad because most of America is overweight and if they raised the prices of junk food and lower the prices of h ealthier stuff most of America would probably be healthier then what it is now. Carol, 12, stated theyre more e xpensive and Chris, 12, said, I think its too expensive. Another disadvantage of eating organic fruits an d vegetables that 46% of the participants mentioned when interviewed was taste. Lisa, 12, stated, People like candy more than green beans, and Rachel, 12, said, I don t think they taste as good. Chari, 12, said, My mom used to buy like organic food and the food kind of ta ste like metal. Cindy, 12, stated, Theyre going to taste different so if you want to be healthy you might just have to get used to them or something. Since all of these participan ts did not purchase the household groceries, convenience may be considered a barrier to them eating organic fruits and vegetables. Nineteen of the participants stated either their mother or their father made the primary food choices in the home. However,
62 22 of the girls said they either participated in the food shopping process or had input as to what food choices were made. Another barrier to the particip ants consuming organic fruits and vegetables could be lack of knowledge. Only seven participants understo od organic food to be that which is grown without chemicals or pesticides. However, the su rvey results suggested th at 35% strongly agreed and 31% agreed that they were interested in knowing more about these types of foods. In summary, the adolescent girls in this study revealed several significant barriers or obstacles that may prevent them from eating orga nic fruits and vegetables. The participants stated factors such as cost, taste, convenien ce, and lack of knowledge may prevent them from consuming these foods. Research Question 5: What overall themes emerge from the interv iews and the focus groups with the adolescent girls regardi ng the consumption of organic foods? Additional dimensions of conducting research using qualitative methods such as focus groups and interviews are the dominant themes which become apparent. Key themes often emerge through the comparison and review of the data and the notes from research studies. This research study of the 26 adolescent girls was not an exception. After an evaluation of the findings from the interviews and the focus groups, se veral prominent themes em erged as a result. The first dominant theme in this study was an awareness theme. It seems that these adolescent girls were basically aware which food choices were healthy options for them to consume, and which food choices were not. The girls categorized unhealthy or bad foods as those which are treated with hormones, chemicals, and fertilizers, and those foods which contain artificial stuff. The pa rticipants also believed that j unk food is food which is greasy and fried and contains saturated fats and trans fats. Foods that have high sugar content such
63 as chocolate, ice cream, candy and cake, were al so considered unhealthy by the adolescents in this study. The participants seem to understand that consuming organic food was a healthy food option. Many of them knew specifically that orga nic fruits and vegetables were grown without the use of chemicals or pesticides, and believed that organic fruits and vege tables were better for them than conventional fruits and vegetables. These adolescent girls were cognizant that eati ng organic food, particularly organic fruits and vegetables, would help them look, feel, and ac t healthier. The girl s recognized they would be thinner, have clearer skin, have more ener gy, and prevent disease as a result of consuming these foods. The second dominant theme in this study was a cultural theme. The concept that people are a product of their social environment seems ev ident throughout the results of this study. The adolescent girls were often influenced by their parents food choices. When the participants were questioned why particular food habits were established in their household, they stated it came from their culture. Theref ore, the food choices of the girls parents often seemed to be established from the grandparents and other relatives. Since the participants were adolescents, they were very dependant upon parents for purchasing and preparing their food. This fact also had an influence on their food choices. However, the girls admired their family members who advocated good nutrition and were interested in following their advice about food choices. Another theme that was dominant in this resear ch study is a cost vers us benefit theme. These adolescent girls were certainly aware of th e various benefits of consuming organic fruits
64 and vegetables. However, even though they did not purchase the household food, more than 50% of the girls believed that cost is a deterring factor in consuming these foods. In addition to the awareness, cultural, and co st versus benefit themes, a receptivity theme also emerged in this study. Th e adolescent girls expressed a dis like for the greasy food served in their school cafeteria and wa nted healthier options. In ad dition, none of th e participants expressed any complaints because their parents would not allow th em to eat more junk food. In fact, they were compliant with limiting their b ad choices and focusing on healthier options. Sixty-six percent of the partic ipants expressed an interest in knowing more about organic fruits and vegetables. The adolescent girls we re receptive about the idea of watching a television program or going on the Internet to learn more a bout organic fruits and vegetables. Many of the participants were involved in at hletics and were particularly in terested in the positive effect consuming organic fruits and ve getables would have on their ove rall energy levels and on their performance in sports.
