Family Economics and Nutrition Review [Volume 14, Number 2]

              Research Articles
3 Expenditures on Children by Families
11
Mark Uno
Consumers' Retail Source of Food: A Cluster Analysis
Andrea Carlson, Jean Kinsey, and Carmel Nadav
Food, Health, and Supplements: Beliefs Among Food Stamp-Eligible Women
Vivica Kraak, David L. Pelletier, and Jamie Dol/ahite
36 Factors Affecting Meat Preferences Among American Consumers
Arbindra P. Rima/
44 Food Acquisition Practices Used by Limited-Resource Individuals
Kathryn M. Kempson, Debra Palmer Keenan, Puneeta Sonya Sadani,
Sylvia Rid/en, and Nancy Scotto Rosato
Trends in Food and Nutrient Intakes by Children in the United States
Cecilia Wilkinson Enns, Sharon J. Mickle, and Joseph D. Goldman
Trends in Children's Consumption of Beverages: 1987 to 1998
Yi Kyung Park, Emily R. Meier, Peri Bianchi, and Won 0. Song
Research Briefs
Insight 23: The Role of Nuts in a Healthy Diet
Mark Uno, Kristin Marcoe, Julia M. Dinkins, Hazel Hiza, and Rajen Anand
83 Insight 24: Food Trade-Offs: Choosing How to Balance the Diet
Julia M. Dinkins and Mark Uno
Regular Items
USDA Activities • Federal Studies • Journal Abstracts • Food Plans
• Consumer Prices • Poverty Thresholds
Ann M. Veneman, Secretary
U.S. Department of Agriculture
Eric M. Bost, Under Secretary
Food, Nutrition, and Consumer Services
Steven N. Christensen, Acting Director
Center for Nutrition Policy and Promotion
P. Peter Basiotis, Director
Nutrition Policy and Analysis Staff
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Julia M. Dinkins
Assistant Editor
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Features Editor
Mark Uno
Managing Editor
Jane W. Fleming
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Hazel Hiza
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Research Briefs
80 Insight 23: The Role of Nuts in a Healthy Diet
Mark Uno, Kristin Marcoe, Julia M. Dinkins, Hazel Hiza, and Rajen Anand
83 Insight 24: Food Trade-Offs: Choosing How to Balance the Diet
Julia M. Dinkins and Mark Uno
Regular Items
86 Research and Evaluation Activities in USDA
90 Federal Studies
98 Journal Abstracts
100 Official USDA Food Plans: Cost of Food at Home at Four Levels, U.S. Average,
December 2002
101 Consumer Prices
102 U.S. Poverty Thresholds and Related Statistics
103 Reviewers of 2002 Articles
Volume 14, Number2
2002
2
United States Department of
Agriculture
CENTER FOR NUTRITION
POLICY AND PROMOTION
Check the CNPP Web site (www.cnpp.usda.gov)
for the following information and publications:
The Healthy Eating Index: 1999-2000
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Dietary Guidelines for Americans, 2000, 5th Edition
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About CNPP
CNPP Strategic Plan 2000-05
How to Get Information from CNPP
Nutrition Insights
Dietary Guidelines for Americans
Food Guide Pyramid
Food Guide Pyramid for Young Children
USDA Healthy Eating Index
Expenditures on Children by Families
Family Economics and Nutrition Review
Nutrient Content of the U.S. Food Supply Summary Report
Interactive Nutrient Content of the U.S. Food Supply
Official USDA Food Plans
Putting the Guidelines into Practice: A Series of Brochures
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USDA Supports 5 A Day for Better Health
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Miscellaneous Files
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Family Economics and Nutrition Review
Mark Uno, PhD
U.S. Department of Agriculture
Center for Nutrition Policy and Promotion
2002 Vol. 14 No.2
Expenditures on Children
by Families
Since 1960 the U.S. Department of Agriculture has provided annual estimates of
expenditures on children from their birth through age 17. This article presents the
2001 estimates for husband-wife and single-parent families. Data and methods
used in calculating annual child-rearing expenses are described. Estimates are
provided by budgetary component, age of the child, family income, and region of
residence. For the overall United States, estimates of child-rearing expenses
ranged between $9,030 and $10,140 for a child in a two-child, married-couple
family in the middle-income group.
C hild rearing is a costly endeavor.
Since 1960 the U.S. Department
of Agriculture (USDA) has
provided annual estimates of family
expenditures on children from their
birth through age 17. USDA's annual
child-rearing expense estimates are
used in four major ways:
• To determine State child support
guidelines. Under the Family
Support Act of 1988, States are
required to have numeric child
support guidelines and to consider
the economic costs of raising a child
in these guidelines. The economic
well-being of millions of children
is affected by child support.
• To determine State foster care
payments. In 1999 about 581,000
children were in foster care (U.S.
Department of Health and Human
Services, 2001).
