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Journal of the American College of Nutrition, Vol. 25, No. 5, 382-388 (2006)
Published by the American College of Nutrition

Food Cravings, Ethnicity and Other Factors Related to Eating Out

Violet Perez Siwik, MD and Janet H. Senf, PhD

Department of Family and Community Medicine, University of Arizona, Tucson, Arizona

Address reprint requests to: Dr. Violet Perez Siwik, 707 North Alvernon Way, Tucson, AZ 85711. E-mail: vsiwik{at}u.arizona.edu


   ABSTRACT
TOP
 FOOTNOTES
 ABSTRACT
INTRODUCTION
 METHODS
 RESULTS
 CONCLUSIONS
 ACKNOWLEDGMENTS
 REFERENCES
 
Objective: Our objective was to study factors related to eating patterns, specifically whether certain food cravings were associated with frequency of meals eaten away from home.

Methods: Data were collected from 277 patients from a family medicine residency office in Arizona. The survey questionnaire included information about the respondents’ demographics, socioeconomic status, food cravings, as well as, number of meals eaten away from home. The food craving inventory included foods in four categories identified by factor analysis: fast foods, carbohydrates, sweets and snacks. Data on food cravings were factor analyzed and scale scores were derived.

Results: Being a Hispanic adult, working outside the home, and cravings for individual food items were related to eating more meals away from home. If the mother was working outside the home, the youngest child ate an average of two additional meals away from home each week. In general respondent’s cravings for some specific food items were also related to higher numbers of meals their child ate away from home. Cravings for both fast food and snacks were positively correlated with adult eating out. None of the respondents’ scale scores were related to child’s eating away from home. Adults with Arizona Health Care Cost Containment System insurance (AHCCCS—a form of Medicaid) and older adults were less likely to eat away from home compared to patients with other types of insurance.

Conclusions: Socioeconomic status, ethnicity, and food cravings are related to adult and child patterns of eating meals away from home.

Key words: food cravings, meals away from home, eating patterns

Abbreviations: AHCCS = Arizona Health Care Cost Containment System


   INTRODUCTION
TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
METHODS
 RESULTS
 CONCLUSIONS
 ACKNOWLEDGMENTS
 REFERENCES
 
Obesity is a major contributor to morbidity and mortality in the United States and the prevalence both among adults and children has been increasing rapidly [1–3]. Among adults twenty years old and older the proportion who are obese has doubled from 15% in 1976 to 31% in 2000 [3]. The prevalence of overweight children and teens aged 6–19 years tripled between 1980 and 2000 [4]. Obesity has been linked to increased risk of heart disease and diabetes, among adults [3] and increasingly among children [5,6].

Individual food options, choices and eating behaviors are influenced by a complex interplay of a number of factors including the individual’s nationality, culture, community, family and the individual’s food likes and dislikes [7], which are affected by these more global attributes, but that also appear to be related to an individual’s genetic make up [8,9]. In the case of children, the parents and family play an even more important role. Parents influence the child’s behavior by determining the amount and type of food available, providing a role model for the child, and often directly controlling the eating behavior of the child [10,11]. Especially with young children, parents have almost complete control over the choices available. Demographic factors embody the intersection of the multiple influences on eating options and choices and thus become essential in looking at specific eating behaviors.

At the most basic level, the increase in the percentage of people who are overweight represents an imbalance in energy expenditure and energy intake. Analysis of trends for adults does suggest that energy intake has increased both for adult men and women from the early 1970’s to 2000 [12], although most studies of children do not show this same increase [12–14].

A number of specific factors have been identified that may be contributing to the increase in overweight, on both sides of the energy equation. Research indicates that sedentary behaviors are increasing both in adults and children. Increased television viewing has been shown to be related to a higher body mass index (BMI)(kg/m2) [15–17]. Lower amounts of vigorous physical activity also has been linked with a higher BMI [18–19]. Behaviors related to increased energy intake have also been identified. Drinking sugar sweetened beverages, in particular soda, is associated with higher BMI’s in both adults and children [20,21]. Eating meals away from home and eating at fast food restaurants have both been shown to be related to overweight in adults although in some analyses the relationship was not found or was very small [22]. This relationship has not been found among children or adolescents [19,23–27].