65 CHAPTER 5 DISCUSSION The Theory of Planned Behavior The purpose of this study was to examine adolescent girls attitudes, knowledge, and beliefs about the benefits of eating organic fruits and vegetables. This topic has been discussed continually in the media. However, despite public concern about the quality of health of todays youth, relatively little research has been done ab out the impact of child rens consumption of these products. In fact, there were no qualitative studies that specifically addressed the attitudes, knowledge, and beliefs of adol escent girls consuming organi c fruits and vegetables. Prior research suggests that orga nic fruits and vegetables are healthier for adolescents than conventional produce (Sullivan, 2003; Hood, 2003; Cropper, 2004; Mangels, 2006). However, no research has focused on the probability of adolescents consuming these foods. In this study, Ajzens Theory of Planned Behavi or provided a framework from which to view the beliefs that may impact adolescents likelihood of eating organic fruits and vegetables. The purpose of the Theory of Planned Behavior is a framework to examine whether an individual intends to perform a specific acti on. Although there is not a perfect relationship between behavioral intention and ac tual behavior, this theory can be used as a measure to help predict behavior. There are three constructs involved in th is theory: attitude, subjective norm, and perceived behavioral control (Francis et al., 2004). In this research study of 26 a dolescent girls, the Theory of Planned Behavior may be helpful as a framework to view th e participants responses. The firs t construct, which is attitude, concerns whether a person is in favor of performing the desired action. The attitude toward the behavior and the possible consequences is a pers ons overall evaluation of the behavior (Francis et al., 2004).
66 Based on the findings in this study of sixth-grad e girls, the participants seemed to have a positive perception of someone who consumes organi c fruits and vegetables. Most participants visualized an athletic, healthy female as some one who would purchase a nd consume these foods. The adolescent girls in this study also acknowle dged several positive benefits from consuming organic fruits and vegetables. In fact, this group recognized the potential to have more energy, have clearer skin, be healthier, be thinner, a nd prevent diseases. However, their attitude about the taste and the cost of these products also ma y have a negative influence on their consumption of them. More than half of the participants thought it was important that they consume organic fruits and vegetables on a daily basis and whe never I can. In addition, a majority of the adolescent girls stated that they were willing to learn more about these foods. In a survey completed after the interviews, 35% strongly agreed that they were interested in knowing more about organic produce. Therefore, by examining th e first construct of th e Theory of Planned Behavior in this study, the adolescent girls appeared to have a positive attitude toward the idea of consuming these foods. As a result, this particip ants attitude may have a positive affect on their behavioral intention to consume organic fruits and vegetables. The second construct in the Theory of Planned Behavior is the subjective norm; it measures how much a person feels social pressure to perform a specific action (Francis et al., 2004). Results of this study suggest this framewor k may be appropriate to view this behavior. The participants in this study seemed to have a positive social pressure to eat organic fruits and vegetables and the relationships between subjectiv e norm and behavioral intention seem to be strong.
