Food choices among newly married couples: convergence,conflict, individualism,and projects

Individuals entering marriage merge their personal food systems to create a joint spousal food system. This investigation examined newly married couples' food choices. Qualitative interviews conducted with 20 couples as they entered marriage and again 1 year later revealed that some reported initial food homogamy, while others had varying degrees of compatibility in food preferences and tolerances. All couples reported some dietary convergence. Convergence was initially symmetrical (similar merging for both partners) or asymmetrical (one partner changed more), and sometimes convergence patterns evolved further. Unresolved food choice negotiations led to food conflicts. Prior food broadening experiences, initial dietary congruity, health/weight philosophies, foodwork, and commensal patterns were conditions shaping couples' food choice negotiations and dietary convergence patterns. Some food individualism persisted for most partners, helping to alleviate food choice conflicts. Food projects occurred when one partner was committed to molding the other's food choices. Overall, food choice negotiations involving both convergence and conflict were important components of marital adjustments that may have later health consequences.     

Food Choices in Three Ethnic Groups: Interactions of Ideals,Identities, and Roles

Ethnicity is one of the many factors that play a role in food choices.This project examined how ethnicity was enacted in food choices among 86 adults in one U.S. city, purposively recruited to vary in ethnic identity (Black, Latino, White). Qualitative research methods were used to conduct semistructured depth interviews about participants’ ethnic identity, food choices, and influences on food consumption. Analysis of these data produced a conceptualization of influences on food choices that spanned the different ethnic groups. Ideals, identities, and roles interacted with each other and the food and eating context in reciprocal and dynamic ways to influence food choice. Differences in ideals, identities, and roles were related to ethnic group affiliation and were most apparent during times of personal transition and in contexts highlighting contrasts. This conceptualization can enhance the ability of nutrition educators working in a multicultural society to identify processes underlying ethnic food choices and apply this understanding to research and practice.     

Understanding the food choice process of adolescents in the context of family and friends

PurposeTo understand from the adolescents’ own perspective the decision-making processes they use to make food choices on an everyday basis and how they resolve their need for personal control over food choices with the values of family and peers.MethodsA sample of 108 adolescents, aged 11–18 years, were individually interviewed. They were asked in a simulated task to choose a lunch from a menu of offerings and give reasons for their choices. In addition, open-ended questions probed for meal structures, dinners, perceptions of degree of choice, role of family and peers. Interviews were audio-taped, transcribed, coded, and analyzed for emerging themes.ResultsPrimary food choice criteria were taste, familiarity/habit, health, dieting, and fillingness. Lunches had a definite structure, and lunches differed from dinners. The food choice process involved personal food decision-making rules such as trade-offs among choice criteria within a meal (e.g., taste for core items and health for secondary items), and between lunches with peers (taste) and family dinners (health); negotiation patterns with the family (autonomy versus family needs); and interactions with peers.ConclusionsThe food choice process for most adolescents seemed to involve cognitive self-regulation where conflicting values for food choices were integrated and brought into alignment with desired consequences. Educators and practitioners should recognize the dilemmas adolescents face in making food choices and help them develop strategies for balancing less healthful with more healthful food items, through: (a) personal food decision-making rules, (b) effective negotiations with family members; and (c) appropriate interaction patterns with peers.     

Factors Influencing Childcare Providers' Food and Mealtime Decisions: An Ecological Approach

To better understand and promote healthy nutritional behaviour development in children, research suggests the need to develop a stronger comprehension of influences from their social environment. Yet research has favoured studying parents, with little attention being paid to other important individuals in children's lives, especially from a qualitative research approach. Thus, the goal of this study was to understand the factors influencing childcare providers' decisions regarding nutrition in childcare settings. Semi-structured interviews were conducted with 13 home-based and centre-based childcare providers in the Ottawa region. Through use of the social ecological model, results revealed a comprehensive understanding of different personal, community, and societal factors that influence providers in their decisions regarding food and mealtimes. To promote healthy nutritional behaviours in children, the variety of factors that influence nutritional decisions by providers need to be addressed, given the amount of time Canadian children spend in early childcare settings.     

Exploring the Experience and Determinants of the Food Choices and Eating Practices of Elderly Thai People: A Qualitative Study

Over the past decade, Thailand has experienced a rapid increase in its elderly population. Many unfavorable health outcomes among elderly people are associated with nutrition. Nutrition in elderly people is affected by physical, mental, and social factors. This study explored the food choices and dietary practices among community-dwelling elderly people in Thailand from the perspective of both caregivers and the elderly people themselves. Six focus group discussions and six semistructured interviews were conducted in the Samut Sakhon Province of Thailand. Deductive thematic analyses were conducted based on the “food choice process model framework.” The results show that physical and mental factors and societal factors are important determinants of food choices. Moreover, a changing food environment and economic factors were found to affect food choices. Issues of trust in food safety and food markets were highlighted as growing issues. Therefore, fostering healthy food choice interventions that consider both environmental and societal aspects is necessary.     