The apparent relationship between eating food away from home and increased BMI is especially important because one of the most striking trends in the eating patterns of Americans is the increase in meals eaten away from home [22,28]. Based on the ongoing Continuous Survey of Food Intake by Individuals (CSFII) the proportion of foods consumed from restaurants and fast food outlets increased from 16% in 1977–1978 to 27% in 1995 [29]. One study in 2003 found that adults eat approximately 30% of their meals away from home, including 19% of breakfasts, 54% of lunches, and 20% of dinners [30].

Food eaten away from home may be related to increased weight because energy density is higher in these meals [23,26,31] and portion sizes are larger [14]. A number of studies have demonstrated that school age children and adults consume more when portion sizes are larger [32–34] and research has demonstrated that both energy density and portion size contribute independently to energy intake [32,35]. Given the link between eating away from home and higher energy intake and higher BMI among adults, it would appear that the increased frequency of eating away from home is at least in part responsible for the overall increase in obesity in the United States. While research has not shown a relationship between eating out and obesity in children, it is possible that patterns established during childhood persist into adulthood, creating the potential for problems later.

There are costs and benefits to eating meals prepared outside the home that are likely related to demographic factors that are related to this behavior. Eating meals away from home requires mobility, and is also more expensive than home meals. On the other hand, eating out saves time in food preparation and can allow different members of the family to choose their own meal. However, because eating meals prepared away from home is related to increased BMI among adults, identifying the factors that predict who is likely to eat away from home is important. There have been a few studies that examined these factors. Studies have found that younger adults eat away from home more frequently [22,26], although the proportion is lower among children under ten [25]. There is evidence that men eat away from home more than women do [25,27]. The findings on ethnicity are mixed, with one study finding that ethnic minorities eat away from home more often [26], and another that there are similar rates [25]. There are also inconsistent results with respect to income, with one study finding more eating of fast food among those with higher incomes [25], and another finding less [26].

There have been few studies on factors other than demographics related to eating fast food or food away from home, although one study analyzed cravings for a list of different foods [36]. Using factor analysis White et al. found that, in addition to cravings for groups of foods that are, 1) sweet, 2) high fat, 3) carbohydrates/starches, there was a category of cravings that included fast foods. The current study was designed to examine factors related to eating away from home both for adults and for children including whether cravings for fast foods is related to eating away from home more often.


   METHODS
TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 METHODS
RESULTS
 CONCLUSIONS
 ACKNOWLEDGMENTS
 REFERENCES
 
A questionnaire was developed that asked for demographic information including gender, type of health insurance, which was used as a proxy for income, number of people in the household, and employment status outside the home. In addition, respondents were asked the frequency of meals they had eaten away from home for the prior week on a scale of zero to seven for breakfast, lunch, and dinner, and, if they had children, how frequently their youngest child had eaten away from home in the past week, using the same scales. Number of meals actually eaten in the past week was not assessed. Meals eaten out was defined for respondents as any meal that was prepared by a restaurant or cafeteria whether it was eaten out or picked up to eat somewhere else. Respondents were also asked to indicate how often their children eat at fast food restaurants. The questionnaire included questions about food cravings (a strong desire to eat the food) during the past week in a format similar to prior research in this area [36]. The original questionnaire was developed in the South and included foods common to that area. For this study the original list of 28 foods was reduced to 15 and modified to include foods more appropriate to the southwest including tortilla chips and chorizo, a Mexican sausage.1 All of the fast food items were retained, and at least three items from each of the other categories were either kept or slightly modified. Cravings were measured on an ordinal scale of 1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, and 5 = Always/Most every day. Scale scores were computed by adding the numeric value of each item in the scale.