67 Individual interviews and focus groups with 22 of the 26 adolescent girls revealed they had received information about health, diet, and nutr ition from a family member. The majority of adolescent girls in this study rece ived health, diet, and nutrition information from their mothers. However, other participants mentioned a father, a unt, sister or both parent s. One girl stated her aunt is a vegetarian and eats really healthy and has told her to eat organic food. Another participants sister said she buys organic food. One adolescent woman said her mother has encouraged her to eat organic food. In addition, one participant stated her mother gets all organic fruits and vegetables and another girl said everything in her refrigerator and pantry was organic. Five of the participants mothers regularly s hopped at the organic se ction at the grocery store or at Whole Foods Market The adolescent girls in th is study admired their family members who advocated good nutrition and were in terested in following their advice about health food choices. The participants also seem ed positive about their parents encouragement to make healthy food choices rather than eating junk food and making unhealthy food choices. In conclusion, it appears there is a positive influence from family members to consume organic fruits and vegetables. The participants intention to eat a healthy diet suggests that family members, particularly mothers, were important in fluencers in their food choices. The girls often adhered to the advice of family memb ers regarding health and diet. Other factors in addition to family relations could also have an impact on the subjective norm in this study. Peer influence among the pa rticipants during the focus groups may have influenced their answers during th is study. The adolescent girls al so may have felt influenced by the interviewer to answer quest ions a certain way during the interviews and focus groups. However, in the survey given to the adolescent girls after the interviews, they were asked
68 whether they felt pressured to respond to questi ons in a particular manner. In response, 31% neither agreed or disagreed and 31% disagreed th at they had to answer the questions a certain way. Therefore, the participants seemed to feel a positive social pressu re to consume organic fruits and vegetables. In addition, the influen ce of the social pressure could be a positive motivation for the participants in this study to comply. In addition to attitude and s ubjective norm, another construc t in the Theory of Planned Behavior is perceived beha vioral control. This construct is the persons belief about his control over the behavior and how easy or difficult it will be to perform. Percei ved behavioral control can also influence behavior directly in situations where behavior is not un der the total control of the person (Montano & Kasprzyk, 2002; Brown, 1999). In this study, the adolescent girls had influe nce in their food choices but not total control in this area. The participants did not purchase the household groceries and the mothers or fathers primarily made the food choices in the home. Twenty-two of the 26 girls said they either participated in the food shopping or had input as to what food choices were made. However, in a survey given to the participants, 31% neither agreed or disagreed, and 31% disagreed that organic fruits and vegetables we re not easily available to them. The factor of cost may also have an impact on the perceived behavior al control in this study. Based on the findings in a survey, more th an 50% of the adolescent girls perceived that organic fruits and vegetables we re too expensive. Therefore, the participants belief about the disadvantage of cost may have an affect on thei r purchasing organic frui ts and vegetables. In conclusion, by examining the Theory of Planne d Behaviors construct of perceived behavioral control in this study, the participants appeared to have some, but not total contro l regarding their ability to consume organic fruits and vegetables The two factors of availability and cost may
69 have an influence on the adolesce nt girls perceived behavioral control toward purchasing and eating these foods. Implications Adolescents m ake decisions and develop habits that often continue into adulthood. In fact, evidence indicates that dietary patterns es tablished during adolesce nce can be a significant predictor of food intake in adulthood (Lake, et al ., 2006; Adamson, et al., 2004). Encouraging adolescents to consume organic frui ts and vegetables as part of a plant-based diet also could have positive implications for their health a nd prevention of obesity and disease. This study seems to indicate that in this cohort of sixth-grade girls, Ajzens Theory of Planned Behavior is a helpful guide to view their intention to consume organic fruits and vegetables. Subjective norms and attitude could be especially important influences in examining their intention to eat these products. However, pr actitioners could attempt to strengthen attitude by allowing adolescent girls to taste more organic foods, incl uding fruits and vegetables. Practitioners also could try to facilitate cons umption of organic produce by strengthening perceived behavioral control while being aware of adolescents accessibility to these foods. The present data from this study reve als the need for medi a literacy curriculum specifically designed to reach ad olescent girls. The information from this study could provide information to teach young girls how to analyze and evaluate media messages about nutrition and food choices. The Kaiser Family Foundati on conducted the larges t study of television advertising and found that children ages 8 to 12 years watch the most food ads of any age group. Kaiser Foundation Vice Presiden t Vicky Rideout said, In this era when we are so concerned about childhood obesity, its surprising that f ood advertisements aime d at children are so overwhelmingly on the side of foods that kids should be eating less of, not more of (Hellmich,
70 p.2). Therefore, media literacy could be created as a positive influence to help adolescent girls make nutritious food choices. The present data substantiates the need for th e media to be used as effective avenues to educate adolescents and their parents about th e benefits of consuming organic fruits and vegetables. Since the Internet television, and magazines are me dia heavily used by adolescents, content analyses of Web sites, advertising, programs and articles with health, diet, and nutrition information could be helpful. Food-related tele vision programs such as Rachel Ray were often viewed by the participants and their parents. Therefore, information about the benefits of consuming these foods could be included in these programs, as well as in Web sites and magazines. Findings from this study suggest that media campaigns pr omoting organic produce could be effective in encouraging adolescent gi rls to consume these foods. Contemporary programming that attracts adolescents could be used. In addition, since the participants perceived healthy and athletic people as thos e who consumed organic fruits and vegetables, professional athletes could be used as role models in the media messages. This research study could provide informati on for schools to implement better nutrition teaching for students. These findings, along with organizations such as the Organic Consumers Association and Whole Foods Markets, coul d help develop curriculum which could be implemented into students course work about th e importance of eating organic produce. Based on these findings, changes also could be made to offer students healthier food choices, which included organic fruits and vegetables, in the school cafeteria. Thes e positive changes would educate students and also help them discover the tastes and other benefits of these foods.