Under- and Over-Nutrition Among Refugees in San Diego County, California

Resettled refugees often arrive in their host country with little knowledge of nutrition or available food choices. We explored nutrition-related issues of recent refugee arrivals to San Diego County—the second largest California resettlement site. In-depth interviews (n = 40) were conducted with refugees, health care practitioners, and refugee service organizations. Content analysis identified nutrition-related themes. Unhealthy weight gain after arrival was the most common concern and was attributed to social pressures among adolescents, food choices and a more sedentary lifestyle. Conversely, undernutrition remained a concern due to poor diets. Factors influencing nutritional problems included continuation of past habits, acculturation, unfamiliarity with available foods and socio-economic influences. The nutritional concerns encountered by resettled refugees in San Diego are not unique to this group but are aggravated by their past experiences, and abrupt changes to food choices and behavior. Addressing contextual factors of poor food choices may prevent some of the long term health consequences of poor nutrition.     

Managing values in personal food systems

People in post-industrial societies are faced with many food products and diverse eating situations that can make food-choice decisions complex. This study examined the ways that people managed values in making food choices in various contexts. An analysis of 86 semi-structured, in-depth qualitative interviews from a diverse population of urban adults living in upstate New York revealed that all participants used a personal food system, which was a dynamic set of processes constructed to enact food choices. Within these personal food systems people managed the five main food-related values of taste, health, cost, time and social relationships, and other less prominent values of symbolism, ethics, variety, safety, waste and quality. The salience of these values varied among the participants as well as across the eating situations that confronted each participant. Participants used three main processes in their personal food systems: (i) categorizing foods and eating situations; (ii) prioritizing conflicting values for specific eating situations; and (iii) balancing prioritizations across personally defined time frames. Understanding the personal food systems people use to help them make food choices can be useful for developing theories about eating behavior and communicating health messages related to food and eating.     

"A lot of sacrifices:" work-family spillover and the food choice coping strategies of low-wage employed parents

Integrating their work and family lives is an everyday challenge for employed parents. Competing demands for parents' time and energy may contribute to fewer meals prepared or eaten at home and poorer nutritional quality of meals. Thus, work-family spillover (feelings, attitudes, and behaviors carried over from one role to another) is a phenomenon with implications for nutrition and health. The aim of this theory-guided constructivist research was to understand how low-wage employed parents' experiences of work-family spillover affected their food choice coping strategies. Participants were 69 black, white and Latino mothers and fathers in a Northeastern US city. We explored participants' understandings of family and work roles, spillover, and food choice strategies using open-ended qualitative interviews. Data analysis was based on the constant comparative method. These parents described affective, evaluative, and behavioral instances of work-family spillover and role overload as normative parts of everyday life and dominant influences on their food choices. They used food choice coping strategies to: (1) manage feelings of stress and fatigue, (2) reduce the time and effort for meals, (3) redefine meanings and reduce expectations for food and eating, and (4) set priorities and trade off food and eating against other family needs. Only a few parents used adaptive strategies that changed work or family conditions to reduce the experience of conflict. Most coping strategies were aimed at managing feelings and redefining meanings, and were inadequate for reducing the everyday hardships from spillover and role overload. Some coping strategies exacerbated feelings of stress. These findings have implications for family nutrition, food expenditures, nutritional self-efficacy, social connections, food assistance policy, and work place strategies.     

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

As obesity persists in the United States, many public health interventions have been conceived to encourage people to change their diets. These interventions are based on encouraging people to prioritize healthier alternatives in food choice. However a consideration of the existing but limited literature on food choice for diverse populations renders such an assumption problematic. This qualitative study examined the food choices of a population most at risk for obesity - low-income African American women - by considering psychological factors, social and cultural meanings of foods, and structural conditions that shape how women decide what to eat. Interviews revealed the complexity of their food choices, illustrating the extent to which multiple influences operate simultaneously on food choice decisions. Implications for obesity prevention are discussed, in particular highlighting the problem that some types of public health interventions do not correspond to the lived experiences of the populations they intend to target.     

Embodied Context: Social Institutional Influences on Employed Mothers' Health Decision Making

The purpose of this critical ethnographic study was to explicate the ways that employed mothers' personal and family health decision making were socially organized through the institutions of motherhood, the family, the workplace, and the health care, education, and social systems in Canada. Data were analyzed from individual interviews, a focus group, workplace policy documents, and popular media articles. Twenty women participated over 2 years. Family, workplace, and social contexts were external influences on women's choices and were embodied through internal influences such as personal expectations that framed decision making. Strategies are suggested to promote the health and well-being of employed mothers and their families.     