In addition a measure was created that reflected intensity of cravings across all 15 food items. This measure was the percent of cravings for the 15 items that were either "often" or "most every day" and could range from none (0 of 15) to 100% (15 of 15).

These questionnaires were anonymous, self-administered and in English only. This questionnaire was pilot tested and revised. The population studied included patients with appointments in the University of Arizona Family and Community Medicine Family Practice Office from March 2004 through May 2004. Surveys were left at the front desk and the front office and nursing staff encouraged patients to complete the surveys at the time of their visit. Patients who were perceived to be too frail or too ill to complete the questionnaire were not asked to complete the survey. This study was exempted by the University of Arizona Human Subjects Institutional Review Board.


   RESULTS
TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
CONCLUSIONS
 ACKNOWLEDGMENTS
 REFERENCES
 
Surveys were completed by 277 patients. Eighty-one percent were female. The average age was 43 with a range from 16 to 82. Sixty percent were White, 30% Hispanic, 4% Asian/Pacific Islander, 3% African American, 2% Native American, and 1% listed themselves as "other." The average household size was 2.8 and ranged from one to ten. Forty-three percent of these households included children. Sixty-one percent of the households included a spouse. Fifty-five percent of the respondents were working outside the home; 51% of the females were and 69% of the males. Thirty percent had Arizona’s Medicaid program (AHCCCS) as their insurance, 37% had a health maintenance organization, 7% had Medicare, 1% had no insurance and 25% had private or indemnity plans. The number of youngest children who were boys or girls was almost identical (51 girls, 50 boys, 4 gender unknown). In addition, some respondents answered for their grandchildren (2 grandsons and 1 granddaughter). The mean age of the "youngest" child was eight years and the range was from less than a year to 33, with 96% 20 or younger.

Eating Out
The average number of meals eaten away from home during the previous week for the adults was 4.2. This total included 0.7 breakfast meals, 1.8 lunches and 1.7 dinners out of a possible seven in each category. For the youngest child in the family the average was 4.7 including 0.7 breakfasts, 2.2 lunches and 1.5 dinners. Twelve percent of the adults and 8.7% of the children had no meals away from home. No respondent had all of their meals away from home. Forty percent of the parents reported that when their children ate away from home it was "always" or "most of the time" at a fast food restaurant. Eating away from home was not related to gender, marital status, or number of children in the household (at p < 0.05). Adult and child eating away from home were positively correlated (Pearson’s R = 0.48, p < 0.001), however, the correlation was related to the youngest child’s age. For children two and a half or younger, the correlation was negative and not significant (Pearson R = –0.23, p = 0.35). When the youngest child was between three and six it was .68 (p < 0.001), increasing to .84 (p < 0.001) for children ages seven to 11, and dropping again for children who were 12 or over (R = 0.48, p = 0.02).

Compared to other ethnic groups Hispanic adults were more likely to eat away from home (5.1 vs. 3.9, p = 0.02), which was primarily due to Hispanic women eating away from home at lunch (Fig. 1, p < 0.001) in particular Hispanic women who work outside the home (Fig. 2, p < 0.001). Adults whose insurance was AHCCCS were less likely to eat away from home (3.1 vs. 4.8, p = .001) than were those with other types of health insurance. Working outside the home was related to eating more meals away from home for adults (4.9 vs. 3.3, p < 0.001), and if the mother was working outside the home, the youngest child ate an average of two more meals away from home each week (5.6 vs. 3.4, p < 0.02). Eating away from home was not significantly related to having two working parents. Eating away from home was also inversely related to age, for total meals (Pearson R = –0.14, p = 0.03), for lunches (Pearson R = 0.15, p = 0.02, and for dinner (Pearson R = –0.13, p = 0.04).


Figure 1
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  		Fig. 1. Ethnicity and gender by average number of meals eaten away from home.

 

Figure 2
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  		Fig. 2. Ethnicity and work status by average lunches eaten away from home.

