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Healthy and Unhealthy Dietary Behaviors among Adults: A Cross-Sectional

Study

Article  in  Korean Journal of Health Education and Promotion · December 2017

DOI: 10.14367/kjhep.2017.34.5.83

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보건교육건강증진학회지 제34 권 제5 호(2017. 12) pp.83-94
Korean J Health Educ Promot, Vol.34, No.5 (2017)
https://doi.org/10.14367/kjhep.2017.34.5.83

Healthy and unhealthy dietary behaviors among adults:

a cross-sectional study
* **† ***
Meredith G. Wagner , Young-Jae Kim , Yeong Rhee
*
Concordia College, Department of Nutrition and Dietetics
**
Yeungnam University, Department of Forest Resources and Landscape Architecture
***
North Dakota State University, Department of Health, Nutrition, and Exercise Sciences

Objectives: The prevalence of overweight and obesity continue to increase among adults in the United States, which warrants an increased
need for research on factors impacting lifestyle behaviors. This study examines the relationships between socioeconomic status, health
status, attitude about overall eating habits, retail food environment and healthy and unhealthy dietary behaviors. Methods: We conducted
a cross-sectional study of 125 adults living in the Midwest metropolitan area comprising Fargo (North Dakota) and Moorhead (Minnesota)
of the United States. Chi-square, t-tests and binomial logistic regressions were used for the statistical analyses. Results: The results from
this study represent that low household incomes, poor health status, single status were associated with unhealthy dietary behaviors such
as eating while watching TV/reading and using food as a punishment, while neighborhood grocery store having a wide selection of fruits
and vegetables decreased the odds of using food as a punishment. Furthermore, eating healthy snacks, eating dinner with family, and
having scheduled meals were associated with good eating habit, consuming a diet medium in fat compared to high in fat, and high
household income, respectively. Conclusions: The findings from this study can be used in developing effective public health strategies
and interventions aimed at improving overall health status of adults.

Key words: dietary behaviors, adults, socioeconomic status, health status, retail food environment

Ⅰ. Introduction Matsudo, & do Carmo Luiz, 2014; King et al., 2010),

The prevalence of overweight and obesity continue to
increase among adults in the United States (Ogden, Carroll,
Fryar, & Flegal, 2015), which warrants an increased need for
research on factors impacting lifestyle behaviors, namely
dietary intake and physical activity. Lifestyle behaviors
associated with decreased weight and thus, decreased risk of
morbidity and mortality include eating at scheduled times
throughout the day (Ducrot et al., 2017; St-Onge et al., 2017),
incorporating healthy snacks into the dietary intake (Njike et
al., 2016), and consuming meals with family members (Tumin
& Anderson, 2017). On the other hand, behaviors such as
spending a prolonged time engaging in sedentary activities
like TV-viewing and reading (de Rezende, Lopes, Rey-López,
particularly when simultaneously eating (Avery, Anderson, &
McCullough, 2017; Bowman, 2006; French, Story, & Jeffery,
2001; Ramos, Costa, Araújo, Severo, & Lopes, 2013), and
assigning value to foods so they become either a source of
reward or punishment (Jonker, Bennik, & de Jong, 2016), are
associated with adverse health implications.
Lifestyle behaviors of adults are influenced by both internal
and external stimuli. Gender (King et al., 2010; Tumin &
Anderson, 2017), age (Hulsegge et al., 2016), ethnicity
(Ogden et al., 2015), education (Ducrot et al., 2017; Ogden
et al., 2015), income (Ducrot et al., 2017; Ogden et al., 2015),
and past and present health conditions (Schifferstein &
Ophuis, 1998) may impact whether or not a person engages
in a particular type of lifestyle behavior. Likewise, the