71 Limitations of the Study Lim itations of this study include factors of availability, school selection, time, peer influence and demand characteristic. The sa mple population used in this study is not representative of the entire adolescent female po pulation in Orlando, Florida. The 26 adolescent girls were only a small sample of the sixth-grade female population in Central Florida. The adolescent girls in this study were recruited by a sixth-grade teacher employed by the private school. The participants interviewed consisted of those girls who were present in school during those times. This study was conducted at a private school. The participants seemed to have good access to media and technology. The girls also seemed to good parental involvement and support. Therefore, the selection and location of school may be considered a limitation as does not include public school students and t hose from lower socio-economic areas. Time was also a limitation in this study. Interviews and focus groups were conducted over three weekdays during school hours. Th is study was conducted during school hours and there were time constraints imposed. Limited ti me may have prevented in-depth answers or details otherwise discussed, particularly during the focus group that consisted of eight girls. Another limitation factor may be peer influe nce. During the focus groups, the participants sometimes repeated the previous persons response. Hence, some of the participants may have been influenced by each others answers. Demand characteristic may also be consider ed as a limitation in this study. Demand characteristic occur when participants are aware of what the researcher expects to find or how they are expected to behave. This factor may affect the outcome of th e study since participants may change their behavior to conform to th e researchers expect ations (Wagner, 2008).
72 During the individual interviews and focus groups, the participants were asked where they would go to find more information about organic fruits and vegetables. They were prompted with options such as friends, family, a h ealth professional, or the media. However, the option of school was not presente d. This also may have affect ed their answers and therefore be considered a limitation factor. Future Research As obesity and diseases increase, there is a national concern for im proving the dietary behaviors of adolescents. Studies show that a plant-based diet which includes organic fruits and vegetables is a healthy diet for adolescent gi rls. However, the development of effective strategies to educate and encour age them in this lifestyle requ ires an understanding of their eating behaviors and other factors wh ich influence these behaviors. Parents, particularly mothers, apparently influence adolescent girls food choices. Therefore, future research should focus on the attitudes, knowledge and underlying beliefs of the mothers of adolescent girls. Questions such as where these mothers obtain their information about nutrition, health and diet co uld be explored. In addition, th e barriers and obstacles that prevent mothers of adolescent girls from purchas ing organic produce could be researched. It also might be of interest to investigate whethe r the adolescent girls infl uence their parents food choices. Since the media have such a powerful influe nce on adolescents, they could be used as effective tools to educate and encourage adolesce nt girls to consume these foods. However, it may be helpful to examine how the media may be influencing adolescent girls dietary choices and behaviors. For example, it could be interest ing to examine how the Internet, magazines, and television portray the value of organic fruits a nd vegetables. Questions such as What do Web
73 sites, celebrity magazines and television progr ams specifically communicate about health, diet and nutrition? could also be explored. The findings from this study substantiate the need for researchers to determine how the media could be used to influence positive percepti ons of organic fruits and vegetables. Studies also could be done to explore th e potential of developing televisi on and web-based advertising to promote these products. In addition, an analysis of how professional athletes could be used as positive role models to encourage adolescent girl s to eat organic produce could be included. The findings from this study, as well as th e example of Appleton Central Alternative Charter High School, show the need for future case studies which could implement better nutritional information and dietary choices in schools. Principals, teachers, and parents could be given this information at parent/teacher meetings. They could be encouraged to implement health and wellness programs and offer better nu tritional food choices in the school cafeterias. The students in this study seemed to have media access and excellent parental involvement. Therefore, future research could include conducting this study in a public school in a lower socio-economic area. Findings from both studies could be compared to determine similarities and differences in the data. The 26 adolescent girls in this study were pa rt of a pioneer study which can have a positive impact on the health of their generation and those young people in the future. It could be interesting to revisit each of the participants in this study in a few years and interview them again. The purpose would be to re-evaluate their attitudes, knowledge, and beliefs about consuming organic fruits and vege tables and determine any change s that have occurred since the first study.