 
Individual Food Cravings
The respondent’s craving for certain of the individual food items was related in a linear fashion to the average number of meals she or he ate away from home except for sausage/chorizo (Analysis of Variance, F statistics, Table 1). In addition, the respondent’s craving for individual items was related to the number of meals that their child ate away from home (Analysis of Variance, F statistics, Table 2). Rice was the exception to the general increase in meals eaten away from home as craving increased.


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  		Table 1. Mean number of adult meals eaten away from home by intensity of food cravings for specific items

 

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  		Table 2. Mean number of youngest child’s meals eaten away from home by intensity of adult’s food cravings for specific food items

 
The percent of cravings for all 15 food items that were "often" or "most every day" ranged from none to 93% with a mean of 17% (S.D. = 0.15). This percentage was positively related to eating meals away from home (Pearson R = 0.23 for adults, p = 0.001; R = 0.21 for youngest child, p = 0.05). Strong cravings were higher among Hispanics and among those whose insurance was AHCCCS. These two factors make independent contributions; thus, in a combination of the two variables the percentage was 0.29 among Hispanics with AHCCCS, 0.19 among Hispanics with other insurance, 0.18 among non-Hispanics with AHCCCS and 0.13 among non-Hispanics with other insurance (p < 0.001). Strong cravings were negatively correlated with age (Pearson R = –0.18, p = 0.01) and lower among those who are married (0.14 vs. 0.19 for those not married, p = 0.01). Cravings were not significantly related to gender.

Again using the variable combining ethnicity and insurance status, the average number of adult meals eaten out was, 5.6 for Hispanics without AHCCCS, 4.2 for Hispanics with AHCCCS, 4.5 for non-Hispanics without AHCCCS and 2.4 for non-Hispanics with AHCCCS. Insurance and ethnicity were not significantly related to number of times the youngest child ate out.

Food Craving Scales
Principal Component factor analysis with Equamax rotation was carried out with the 15 food craving items. Four factors with eigenvalues greater than one emerged (Table 3) together accounting for 57.5% of the total variance. The Kaiser-Meyer-Olkin Measure of Sampling Adequacy was .82, and Bartlett’s Test of Sphericity was significant at p < 0.001. Sausage/Chorizo was dropped because it loaded almost equally on three factors. Reliability analysis indicated that dropping an additional four items would result in improved alpha coefficients. The final set of items is bolded. The four factors were labeled fast food, sweets, snacks and carbohydrates. Alpha reliabilities were 0.77, 0.72, 0.67 and 0.54 respectively.


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  		Table 3. Factor loadings for the 15 food items

 
Scale scores for carbohydrates ranged from 3 to 15 with a mean of 8.0 (S.D. 2.4). Sweets ranged from two to ten with a mean of 5.5 (S.D. 2.0). Snacks ranged from two to ten with a mean of 4.4 (S.D. 1.9). Fast food ranged from three to 15 with a mean of 7.3 (S.D. 2.6). Scale scores for sweets and carbohydrates were related to gender, with women having more frequent cravings (Sweets 5.6 for women vs. 4.8 for men, p = 0.01; Carbohydrates 8.1 for women vs. 7.3 for men, p < 0.05). Scale scores for three scales were also related to ethnicity and to insurance (Table 4).


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  		Table 4. Ethnicity and insurance by scale scores on food cravings

 
All of the scale scores were positively correlated; the highest correlation was between fast food and snacks (Spearman’s rho 0.58, p < 0.001). Both fast food and snacks were positively correlated with adult eating out (Spearman’s rho 0.26 for fast food, p < 0.001; for snacks 0.18, p = 0.005). None of the scale scores were related to the youngest child’s eating away from home, however the parent’s overall craving for fast food was related to the amount of time the parent reported that their children ate at fast food places (Mean score of 5.5 for "none," 7.4 for "some," 8.5 for "half," 8.1 for "most," and 9.0 for "all," p < 0.05). Table 5 presents the mean number of adult’s meals eaten away from home by quartiles of the fast food scale score.