Corresponding author : Young-Jae Kim

Department of Forest Resources and Landscape Architecture, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk
38541, Republic of Korea
Tel: +82-53-210-2978, Fax: +82-53-810-4660, E-mail: youngjae_kim@yu.ac.kr
∙Received: November 10, 2017 ∙Revised: December 17, 2017 ∙Accepted: December 21, 2017
84 보건교육건강증진학회지 제34권 제5호
external environment, which includes an individual’s home
(Davis-Kean, 2005), work (Kamarulzaman, Saleh, Hashim,
Hashim, & Abdul-Ghani, 2011), social, and physical environment
(Maddison et al., 2009), can support or discourage certain
healthy and unhealthy behaviors (Farhud, 2015).
Strategies and interventions aimed at promoting healthy
lifestyle behaviors and discouraging engagement in unhealthy
lifestyle behaviors may be more effective if a better
understanding existed of the relationship between internal and
external variables and healthy and unhealthy lifestyle behaviors.
Thus, the purpose of the current study was to examine
relationships between socioeconomic status, health status,
attitude about overall eating habits, retail food environment
and healthy and unhealthy dietary behaviors among adults.
Ⅱ. Materials and Methods
1. Study setting and data collection
This cross-sectional study used survey data collected from
adults living in or nearby a city of approximately 190,000 in
the Midwestern portion of the United States, which comprises
Fargo (North Dakota), Moorhead (Minnesota) and the surrounding
communities. The survey included questions about socioeconomic
and demographic information, health status or current diagnosis
of chronic diseases, and family rules, dietary behaviors, food
availability at home, and retail food environment.
The surveys were sent to the study participants via email
in February 2016 after being approved by the institutional
review boards. Excluding 141 samples, who answered the
selected study questions unclearly, a total of 125 participants
was chosen for this study. The study protocol was approved
by the institutional review board of North Dakota State
University [#HE16185].
2. Dependent variables: healthy eating and unhealthy
dietary behaviors
For dependent variables, two domains – healthy and unhealthy
dietary behaviors – were considered. Three variables related to
healthy dietary behaviors, including (1) whether to eat healthy
snacks, (2) whether to eat dinner with family, and (3) whether
to have scheduled meals, were chosen. Two variables, (1)
whether to eat while watching TV/reading and (2) whether to
use food as a punishment, were used as unhealthy dietary
behaviors. The five dependent variables were coded as a
dichotomous scheme (0: no, 1: yes).
3. Independent variables: socioeconomic status,
health status, attitude about overall eating habit,
and retail food environment
In terms of independent variables, four domains – socioeconomic
status, health status, attitudes about overall eating habit, and
retail food environment – were included. The independent
variables related to the socioeconomic status were participants’
education levels, household income, marital status, and
gender. The health history or the current diagnosis of cancer
and high blood pressure were used as the health status factors.
Furthermore, the physical activity variable, which was
measured based on a survey question asking about ‘times per
week’ for taking part in any physical activities such as
running, calisthenics, or walking for exercise was included in
the health status domain.
For attitudinal variables, three variables including eating
habit categorized by poor, fair, and good, ‘times per week’ for
eating out, and overall diet in fat, which was categorized by
low, medium, and high were used. For retail food
environment variables, two items asking participants whether
or not ‘their grocery stores have a wide selection of fruits and
vegetables’ and ‘they feel fruits and vegetables are expensive’
were used.
4. Data analysis
For bivariate analysis, chi-square tests and t-tests were
conducted to specify the sample characteristics and to assess
the differences in the frequency or the mean of the
independent variables between ‘no’ and ‘yes’ groups of
 Healthy and unhealthy dietary behaviors among adults: A cross-sectional study
participants engaging in healthy and unhealthy dietary behaviors.
In order to further examine the relationships between
socioeconomic status, health status, attitude about overall
eating habit, and retail food environment and healthy and
[Figure 1] Study framework
Ⅲ. Results
1. Sample characteristics and bivariate tests
estimating differences in characteristics of the
study variables between ‘no’ and ‘yes’ groups for
healthy and unhealthy dietary behaviors
Tables 1 and 2 presents the comparison results of the
sample characteristics between ‘no’ and ‘yes’ groups for
healthy and unhealthy dietary behaviors. In the socioeconomic
status domain, the education levels were lower for respondents
eating while watching TV, which was marginally significant
at the 0.10 level. On the other hand, respondents who had
higher education levels were more likely to eat dinner with
family and have scheduled meals, compared to respondents
who had lower education levels. Furthermore, the household
income was higher for the ‘no’ group for eating while
85
unhealthy dietary behaviors (five dependent variables),
binomial logistic regressions were conducted [Figure 1].
Furthermore, the present study used STATA version 14 to
develop five regression models.
watching TV, ‘yes’ group for eating dinner with family, and
‘yes’ group for having scheduled meals. More respondents
eating dinner with family and those having scheduled meals
were married or partnered, while higher number of
respondents who did not eat dinner with family and of those
who did not have scheduled meals were single. Female
respondents were more likely to eat while watching TV
compared to male adults.
In terms of health status variables, no significant differences
were noted between ‘no’ and ‘yes’ groups for engaging in
healthy and unhealthy dietary behaviors, except for the
physical activity variable. On average, respondents eating
healthy snacks engaged in physical activity 4.8 times per
week while those who did not eat healthy snacks engaged in
physical activity only 2.2 times per week.
Regarding attitude about overall eating habit, a higher
number of respondents who had good overall eating habits
86 보건교육건강증진학회지 제34권 제5호

were less likely to use food as a punishment, more likely to
eat healthy snacks, and more likely to have scheduled meals.
Respondents eating out more times per week were more likely
to use food as a punishment and were less likely to eat
healthy snacks.
Furthermore, the number of respondents who answered that
grocery stores in their neighborhood do not have a wide
selection of fruits and vegetables was higher for respondents
who ate while watching TV and used food as a punishment.
In contrast, respondents recognizing that grocery stores in
their neighborhood have a wide selection of fruits and
vegetables were more likely to eat dinner with family and
have scheduled meals. The percentage of respondents
answering that fruits and vegetables in retail food stores are
expensive was higher for respondents eating while watching
TV than the counter-part group. On the other hand, the
percentage of respondents who thought that fruits and
vegetables are not expensive were higher for the group having
scheduled meals than for the group not having scheduled
meals.