Perceptions of the Community Food Environment and Related Influences on Food Choice Among Midlife Women Residing in Rural and Urban Areas: A Qualitative Analysis

Introduction: Qualitative research on food choice has rarely focused on individuals' perceptions of the community food environment. Women remain gatekeepers of the family diet and food purchasing. Therefore we assessed midlife, Southern women's perceptions of the food environment. Related influences on food choices at work and at home were also examined.

Methods: We recruited 28 low- and moderate-income, midlife (37–67 years) women from rural and urban areas of southeastern North Carolina, using typical case and snowball sampling. They responded to questions about multilevel influences on food choice in semi-structured, in-depth interviews.

Results: Women perceived differences between urban and rural food environments, with rural areas having fewer supermarkets and fast food restaurants compared to urban areas, which had fewer produce stands. Workplace food choices were affected by the social environment (co-workers), personal health concerns, and the surrounding food environment. Food chosen at home was primarily influenced by family members, health concerns, and convenient food sources.

Discussion: While future studies should explore findings in more representative populations, potential intervention strategies can be inferred, including emphasizing healthful aspects of the food environment. Intervention and advocacy efforts are needed to improve aspects of the food environment that make healthy choices difficult.     

Sandwiching it in: spillover of work onto food choices and family roles in low- and moderate-income urban households

Lower status jobs, high workloads and lack of control at work have been associated with less healthful diets, but the ways through which work is connected to food choices are not well understood. This analysis was an examination of workers' experience of the relationship of their jobs to their food choices. Fifty-one multi-ethnic, urban, low- and moderate-income adults living in Upstate New York in 1995 participated in a qualitative interview study of fruit and vegetable choices and discussed employment and food choices. The workers who participated in this study described a dynamic relationship between work and food choices that they experienced in the context of their other roles and values. These workers presented a relationship that was characterized by positive and negative spillover between their jobs and their ability to fulfill family roles and promote personal health, linked by a spectrum of food choice strategies. Participants' narratives fit into three different domains: characterizations of work and their resources for food choice, strategies used to manage food choices within the constraints of work, and affect related to the negative and positive spillover of these strategies on family roles and on personal food choices. Characterizations of work as demanding and limiting or demanding and manageable differentiated participants who experienced their food choice strategies as a source of guilt and dissatisfaction (negative spillover) from those who experienced food choices as a source of pride and satisfaction (positive spillover). Ideals and values related to food choice and health were balanced against other values for family closeness and nurturing and personal achievement. Some participants found work unproblematic. These findings direct attention to a broad conceptualization of the relationship of work to food choices in which the demands and resources of the work role are viewed as they spill over into the social and temporal context of other roles and values.     

Embodied context: social institutional influences on employed mothers' health decision making

The purpose of this critical ethnographic study was to explicate the ways that employed mothers' personal and family health decision making were socially organized through the institutions of motherhood, the family, the workplace, and the health care, education, and social systems in Canada. Data were analyzed from individual interviews, a focus group, workplace policy documents, and popular media articles. Twenty women participated over 2 years. Family, workplace, and social contexts were external influences on women's choices and were embodied through internal influences such as personal expectations that framed decision making. Strategies are suggested to promote the health and well-being of employed mothers and their families.     

'Trying to make it all come together': structuration and employed mothers' experience of family food provisioning in Canada

This research examined the aetiology of employed mothers' food choice and food provisioning decisions using a qualitative, grounded theory methodology. Semi-structured interviews using the Food Choice Map were conducted with eleven middle-income employed mothers of elementary school-age children. Results demonstrated that the women exhibited conflicting identities with respect to food choice and provisioning. As 'good mothers' they were the primary food and nutrition caregivers for the family, desiring to provide healthy, homemade foods their families preferred at shared family meals. They also sought to be independent selves, working outside the home, within the context of a busy modern family. Increased food autonomy of children, and lack of time due to working outside the home and children's involvement in extracurricular activities, were significant influences on their food choice and provisioning. This resulted in frequently being unable to live up to their expectations of consistently providing healthy homemade foods and having shared family meals. To cope, the women frequently relied on processed convenience and fast foods despite their acknowledged inferior nutritional status. Using Giddens' structuration theory, the dynamic relationships between the women's food choice and provisioning actions, their identities and larger structures including socio-cultural norms, conditions of work and the industrial food system were explored. The ensuing dietary pattern of the women and their families increases the risk of poor health outcomes, including obesity. These results have implications for public health responses to improve population health by shifting the focus from individual-level maternal influences to structural influences on diet.     

Participation in medical decision making: the patients' perspective.