• To appraise damages arising from
personal injury or wrongful death
cases. For example, if a person with
children is hurt on a job such that he
or she cannot work, the courts use
the expense figures to determine
compensation for the family.
• To educate anyone considering
when or whether to have children.
These expense estimates also may
encourage teens to wait until they
are adults and more prepared
financially to have children.
This article presents the 2001 expendi­ture
estimates associated with rearing
children. Data and methods used in
calculating the child-rearing expenses
are described; then, the estimated
expenses are discussed.
USDA Method for Estimating
Expenditures on Children by
Families1
USDA provides annual estimates of
expenditures on children, by husband­wife
and single-parent families, from
their birth through age 17. Expendi­tures
on children are estimated for the
1 Expenditures on Children by Families: 2001
Annual Report provides a more detailed
description of the data and methods. To obtain
a copy go to http://www.cnpp.usda.gov, or
contact USDA, Center for utrition Policy
and Promotion, 31 01 Park Center Drive,
Room I 034, Alexandria, VA 22302
(telephone: 703-305-7600).
3
major budgetary components: housing,
food, transportation, clothing, health
care, child care/education, and
miscellaneous goods and services
(see box below).
The most recently calculated child­rearing
expenses are based on 1990-92
Consumer Expenditure Survey (CE)
data, which are updated to 2001 dollars
by using the Consumer Price Index
(CPI). The CE, administered by the
Bureau of Labor Statistics, U.S.
Department of Labor, is the only
Federal survey ofhousehold expendi­tures
collected nationwide. It contains
information on sociodemographic
characteristics, income, and expendi­tures
of a nationally representative
sample of households. The sample
consisted of 12,850 husband-wife
and 3,395 single-parent households,
weighted to reflect the U.S. population
of interest.
In determining child-rearing expenses,
USDA examines the intrahousehold
distribution of expenditures by using
data for each budgetary component.
The CE contains child-specific
expenditure data for some budgetary
components (clothing, child care, and
education) and household-level data
for the other budgetary components
(housing, food, transportation, health
care, and miscellaneous goods and
services). Multivariate analysis was
used to estimate household and child­specific
expenditures, controlling for
income level, family size, age of the
child, and region of residence (when
appropriate) so expenses could be
determined for families with these
varying characteristics. Estimates of
child-rearing expenses are provided for
three income levels ofhusband-wife
families. These income groups were
determined by dividing the sample for
the overall United States into equal
thirds.
Categories of Household Expenditures
For each income level, the estimates
are for the younger child in families
with two children. These younger
children were grouped in one of six
age categories: 0-2,3-5,6-8,9-11,
12-14, or 15-17. Households with two
children were selected as the standard
because this was the average household
size in 1990-92. The focus is on the
younger child because the older child
may be over age 17.
USDA's estimates are based on CE
interviews of households with and
without specific expenses. For some
families, expenditures may be higher
or lower than the mean estimates,
depending on whether or not they incur
the expense. Child care and education
are examples, since about 50 percent
of husband-wife families in the study
spent no money on these services.
Also, the estimates cover only out-of­pocket
expenditures on children made
by the parents and not by others, such
as grandparents or friends.
Housing expenses: shelter (mortgage interest, property taxes, or rent; maintenance and repairs; and insurance), utilities
(gas, electricity, fuel, telephone, and water), and house furnishings and equipment (furniture, floor coverings, and major
and small appliances). For homeowners, housing expenses do not include mortgage principal payments; in the data set
used, such payments are considered to be part of savings.
4
Food expenses: food and nonalcoholic beverages purchased at grocery, convenience, and specialty stores, including
purchases with food stamps; dining at restaurants; and household expenditures on school meals.
Transportation expenses: the net outlay on the purchase of new and used vehicles, vehicle finance charges, gasoline and
motor oil, maintenance and repairs, insurance, and public transportation.
Clothing expenses: children's apparel such as diapers, shirts, pants, dresses, and suits; footwear; and clothing services
such as dry cleaning, alterations and repair, and storage.
Health care expenses: medical and dental services not covered by insurance, prescription drugs and medical supplies not
covered by insurance, and health insurance premiums not paid by the employer or other organizations.
Child care and education expenses: daycare tuition and supplies; babysitting; and elementary and high school tuition,
books, and supplies.
Miscellaneous expenses: personal care items, entertainment, and reading materials.
Family Economics and Nutrition Review
After estimating the various overall
household and child-specific expendi­tures,
USDA allocated these total
amounts among family members (i.e.,
in a married-couple, two-child family,
the total amounts were allocated to the
husband, wife, older child, and younger
child). Because the expenditures for
clothing, child care, and education are
child-specific and thus apply only to
children, allocations of these expenses
were made by dividing them equally
among the children. The CE does
not collect expenditures on food and
health care. Thus, to apportion these
budgetary components to a child by his
or her age, USDA used data from other
Federal studies that show the shares of
the household budget spent on
children's food and health care.