<Table 1> Sample characteristics and bivariate tests for unhealthy dietary behaviors

Unhealthy dietary behaviors

Variables Eating while watching TV Using food as a puishment
2
No Yes X or t No Yes X 2 or t
Socioeconomic status
Education (n (%))
High school graduate 1 (8.3%) 2 (1.6%) 3 (2.4%) 0 (0.0%)
Some college 1 (8.3%) 32 (25.8%) 28 (22.0%) 5 (55.6%)
2 year degree 0 (0.0%) 5 (4.0%) 5 (3.9%) 0 (0.0%)
6.8
4 year degree 3 (25.0%) 48 (38.7%) 9.9* 49 (38.6%) 2 (22.2%)
Professional degree 2 (16.7%) 20 (16.1%) 20 (15.8%) 2 (22.2%)
Doctorate 5 (41.7%) 17 (13.7%) 22 (17.3%) 0 (0.0%)
Household income (n (%))
Less than $10,000 1 (8.3%) 15 (12.2%) 13 (10.3%) 3 (33.3%)
$10,000 - $ 9,999 0 (0.0%) 10 (8.1%) 9 (7.1%) 1 (11.1%)
$20,000 - $29,999 0 (0.0%) 12 (9.7%) 12 (9.5%) 0 (0.0%)
$30,000 - $39,999 0 (0.0%) 9 (7.3%) 9 (7.1%) 0 (0.0%)
$40,000 - $49,999 0 (0.0%) 11 (8.9%) 11 (8.7%) 0 (0.0%)
$50,000 - $59,999 0 (0.0%) 5 (4.0%) 5 (4.0%) 0 (0.0%)
19.5*
$60,000 - $69,999 0 (0.0%) 8 (6.5%) 8 (6.4%) 0 (0.0%) 10.3
$70,000 - $79,999 0 (0.0%) 7 (5.7%) 6 (4.7%) 1 (11.1%)
$80,000 - $89,999 1 (8.3%) 6 (4.9%) 6 (4.7%) 1 (11.1%)
$90,000 - $99,999 3 (25.0%) 4 (3.2%) 6 (4.7%) 1 (11.1%)
$100,000 - $149,999 4 (33.3%) 23 (18.7%) 25 (19.8%) 2 (22.2%)
More than $150,000 3 (25.0%) 13 (10.5%) 16 (12.7%) 0 (0.0%)
Marital status (n (%))
Single 2 (16.7%) 58 (46.8%) 54 (42.5%) 6 (66.7%)
5.2 2.1
Married or partnered 10 (83.3%) 61 (49.2%) 68 (53.5%) 3 (33.3%)
 Healthy and unhealthy dietary behaviors among adults: A cross-sectional study 87