PURPOSE: Variability in reports of patients' preferences to participate in decision making may be due in part to a lack of understanding about how patients conceptualize their participation. The authors sought to learn more about how patients view their involvement in decisions related to their health care. METHODS: The authors conducted individual interviews to allow patients to frame the decision-making process from their own perspective. The constant comparative-method approach to analysis was employed to ensure that the analysts defined the codes in a consistent manner. RESULTS: Twenty-six persons were interviewed. The main themes discussed by the participants reflecting how they viewed their involvement in medical decision making are the following: 1) decision making is often an ongoing process in which patient participation may change over time, 2) decision making is performed within an extended social context, 3) the decisions patients report being involved in are often distinct from those traditionally studied (choice of treatment or screening strategies), 4) patient involvement in decision making occurs in response to physicians' recommendations, and 5) patients make choices in the context of their specific illness perceptions. CONCLUSIONS: Participants in this study view their participation in decision making as including ideas distinct from those traditionally discussed by researchers. These findings suggest that the variability in patient participation noted in previous studies may be due in part to limitations in study design.     

The convivial and the pastoral in patient–doctor relationships: a multi-country study of patient stories of care,choice and medical authority in cancer diagnostic processes

Experiences of cancer diagnosis are changing in light of both the increasingly technological-clinical diagnostic processes and the socio-political context in which interpersonal relations take place. This has raised questions about how we might understand patient–doctor relationship marked by asymmetries of knowledge and social capital, but that emphasise patients’ empowered choices and individualised care. As part of an interview study of 155 participants with bowel or lung cancer across Denmark, England and Sweden, we explored participants’ stories of the decisions made during their cancer diagnostic process. By focusing on the intersections of care, choice and medical authority – a convivial pastoral dynamic – we provide a conceptual analysis of the normative ambivalences in people's stories of their cancer diagnosis. We found that participants drew from care, choice and medical authority to emphasise their relationality and interdependence with their doctors in their stories of their diagnosis. Importantly negotiations of an asymmetrical patient–doctor relationship were part of an on-going realisation of the healthcare processes as a human endeavour. We were therefore able to draw attention to the limitations of dichotomising emancipatory-empowerment discourses and argue for a theorisation of the patient–doctor relationship as a contextually bounded and relationally ambivalent humanity.     

Calories in Context: Conceptual Metaphors and Consumers’ Perception and Use of Calorie Information

The U.S. Food and Drug Administration (FDA) recently made changes to the nutrition facts label so that calories will be emphasized over all other nutrient information (U.S. Food and Drug Administration (FDA), 2016a, August 3). In light of calories’ increased visibility, strategic health communicators need to understand both how individuals perceive calorie information and how calories influence consumption decisions. Therefore, a qualitative study was conducted to analyze the metaphors that structure consumers’ thoughts about calorie information and food choices. In-depth interviews were conducted with 34 women from diverse racial/ethnic and socioeconomic backgrounds. Through the interviews and subsequent thematic analysis, metaphors were gathered that explained perceptions of different kinds of calories and how calories function in the diet. Five conceptual metaphors were uncovered. The metaphors individuals used varied based on their eating paradigms, and the metaphors were related to different approaches to consumption decisions. The implications of using these different calorie metaphors for translational communication interventions are further discussed.     

Associations of social status and health-related beliefs with dietary fat and fiber densities

BACKGROUND. Lower social status groups have higher mortality rates from some diet-related diseases and higher dietary fat and lower dietary fiber intakes. Such dietary patterns have been found to be related to social status, environmental influences, and health-related beliefs and expectations. METHODS. Associations of social status and diet-related and health-related beliefs and expectations with dietary fat and fiber densities were examined in a population sample of 874 respondents to a postal questionnaire. A food frequency listing of 172 foods was used to assess usual dietary intake. RESULTS. More positive beliefs and expectations were associated with lower dietary fat and higher dietary fiber densities in univariate models; beliefs and expectations differed little between social status groups. In multivariate models, stronger perceptions of external influences on food choices, fewer perceived barriers to eating a healthy diet, and social status were independently associated with low dietary fat density. Diet-related and health-related beliefs and perceptions of external influences on food choices, but not social status, were independently associated with high dietary fiber density. The belief that diet is a major cause of stroke, diabetes, and hypertension was weakly associated with the dietary fiber density of lower social status groups. CONCLUSIONS. Social status and perceptions of external influences on dietary choice, as well as personal beliefs, have independent associations with food intake. Although exclusive targeting of lower social status groups is not indicated, interventions to increase dietary fiber intake should address expectations, attitudes, and beliefs about dietary fiber and health and perceptions of external influences on food choices, especially among lower status groups; interventions to lower dietary fat intake should address a broad range of external and social factors, as well as personal beliefs.