74 Americas young people are not exempt from t odays health crisis. The incidence of disease among youth is steadily incr easing. Yet, it appears to be a crisis that is somewhat preventable. Poor dietary practices are a leadi ng contributor to the deve lopment of obesity and chronic diseases. These issues could be effectively addressed during adolescence by teaching and encouraging good nutritional habits to young people, as well as to their parents. America is a nation that abounds with the latest technology. The media and the educational system can be an effective avenue for edu cating and promoting healthier food choices so young people are given the tools to make healthier fo od choices now and in the future.
75 APPENDIX A INTERVIEW CONENT FORM College of Journalism a nd Communications University of Florida Gainesville, FL 32611 Parental Consent Dear Parent/Guardian, I am a graduate student in the College of Jour nalism and Communications at the University of Florida, conducting research on th e attitudes, knowledge and beliefs of consuming organic fruits and vegetables on adolescent girls. The purpose of the study is to ascertain adolescent girls knowledge and assumptions about organic fruits and vegetables and where they get their information about health, diet and nutrition. The results of the study may help researchers better understand the amount of knowledge gained and a llow them to design instructional practices accordingly. These results may not directly help your child today, but may benefit future students. With your permission, I would like to ask your child to volunteer for this research. I will interview all of the particip ating children either individually or in a group of approximately six other children. I will ask them a set of questions and tape record their answers for transcription. After each interview, I will give them a short questionnaire to answer. The estimated time needed for this study is an hour. With your permission, your child may also be videotaped during this period. The video will be accessible only to the research team for verifica tion purposes. At the end of the study, the tape will be erased. Although the children will be aske d to write their names on the questionnaires for matching purposes, their identity will be kept co nfidential to the extent provided by law. We will replace their names with c ode names. Results will only be reported in the form of group data. You and your child have the right to withdraw consent for your ch ilds participation at any time without consequence. There are no known risks or immediate benefits to the participants. No compensation is offered for participation. Group results of this study will be available in December upon request. If you have any questions about this research protocol, please contact me at 407-928-9618 or my faculty supervisor, Dr Debbie Treise, at ( 352)392-6557. Questions or concerns about your childs ri ghts as research participants may be directed to the UFIRB office, University of Florida, Box 112250, Gainesville, FL 32611, (352) 392-0433. Holly L. Meade I have read the procedure described above. I voluntarily give my c onsent for my child, ____________________, to participate in Holly Meades study of adolescent girls attitudes, knowledge, and beliefs about consuming organic fruits and vegetables. I ha ve received a copy of this description. _________________________ ____________ Parent/Guardian Date _________________________ ____________ 2nd Parent/Witness Date