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  		Table 5. Mean number of meals eaten away from home by fast food scale groups*

 
Stepwise multiple regressions were carried out with adult meals away from home as the dependent measure. Independent measures included ethnicity (Hispanic yes/no), socioeconomic status (AHCCCS yes/no), gender (female yes/no), work outside the home (yes/no) number of children in the family, and the scale scores for fast food, carbohydrate, sweet, and snack cravings. Three variables entered the equation, fast food score (Beta = 0.38, p < 0.001), socioeconomic status (Beta = –0.21, p = 0.001) and work outside the home (Beta = 0.16, p = 0.02). The multiple R for the model was .44 with an adjusted R2 of 0.18.


   DISCUSSION
 
This study addresses the link between meals eaten away from home, food cravings and other demographic factors. This study found that not only were the parent’s cravings for fast food and snacks positively related to the number of their meals eaten away from home, but their cravings for individual fast food items were also positively related to the number of meals their youngest child ate away from home. It can be hypothesized that the eating out described is at fast food places, given the parent’s cravings and their reports of where their children are eating. This relationship may in turn create patterns of eating out for both parents and children that are known to be linked to overweight in adults. Unfortunately the data from this study do not reveal conclusively where the respondents were eating out. In addition, whether food cravings cause people to eat out more frequently or eating food away from home frequently has conditioned respondents to crave certain foods can not be determined with this study design. In this study respondents ate out somewhat less frequently than has been previously reported for breakfasts and lunches, but somewhat more frequently for dinners [25].

The most recent NHANES confirms increased obesity among minority populations. Hispanic adults in this study reported eating out more often compared with other ethnic groups. The majority of those eating out were Hispanic women who ate lunch away from home. A possible hypothesis for the higher frequency of Hispanic women eating lunches away from home is that the lunch hour functions as a time for social activity in addition to getting something to eat.

The data show that while more Hispanics eat meals away from home, Hispanics on AHCCCS had higher food cravings but did not eat more meals away from home than those who were not on AHCCCS. Clearly there are factors that moderate the relationship between eating meals away from home and food cravings. In this situation, lack of money in the lower socio-economic group likely prohibited those who craved certain food items from eating out. In addition to lower SES, lack of transportation and advanced age may change a person’s ability to eat meals away from home even though the desire exists.

Limitations of this study include the small convenience sample. The survey also did not ask parents their weight, so we were unable to determine if those who were eating out more often also tended to weigh more. In addition, socioeconomic status was not measured directly.


   CONCLUSIONS
TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 CONCLUSIONS
ACKNOWLEDGMENTS
 REFERENCES
 
Although a number of studies have examined demographic correlates of frequency of eating meals away from home, more research needs to be done on the range of factors associated with eating food away from home and on the type of restaurant and food that is chosen. In particular, it would be useful to know whether a parent’s craving for fast food does result in eating more often at fast food places, both for them and for their children.


   ACKNOWLEDGMENTS
TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 CONCLUSIONS
 ACKNOWLEDGMENTS
REFERENCES
 
We would like to acknowledge the front office and nursing staff at the Family Medicine Clinic in Tucson, Arizona. Their assistance in distributing the surveys greatly facilitated this research study.


   FOOTNOTES
TOP
 FOOTNOTES
ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 CONCLUSIONS
 ACKNOWLEDGMENTS
 REFERENCES
 
1 The fifteen items that were deleted were fried chicken, gravy, fried fish, corn bread, hot dog, brownies, candy, cake, cinnamon rolls, ice cream, rolls, pancakes or waffles, biscuits, baked potato and cereal. Sausage was modified to be sausage/chorizo, sandwich bread was modified to be flour tortilla/bread. Chips was separated into tortilla chips and potato chips. Pretzels was added. Back

Received August 31, 2005. Accepted June 27, 2006.


   REFERENCES
TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 CONCLUSIONS
 ACKNOWLEDGMENTS
 REFERENCES
 

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