Unhealthy dietary behaviors

Variables Eating while watching TV Using food as a puishment
2
No Yes X or t No Yes X 2 or t
Separated 0 (0.0%) 1 (0.8%) 1 (0.8%) 0 (0.0%)
Divorced 0 (0.0%) 4 (3.2%) 4 (3.2%) 0 (0.0%)
Gender (n (%))
Male 7 (58.3%) 27 (21.8%) ***
32 (25.2%) 2 (22.2%)
7.8 0.1
Female 5 (41.7%) 97 (78.2%) 95 (74.8%) 7 (77.8%)
Health status
Physical activity †(mean±SD) 2.75±2.38 4.65±4.70 1.4 4.41±4.05 5.33±9.43 0.6
Cancer (n (%))
No 11 (91.7%) 117 (94.4%) 119 (93.7%) 9 (100.0%)
0.1 0.6
Yes 1 (8.3%) 7 (5.6%) 8 (6.3%) 0 (0.0%)
High blood cholesterol (n (%))
No 11 (91.7%) 104 (84.5%) 109 (86.5%) 6 (66.7%)
0.4 2.6
Yes 1 (8.3%) 19 (15.5%) 17 (13.5%) 3 (33.3%)
Attitude about overall eating habit
Eating habit (n (%))
Poor 0 (0.0%) 9 (7.3%) 6 (4.7%) 3 (33.3%)
***
Fair 5 (41.7%) 54 (43.6%) 1.1 55 (43.3%) 4 (44.4%) 11.9
Good 7 (58.3%) 61 (49.1%) 66 (52.0%) 2 (22.2%)
†
Eating out (mean±SD) 1.58±0.79 1.92±1.64 0.7 1.81±1.39 3.00±3.24 2.2**
Overall diet in fat (n (%))
High 1 (8.3%) 22 (17.7%) 20 (15.7%) 3 (33.3%)
Medium 9 (75.0%) 85 (68.6%) 0.7 89 (70.1%) 5 (55.6%) 1.8
Low 2 (16.7%) 17 (13.7%) 18 (14.2%) 1 (11.1%)
Retail food environment
Grocery store having a wide selection of fruits and vegetables (n (%))
No 0 (0.0%) 25 (20.3%) *
21 (16.7%) 4 (44.4%) **
3.0 4.3
Yes 12 (100.0%) 98 (79.7%) 105 (83.3%) 5 (55.6%)
Expensive fruits and vegetables (n (%))
No 7 (58.3%) 42 (33.9%) *
47 (37.0%) 2 (22.2%)
2.8 0.8
Yes 5 (41.7%) 82 (66.1%) 80 (63.0%) 7 (77.8%)
†
: Denotes ‘times per week’
*
p<.1, ** p<.05, *** p<.001 (two-tailed test)
88 보건교육건강증진학회지 제34권 제5호

<Table 2> Sample characteristics and bivariate tests for healthy dietary behaviors

Healthy dietary behaviors

Variables Eating healthy snacks Eating dinner with family Having scheduled meals
2 2
No Yes X or t No Yes X or t No Yes X 2 or t
Socioeconomic status
Education (n (%))
High school graduate 1 (5.3%) 2 (1.7%) 3 (6.4%) 0 (0.0%) 2 (4.0%) 1 (1.2%)
Some college 5 (26.3%) 28 (23.9%) 17 (36.1%) 16 (18.0%) 17 (34.0%) 15 (17.6%)
2 year degree 0 (0.0%) 5 (4.3%) 1 (2.1%) 4 (4.5%) 4 (8.0%) 1 (1.2%)
4.9 12.5** 12.2**
4 year degree 7 (36.8%) 44 (37.6%) 14 (29.8%) 37 (41.5%) 16 (32.0%) 35 (41.2%)
Professional degree 5 (26.3%) 17 (14.5%) 6 (12.8%) 16 (18.0%) 5 (10.0%) 17 (20.0%)
Doctorate 1 (5.3%) 21 (18.0%) 6 (12.8%) 16 (18.0%) 6 (12.0%) 16 (18.8%)
Household income (n (%))
Less than $10,000 1 (5.2%) 15 (12.9%) 10 (21.7%) 6 (6.7%) 10 (20.4%) 5 (5.9%)
$10,000 - $ 9,999 0 (0.0%) 10 (8.6%) 9 (19.5%) 1 (1.1%) 7 (14.3%) 3 (3.5%)
$20,000 - $29,999 4 (21.0%) 8 (6.9%) 7 (15.2%) 5 (5.6%) 6 (12.2%) 6 (7.1%)
$30,000 - $39,999 1 (5.3%) 8 (6.9%) 2 (4.3%) 7 (7.9%) 4 (8.1%) 5 (5.9%)
$40,000 - $49,999 2 (10.5%) 9 (7.7%) 3 (6.5%) 8 (9.0%) 3 (6.1%) 8 (9.4%)
$50,000 - $59,999 0 (0.0%) 5 (4.3%) 0 (0.0%) 5 (5.6%) 3 (6.1%) 2 (2.3%)
11.6 36.1*** 22.7**
$60,000 - $69,999 0 (0.0%) 8 (6.9%) 2 (4.3%) 6 (6.7%) 3 (6.1%) 5 (5.9%)
$70,000 - $79,999 1 (5.3%) 6 (5.2%) 1 (2.2%) 6 (6.7%) 2 (4.1%) 5 (5.9%)
$80,000 - $89,999 0 (0.0%) 7 (6.0%) 3 (6.5%) 4 (4.5%) 0 (0.0%) 7 (8.2%)
$90,000 - $99,999 2 (10.5%) 5 (4.3%) 0 (0.0%) 7 (7.9%) 1 (2.0%) 6 (7.1%)
$100,000 - $149,999 5 (26.3%) 22 (19.0%) 4 (8.7%) 23 (25.8%) 7 (14.3%) 20 (23.5%)
More than $150,000 3 (15.8%) 13 (11.2%) 5 (10.9%) 11 (12.3%) 3 (6.1%) 13 (15.3%)
Marital status (n (%))
Single 10 (52.6%) 50 (42.7%) 35 (74.5%) 25 (28.1%) 29 (58.0%) 30 (35.3%)
Married or partnered 8 (42.1%) 63 (53.9%) 11 (23.4%) 60 (67.4%) 19 (38.0%) 52 (61.2%)
7.6* 30.1*** 8.9**
Separated 1 (5.3%) 0 (0.0%) 1 (2.1%) 0 (0.0%) 1 (2.0%) 0 (0.0%)
Divorced 0 (0.0%) 4 (3.4%) 0 (0. %) 4 (4.5%) 1 (2.0%) 3 (3.5%)
Gender (n (%))
Male 5 (26.3%) 29 (24.8%) 11 (23.4%) 23 (25.8%) 14 (28.0%) 20 (23.5%)
0.1 0.1 0.3
Female 14 (73.7%) 88 (75.2%) 36 (76.6%) 66 (74.2%) 36 (72.0%) 65 (76.5%)
Health status
Physical activity†(mean±SD) 2.24±1.95 4.81±4.75 2.2** 4.70±3.81 4.36±4.95 0.4 4.63±5.24 4.37±4.18 0.3
Cancer (n (%))
No 17 (89.5%) 111 (94.9%) 45 (95.7%) 83 (93.3%) 48 (96.0%) 79 (92.9%)
0.9 0.3 0.5
Yes 2 (10.5%) 6 (5.1%) 2 (4.3%) 6 (6.7%) 2 (4.0%) 6 (7.1%)
High blood cholesterol (n (%))
No 15 (78.9%) 100 (86.2%) 43 (91.5%) 72 (81.8%) 45 (90.0%) 69 (82.1%)
0.7 2.3 1.5
Yes 4 (21.0%) 16 (13.8%) 4 (8.5%) 16 (18.2%) 5 (10.0%) 15 (17.9%)
 Healthy and unhealthy dietary behaviors among adults: A cross-sectional study 89