76 APPENDIX B INTERVIEW QUESTIONS 1. W hat do you eat in a typical day? a. Breakfast? b. Lunch? c. Dinner? d. Snacks? 2. Tell me how food choices are made in your home? 3. Do you participate in the food shopping in your home? Talk to me about this. 4. Where do you think your parents get information about the food you eat at home? 5. When you are on the Internet, what site s do you typically visit most often? 6. Would you ever visit or have you ever visited the Web for health, diet or nutrition information? Talk to me about this. 7. Do you typically read magazines? 8. Which magazines do you read? a. (Ask for each magazine) What kind of information are you looking for? b. (Ask for each magazine) What ar ticles do you usually read first? c. (Ask for each magazine) Have you ever looked for health, diet and nutrition information? 9. Do you watch television? 10. What programs do you typically watch? 11. Have you ever watched a televi sion program on health, diet or nutrition? If so, tell me about it. 12. What is your definition of organic food? 13. Talk to me about organic fruits and vegetables. 14. What do you know about them? a. Have you ever eaten them? 15. Picture someone who buys organic fruits and vegetables. Tell me about that person. a. Male or female? b. Age? c. Appearance? d. Interests? e. Job, income? 16. What do you think are the advantages/benefits of eating organic fruits and vegetables? 17. These are th e actual benefits. Which of thes e benefits from eating organic fruits and vegetables are most important to you? (H ave individual participants rank in order) a. Keeps you thinner b. Keeps your skin clearer c. Gives you more energy d. Helps prevent disease e. Helps you concentrate 18. What do you think are the disadvantages of eating organic fruits and vegetables? a. Not convenient to buy? b. Too expensive? 19. If you wanted to find more information about organic fruits and vegetables, where would you go?
77 a. Friends? b. Family? c. Health professional? d. Media? 20. Please share an example of when you learned something helpful about health, diet and nutrition. 21. Is there someone you admire who says that health, diet and nutriti on are important? Tell me about that person? a. What is his/her relation to you? b. How does he/she influence you? c. Do you listen to his/her advice?
78 APPENDIX C SAMPLE TRANSCRIPT INDIVIDUAL INTERVIEW HM: Ok. Well just kind of tell m e basically wh at you typically eat in a day beginning with breakfast? Gayle: Breakfast I usually eat snack ah like snack bars. Like Nutr ition Fax or I eat cereal, like Corn Pops, Apple Jacks, ah Honey Nut Cheerios. HM: Ok how about lunch? Gayle: Lunch I usually eat salads and sometimes I eat um like ah usually sometimes I eat fruits. HM: Ok and how about dinner. Gayle: Dinner I usually eat meats. Ah I eat vege tables ah sometimes ah daily products. HM: What about snacks? Gayle: Snacks I usually eat like sometimes I eat plums, apples, oranges, sometimes I eat broccoli, lettuce. HM: Ok did you ever have snacks here at school? Gayle: No. HM: So you eat pretty much fruits and vegetables for your snacks? Gayle: Yeah. HM: And thats pretty typical of what you eat. Ok. Tell me how the food choices are made in your home. Who normally decides what your going to eat. Gayle: My mom usually decides. HM: She does. Ok and do you ever go shopping with her when she goes shopping for food? Gayle: Yes. HM: Tell me about that like how often you usually go. Gayle: Usually we go every Sunday. HM: And do you ah tell her ah like what kind of choices you like and kind of pick tell me what kind of things you choose to have. Gayle: Usually I pick ah the usually I pick the cereals of what we eat and usually I ah pick what were going to have pi ck out for lunch and so HM: What kinds of things do you pick up then? Gayle: Usually I pick out ah kind of like ah snack bars and also I pick out water like Propel and also I well we usually pick up bananas or oranges and then we also have that a little like dessert. HM: Ok what kind of things for dessert. Gayle: Usually we have like brownies or ah like little Zero cakes and we have Pringles or something. HM: Ok, all right. Where do you think like your mom gets inform ation about the food that you eat? Where do you think she goes? Gayle: She ah usually goes to ah like the pyramid chart yeah like what foods to eat that are most important. HM: Does she have one like in the house or something. Gayle: No-ah she like theres a food program that she to follow for the day-care that we own. So she knows from that chart she has. HM: Oh, so she picks the different foods from the different parts of the pyramid? Gayle: Um hum.