Healthy dietary behaviors

Variables Eating healthy snacks Eating dinner with family Having scheduled meals
No Yes X 2 or t No Yes X 2 or t No Yes X 2 or t
Attitude about overall eating habit
Eating habit (n (%))
Poor 6 (31.6%) 3 (2.6%) 4 (8.5%) 5 (5.6%) 3 (6.0%) 6 (7.1%)
***
Fair 11 (57.9%) 48 (41.0%) 28.7 23 (48.9%) 36 (40.5%) 1.7 29 (58.0%) 30 (35.3%) 6.7**
Good 2 (10.5%) 66 (56.4%) 20 (42.6%) 48 (53.9%) 18 (36.0%) 49 (57.6%)
† **
Eating out (mean±SD) 2.68±1.89 1.76±1.50 2.4 1.96±1.57 1.85±1.60 0.4 1.99±1.48 1.85±1.65 0.5
Overall diet in fat (n (%))
High 9 (47.4%) 14 (12.0%) 7 (14.9%) 16 (18.0%) 11 (22.0%) 12 (14.1%)
***
Medium 9 (47.4%) 85 (72.6%) 14.8 36 (76.6%) 58 (65.2%) 2.3 34 (68.0%) 60 (70.6%) 1.8
Low 1 (5.3%) 18 (15.4%) 4 (8.5%) 15 (16.8%) 5 (10.0%) 13 (15.3%)
Retail food environment
Grocery store having a wide selection of fuits and vegetables (n (%))
No 5 (27.8%) 20 (17.1%) 13 (27.7%) 12 (13.6%) 14 (28.0%) 11 (13.1%)
1.2 4.0** 4.6**
Yes 13 (72.2%) 97 (82.9%) 34 (72.3%) 76 (86.4%) 36 (72.0%) 73 (86.9%)
Expensive fruits and vegetables (n (%))
No 9 (47.4%) 40 (34.2%) 15 (31.9%) 34 (38.2%) 13 (26.0%) 35 (41.2%)
1.2 0.5 3.2*
Yes 10 (52.6%) 77 (65.8%) 32 (68.1%) 55 (61.8%) 37 (74.0%) 50 (58.8%)
†
: Denotes ‘times per week’
*
p<.1, ** p<.05, *** p<.001 (two-tailed test)