79 APPENDIX D SAMPLE TRANSCRIPT FOCUS GROUP Sally, Laurel, Yolly, Maureen, and Debbie HM: Lets just talk about what you guys specifica lly eat in a day break fast, lunch and dinner and snacks. Sally, tell m e about what you have? Sally: Like for just breakfast> HM: Tell more for breakfast we ll start with breakfast. Sally: Um I have either a Special K cereal like breakfast or ah like I ll have like a bagel and Ill have Ovaltine. HM: How about Lunch: Sally: For lunch Ill either have like a Lean Cuisine Meal, a turkey sandwich from my mom or ah like something healthy from the cafeteria. HM: What kinds of things do you eat in the cafeteria? Sally: Like they make turkey sandwiches so Id have like a turkey sandwich from them and if they didnt make it Ill have like a grilled ch icken sandwich. HM: Ok. How about you Yolly? What do you have for breakfast. Oh, Im sorry let me ask you any snacks? Sally: Yeah, like my mom has what we bought like a hundred calorie packs. So well have like a 100 calorie packs from different things. HM: Are they like cook ies or crackers or Sally: Like some of them are lik e little cookies from other pl ace and ah like ones but I dont really know. HM: Ok, Yolly breakfast what do you have? Yolly : Ah for breakfast I usually eat like cereal or, or bread HM: How about lunch Yolly: For lunch I usually I most bring my lunch here or HM: What kind of things do you bring? Yolly: I could bring like ah snacks because I dont eat here I eat at my house. HM: You eat at home when you get home. Yolly: Yeah. So I just like to then I eat usually at my house. HM: So what kind of things do you bring to snack on? Yolly: Like cookies, fr uits, ah I think. HM: Then what do you eat when you get home? Yolly: Well we get spaghetti or something or go out to restaurants on special occasions. HM: Eat out and what do you kind of eat when you go out. Yolly: We go to Chinese or Italian restaurants different things. HM: Ok. Ok Laurel, how about you. What do you have for breakfast? Laurel: I usually have like cereal or like on special occasions we make pancakes. HM: Like on the weekends pancakes or Laurel: Yeah better like a birthday or Mothers Day kind of thing we make pancakes. So ah and or cereal ah for lunch I usually have like a peanut butter and jelly occasional honey when I like been to the grocery store. HM: Peanut butter and jelly and honey ok Laurel: Occasionally honey. Ah grapes, yogurt and chocolate milk. HM: Ok dinner?
80 Laurel: Dinner I usually have macaroni and cheese. HM: Thats your favorite huh? Ok. How about snacks any snacks? Laurel: Like snacks I really dont eat that much snacks. Just like a cookie or something. When I really hungry I like a cookie or like a bag of chips. If Ive really like hungry Ill eat like those little Luna thingies. HM: Those little what? Laurel: Luna thingies. HM: Ok Maureen how about you. What do you have for breakfast? Maureen: I have we have little omelets and we microwave them or sometimes today we ate cereal thats only if we have e nough time and like just ah banana or an apple or some turkey. Something like protein HM: How about lunch? Maureen: Ah like sometimes like thei r food is really greasy and fried so we/I try to get like healthy meals, but HM: Like what would you choose. Maureen: Like either grilled chicke n or or salad or sometimes I ll bring my lunch and my mom and me will like share a salad cause my mom works here so we would like share a salad. HM: And then dinner? Maureen: Ah my mom normally doesnt really cook. So I make either like some oatmeal for dinner for me and my sister or maybe eat some cereal or peanut butter and jelly. Something like that? HM: Do you ever have any snacks? Maureen: Ah probably bananas. HM: How about you Debbie? Whats for breakfast? Debbie: Sometimes I eat like Quaker things like th is morning I had like a Quakers banana nut bar yeah and like everything kinda by Quakers or something or I just have fruit or cause I really dont have time cause I live a little far away from here. HM: So you dont always do breakfast fast? Debbie: Well I do it on the to go li ke in the car and stuff and then ah for lunch I actually today I brought my lunch and its whatever we had for dinner. HM: Leftovers. Debbie: and also ah same thing healthy food here cause some of their sandwiches and like some of their food theyre a li ttle disgusting and have like sometimes theyre even molded. HM: Moldy and greasy that kind of thing. Group remarks: They have this disgusting little fruit cup thingie Ive neve r eaten them cause You can see mold inside the cup. Debbie: But like they put juice like juice in and then they put like little pieces of like peaches or pineapple or something and then sprinkles on top. HM: How about dinner what would have? Debbie: Um kind of whatever my mom feels like cooking. Like if she feels ok shell do like something big like last night oh yeah, last nigh t she loves getting stuff from Costco the big value sized meal loves it. So last night she brought home this pasta thing. It was actually pretty good and then also sometimes we just have fr uit with it. On the go to volleyball practice. HM: So a lot of times pasta Debbie: Or like Chinese food, Italian like whatever she feels like making she makes it. HM: How about any snacks? Do you eat snacks?
81 APPENDIX E SURVEY QUESTIONS 1. I think its important to eat organic fruits and vegetables every day. Strongly Agree Somewhat Agree Agree Neither Agree or Disagree Disagree Strongly Disagree 2. I think eating organic fruits and vegetables will help my body be thin. Strongly Agree Somewhat Agree Agree Neither Agree or Disagree Disagree Strongly Disagree 3. I think eating organic fruits and vegetables will give me clearer skin. Strongly Agree Somewhat Agree Agree Neither Agree or Disagree Disagree Strongly Disagree 4. I think eating organic fruits and vegetables will give me more energy. Strongly Agree Somewhat Agree Agree Neither Agree or Disagree Disagree Strongly Disagree 5. I think eating organic fruits and vegetables will keep me from getting a disease. Strongly Agree Somewhat Agree Agree Neither Agree or Disagree Disagree Strongly Disagree 6. If there was an article about organic fruits and vegetables on the Internet, I would probably read it. Strongly Agree Somewhat Agree Agree Neither Agree or Disagree Disagree Strongly Disagree 7. If there was an article about organic fruits and vegetables in a magazine, I would probably read it. Strongly Agree Somewhat Agree Agree Neither Agree or Disagree Disagree Strongly Disagree 8. If there was a television program about organic fruits and vegetables, I would probably watch it. Strongly Agree Somewhat Agree Agree Neither Agree or Disagree Disagree Strongly Disagree 9. I think organic fruits and vegetables cost too much. Strongly Agree Somewhat Agree Agree Neither Agree or Disagree Disagree Strongly Disagree 10. I think organic fruits and vegetables are not easily available to me. Strongly Agree Somewhat Agree Agree Neither Agree or Disagree Disagree Strongly Disagree 11. I think its important to eat organic fruits and vegetables whenever I can. Strongly Agree Somewhat Agree Agree Neither Agree or Disagree Disagree Strongly Disagree 12. I am interested in knowing more about organic fruits and vegetables. Strongly Agree Somewhat Agree Agree Neither Agree or Disagree Disagree Strongly Disagree 13. After the earlier interview, I felt I ha d to answer these questions a certain way. Strongly Agree Somewhat Agree Agree Neither Agree or Disagree Disagree Strongly Disagree
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94 BIOGRAPHICAL SKETCH Holly Mead e received her undergraduate degree in speech and drama and communications at Mercer University in Macon, Georgia. Ho lly also has completed a long-time goal of her masters degree in mass communication in the Colle ge of Journalism and Communications at the University of Florida. She currently produces a daily radio program called, The Lighthouse Report in addition to her freelance work writing, Beyond the Call Holly has written other radio programs and promos and done voiceovers. Sh e has worked behind the scenes producing television programs as well as on-camera standups. Holly also has enjoyed spending many years in live theatre acting in plays and monologues. She con tinues her passion to encourage others to pursue spiritual, physic al, and emotional excellence.