2. Odds ratios for the associations between the study likely to eat dinner with family than single adults.
variables and dietary behaviors Furthermore, female adults were more likely to eat while
watching TV as compared to male adults.
Table 3 presents the odds ratios for the associations of
Among the health status variables, physical activity was
socioeconomic status, health status, overall eating habit, and
only significantly associated with the outcome variable of
retail food environment to unhealthy and healthy dietary behaviors,
model 1. The odds ratio for the physical activity variable in
which were examined by five binomial regression models.
model 1 was 1.55, which indicates that every additional
In terms of socioeconomic status related to unhealthy and
increase in times per week for engaging in physical activities
healthy dietary behaviors, the household income was
increased the odds of eating while watching TV. Adults who
significantly associated with eating while watching TV and
have or have ever had cancer were less likely to eat healthy
having scheduled meals. The estimated odds ratios for the
snacks. Furthermore, the odds ratios for the high blood
household income variable were 0.75 and 1.13 for each model
pressure variable, which shows positive relationships in
1 and model 5, which means that every $10,000 increase in
models 1 and 2, represent that the current or past diagnosis
income decreased the probability of eating while watching TV
of high blood cholesterol increased the probability of eating
by 25% and increased the probability of having scheduled
while watching TV and using food as a punishment.
meals by 13%. The odds ratio for the marital status variable,
Regarding the attitudinal correlates of dietary behaviors,
which was positively associated with the outcome variable of
two independent variables remained significant in the
model 4, indicates that married or partnered adults were more
90 보건교육건강증진학회지 제34권 제5호

regression models. Adults who described that their overall
eating habit is ‘good’ were more likely to eat healthy snacks
compared to adults who described it as ‘poor’. The odds ratios
for the overall diet in fat show different relationships with
healthy dietary variables. Adults who responded that their diet
is medium in fat were more likely to eat healthy snacks and
less likely to eat dinner with family as compared to adults
who answered that their diet is high in fat.
In regard to the retail food environmental correlates of
healthy and unhealthy dietary variables, one variable was
statistically significant in model 2. Adults who responded that
their grocery store has a wide selection of fruits and
vegetables were less likely to use food as a punishment
compared to adults who oppositely reported.

<Table 3> Fully adjusted models estimating the odds of having unhealthy and healthy dietary behaviors

Unhealthy dietary behaviors Healthy dietary behaviors

Eating while Using food as a Eating healthy Eating dinner with Having
Variables
watching TV punishment snacks family scheduled meals
OR p>|z| OR p>|z| OR p>|z| OR p>|z| OR p>|z|
Socioeconomic status
†
Education 0.98 0.948 0.59 0.157 1.17 0.621 0.97 0.861 1.32 0.126
‡ ** *
Household income 0.75 0.046 1.05 0.777 0.82 0.182 1.07 0.356 1.13 0.087
Marital status (Ref.: Single)
Married or partnered 0.23 0.290 0.25 0.315 2.75 0.300 7.42*** 0.001 0.93 0.889
Separated - - - - - - - - - -
Divorced - - - - - - - - 0.68 0.700
**
Gender (0: male, 1: female) 12.77 0.013 0.85 0.880 1.15 0.883 0.94 0.917 1.88 0.231
Health status
Physical activity (times per week) 1.55** 0.027 1.09 0.348 1.30 0.153 1.00 0.960 1.00 0.962
Cancer (0: no, 1: yes) - - - - 0.08* 0.062 - - - -
High blood cholesterol (0: no, 1: yes) 15.79* 0.053 37.96** 0.017 - - - - - -
Attitude about overall eating habit
Eating habit (Ref.: Poor)
Fair - - 0.25 0.313 4.82 0.146 4.37 0.171 0.36 0.282
Good - - 0.19 0.256 65.9*** 0.008 5.36 0.152 0.74 0.764
Eating out (times per week) 1.43 0.284 1.33 0.268 1.12 0.589 1.06 0.719 1.04 0.808
Overall diet in fat (Ref.: High)
* *
Medium 0.97 0.981 1.03 0.982 6.82 0.062 0.26 0.077 1.67 0.431
Low 0.59 0.746 0.79 0.918 5.01 0.419 0.86 0.886 2.37 0.350
Retail food environment
Grocery store having a wide selection
of fruits and vegetables - - 0.12* 0.064 4.39 0.128 1.30 0.670 1.53 0.463
(0: no, 1: yes)
Expensive fruits and vegetables
1.02 0.980 1.54 0.691 2.93 0.223 0.86 0.773 0.59 0.276
(0: no, 1: yes)
“–” Denotes that the variable was “omitted” in the regression model due to a dependency among the independent variables in each proposed model.
†
: The education variable was treated as a continuous variable, which includes the following categories: (1) high school graduate, (2) some college, (3)
2 year degree, (4) 4 year degree, (5) professional degree, and (6) doctorate.
‡
: The household income variable was treated as a continuous variable, which includes the following categories: (1) < $10,000, (2) $10,000 - $ 9,999,
(3) $20,000 - $29,999, (4) $30,000 - $39,999, (5) $40,000 - $49,999, (6) $50,000 - $59,999, (7) $60,000 - $69,999, (8) $70,000 - $79,999, (9) $80,000 - $89,999,
(10) $90,000 - $99,999, (11) $100,000 - $149,999, (12) ≥$150,000.
* ** ***
p<.1, p<.05, p<.001 (two-tailed test)
 Healthy and unhealthy dietary behaviors among adults: A cross-sectional study
Ⅳ. Discussion
Respondents with lower household incomes were more
likely to eat while watching TV/reading. This is consistent
with King and colleagues’ (2010) finding that the subgroup to
have the greatest overall numbers of hours per week of TV
included those with lower income levels (King et al., 2010).
The current finding that women respondents were more likely
to eat while watching TV/reading compared to males differs
somewhat from previous findings. King and colleagues (2010)
also found a greater percentage of women (54%) reported
watching TV greater than 14 hours per week compared to
men (46%) (King et al., 2010), but did not differentiate
between watching TV and eating while watching TV. Tumin
and Anderson (2017) reported very similar frequencies of
eating while watching television or a video by men and women,
35% and 37% respectively (Tumin & Anderson, 2017). More
research about how frequency of eating while watching
TV/reading differs among men and women is needed.
The association between increased physical activity and
more frequent episodes of eating while watching TV/reading
observed in the current study may be explained by what
Owen, Healy, Matthews, and Dunstan (2012) refer to as the
“Active Couch Potato”, referring to those who report both
meeting the physical activity guidelines and engaging in
sedentary behaviors such as watching TV (Owen, Healy,
Matthews, & Dunstan, 2010). Even among physically-active
adults, Owen and colleagues (2012) found significant detrimental
dose-response associations with TV time, reinforcing the
detrimental consequences of sedentary behaviors independent
of the benefits of physical activity (Owen et al., 2010).
Those reporting current or past high blood cholesterol had
an increased probability of eating while watching TV/reading,
which is consistent with findings from other studies (Bowman,
2006). Watching TV, while eating or at other times throughout
the day, has been associated with greater overall caloric intake
(Bowman, 2006; French et al., 2001), and specifically, foods
higher in dietary cholesterol (Ramos et al., 2013), total fat
(Avery et al., 2017; Bowman, 2006; Ramos et al., 2013), and
91
added sugars (Avery et al., 2017; Bowman, 2006). Engaging
in sedentary behaviors, such as television viewing and
reading, is associated with health risks including high blood
cholesterol, cardiovascular disease, type 2 diabetes mellitus,
metabolic syndrome, and cancer (de Rezende et al., 2014). In
a recent study of over 12,000 adults, Tumin and Anderson
(2017) reported approximately one-third of adults watched a
television show or video all or most of the time while eating
meals (Tumin & Anderson, 2017). In addition, they found that
adults who never watched TV or videos during meals had
37% lower odds of being obese compared with those who
always watched TV or videos while eating (Tumin &
Anderson, 2017).
Respondents with a current or past diagnosis of high blood
cholesterol were more likely to use food as a punishment.
Individuals who are highly sensitive to punishment have been
found to restrict their food intake in order to avoid
punishment that potentially comes with overeating such as
weight gain and altered blood lipid profiles, including blood
cholesterol (Jonker et al., 2016).
Adults who responded their grocery store has a wide
selection of fruits and vegetables were less likely to use food
as a punishment compared to adults who reported the
opposite. This finding is inconsistent with a previous study
conducted by Cummins and colleagues (2014), which showed
that a community’s retail food infrastructure improved
residents’ perceptions of food accessibility, but did not lead to
changes in reported fruit and vegetable intake (Cummins,
Flint, & Matthews, 2014). The result from the current study
shows a possibility of changes to eating habits reflective of
the produce selection of neighborhood grocery stores. Having
a wide selection of healthy food items available in the
neighborhood grocery store may decrease residents’ purchase
of less healthy food items, thereby helping to discourage them
from using food as a punishment because less healthy foods
are absent from the home. Additional research on residents’
grocery store purchasing patterns and relationship to eating
habits should be conducted.
Eating healthy snacks was positively associated with
92 보건교육건강증진학회지 제34권 제5호
respondents who reported good eating habits and consuming
a diet medium in fat compared to high in fat. According to
Njike and colleagues (2016), snacking contributes close to
33% of an individual’s daily energy intake (Njike et al.,
2016). Good eating habits constitute incorporating healthy
snacks into the overall daily intake. Examples of healthy
snacks include fruits, vegetables, whole-grain products, nuts,
and seeds. Given that “healthy” generally refers to foods that
are lower in fat, it is also understandable that adults who
reported that their diet is medium in fat were more likely to
eat healthy (i.e. lower-fat) snacks than those who indicated
their diet is high in fat. Respondents who indicated they do
not consume sugar-sweetened drinks were more likely to
report eating healthy snacks than those who consume
sugar-sweetened beverages, which is again, consistent with the
generally accepted definition of “healthy” not including
sugar-sweetened products.
Respondents who reported they currently suffer from or
have ever suffered from cancer were less likely to consume
healthy snacks, a finding which adds to the existing evidence
supporting an association between individual health status and
dietary consumption patterns. A previous study conducted by
Schifferstein and Oude Ophuis (1998) identified that
customers who purchased health and organic food items were
more responsible for their own health and were more likely
to undertake preventive health actions than the general
population (Schifferstein & Ophuis, 1998). In a different
study, Hillers and Massey (1985) researched the effects of
alcohol consumption on diet and health status (Hillers &
Massey, 1985). They identified that health status measured by
blood chemistries was associated with both moderate and high
alcohol consumption and that the nutritional quality of the diet
declined as alcohol intake increased (Hillers & Massey, 1985).
While the variables used in the current study (health status:
cancer, eating habit: consuming healthy snacks) differed from
previous studies, the findings highlight the issue of health
status and its relationship to eating habits, an issue which
deserves more attention by researchers in the future,
specifically examining a variety of health and eating
habit-related variables.
Married participants were more likely than single
participants to report eating dinner with family. Given that
family can be defined fairly loosely to include just a spouse,
a spouse and children, a spouse, children, and immediate
family members, or anyone living in the house, biologically
related or not, a positive association between these two
variables is expected. Other studies have also reported
increased episodes of family meals among married individuals
compared to non-married (Tumin & Anderson, 2017).
Adults who responded that their diet is medium in fat,
compared to high in fat, were less likely to eat dinner with
family. It is important to note that the data in this study were
self-reported based on respondents self-perception of their
dietary fat intake, which may or may not accurately reflect
their actual intake. Another possible explanation offered by a
review of literature pertains to self-monitoring of dietary
intake. In their study of social facilitation of eating,
Hetherington and colleagues (2006) concluded the opportunity
to self-monitor food intake was reduced when others were
present for a meal (Hetherington, Anderson, Norton, &
Newson, 2006). Similarly, De Castro, Brewer, Elmore, &
Orozco (1990) reported that individuals eat more when dining
with others, including spouses, family members, and friends,
than when alone (De Castro, Brewer, Elmore, & Orozco,
1990). While not directly assessed, it could be feasible that
participants prefer not to eat dinner as a family so that they
may more closely engage in self-monitoring of food intake,
including limiting high sources of dietary fat in their diet. The
issue of self-monitoring of dietary intake and differences that
occur while in or not in the presence of others warrants
further study.
Household income and educational level were higher for
respondents who indicated they have scheduled meals, which
is consistent with previous research. In a study of over 40,000
adults, Ducrot and colleagues (2017) reported that adults with
higher household income and education levels were more
likely to plan their meals (Ducrot et al., 2017). Meal planning
was associated with improved adherence to nutritional
 Healthy and unhealthy dietary behaviors among adults: A cross-sectional study
guidelines, greater food variety, and lower odds of being
obese (Ducrot et al., 2017). Likewise, increased frequency of
eating is associated with decreased blood cholesterol levels
and lower risk for obesity, type 2 diabetes mellitus, and
coronary heart disease (St-Onge et al., 2017). Individuals of
higher socioeconomic status may be more likely to have the
time and resources available to have scheduled meals more so
than individuals of lower socioeconomic status, which include
those who are food insecure.
The results of the current study were subject to several
limitations, the largest of which was the collection and
assessment of self-reported data. Therefore, there might have
potential response bias referring to individuals’ tendency to
respond a certain way, regardless of the actual evidence.
Furthermore, this study was a cross-sectional study and any
causal relationship between the study variables and
healthy/unhealthy dietary behaviors cannot be established.
Other limitations include that the results from the multivariate
regression models were based on the moderate sample size,
which was 125 participants. Thus, it may not be easy to
generalize the main findings from this study to large-scale
areas. Lastly, this was a cross-sectional study so that any
causal relationship between the study variables and dietary
behaviors was not established.
Ⅴ. Conclusions
The current findings offer a better understanding of variables
associated with both healthy and unhealthy behaviors. Such
understanding is important as it can inform the process of
developing effective public health strategies and interventions
aimed at improving overall health status of adults. While the
findings offered contribute to evidence supporting positive and
negative relationships between socioeconomic status, health status,
attitude about overall eating habits, retail food environment
and healthy and unhealthy dietary behaviors, additional
research is recommended. More specifically, future studies
should focus on assessing how frequency of eating while
93
watching TV/reading differs among men and women, how
self-monitoring of dietary intake is impacted by the presence
of others, and relationships between health status and eating
habits and grocery store purchasing patterns.
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