Unlike food and health care, no
authoritative source exists for
allocating among family members
the amount the household spends
on housing, transportation, and other
miscellaneous goods and services. Two
common approaches used to allocate
these expenses are the marginal cost
method and the per capita method.
The marginal cost method measures
expenditures on children as the
difference in expenses between couples
with children and equivalent childless
couples. Various equivalency measures
have been proposed, yielding very
different estimates of expenditures
on children, with no standard measure
accepted by economists. Also, the
marginal cost approach assumes that
the difference in total expenditures
between couples with and without
children can be attributed solely to the
presence of children in a family. This
assumption is questionable, especially
because couples without children
often buy homes larger than they
need in anticipation of having children.
Comparing the expenditures of these
couples to those of similar couples with
children could lead to underestimating
2002 Vol. 14 No.2
how much is spent on meeting the
lifetime needs-and wants-of
children.
For these reasons, USDA uses the
per capita method to allocate expenses
on housing, transportation, and miscel­laneous
goods and services among
household members in equal propor­tions.
Although the per capita method
has its limitations, these limitations
are considered less severe than those
of the marginal cost approach. Because
transportation expenses resulting from
work activities are not directly related
to the cost of raising a child, these
expenses were excluded when deter­mining
children's transportation
expenses.
Expenditures on Children by
Husband-Wife Families
Child-Rearing Expenses and
Household Income Are Positively
Associated
Estimated expenses on children
increased as income level rose (fig. 1 ).
Depending on the age of the child, the
annual expenses ranged from $6,490
to $7,560 for families in the lowest
income group, from $9,030 to $10,140
for families in the middle-income
group, and from $13,410 to $14,670
for families in the highest income
group. The before-tax income in 2001
for the lowest income group was less
than $39,100, between $39,100 and
$65,800 for the middle-income group,
and more than $65,800 for the highest
income group.
On average, households in the lowest
income group spent 28 percent of their
before-tax income per year on a child;
those in the middle-income group, 18
percent; and those in the highest group,
14 percent. The range in these percent­ages
would be narrower if after-tax
income were considered, because a
Estimated expenses on children
increased as income level rose
(fig. 1 ).
5
greater percentage of income in higher
income households goes toward taxes.
On average, the amount spent on
children by families in the highest
income group was slightly less than
twice the amount spent by families in
the lowest income group. This amount
varied by budgetary component. In
general, expenses on a child for
goods and services considered to
be necessities (e.g., food and clothing)
did not vary as much as those ·
considered to be discretionary (e.g.,
miscellaneous expenses) among
households in the three income groups.
Housing Is the Largest Expense
on a Child
Housing accounted for the largest share
of total child-rearing expenses; figure 2
demonstrates this for middle-income
families. Based on an average expense
incurred among the six age groups,
housing accounted for 33 percent of
child-rearing expenses for a child in the
lowest income group, 35 percent in the
middle-income group, and 38 percent
in the highest income group. Food, the
second largest average expense on a
child for families regardless of income
level, accounted for 20 percent of
child-rearing expenses in the lowest
income group, 1 7 percent in the
middle-income group, and 15 percent
in the highest income group. Trans­portation
was the third largest child­rearing
expense across income levels,
13 to 14 percent.
Across the three income groups,
miscellaneous goods and services
(personal care items, entertainment,
and reading materials) was the fourth
largest expense on a child for families,
1 0 to 12 percent. Clothing (excluding
gifts or hand-me-downs) accounted for
5 to 7 percent of expenses on a child
for families; child care and education,
8 to 11 percent; and health care, 6 to 8
percent. Estimated expenditures for
health care included only out-of-
6
Figure 1. 2001 family expenditures on a child, by income level and age of
child1
16,000
14,000
12,000
10,000
~
.!!! 0 8,000
0
6,000
4,000
2,000
0
0-2 3-5 6-8 9-11 12-14 15-17
Age of child
Less than $39,100 $39,100 - $65,800 • More than $65,800
1U.S. average for the younger child in husband-wife families with two children.
Figure 2. 2001 family expenditure shares on a child from birth through age 171
Food
17%
Health care
Child care and education
Total expenditures in 2001 dollars = $170,460
1U.S. average for the younger child in middle-income, husband-wife families with two children.
Family Economics and Nutrition Review
Figure 3. 2001 family expenditure shares on a child, by age of child1
100
Miscellaneous
80
,._~...; 1----1 ___ Child care and education
1---....; ir-----li Clothing
Health care
c 60
Q)
Transportation
~
Q)
Cl.. 40 Food
20 Housing
0
0-2 3-5 6-8 9-11 12-14 15-17
Age of child
1U.S. average for the younger child in middle-income, husband-wife families with two children.
pocket expenses (including insurance
premiums not paid by an employer
or other organizations) and not that
portion covered by health insurance.
Expenses Increase as a
Child Ages
Expenditures on a child were generally
lower in the younger age categories
and higher in the older age categories.
Figure 3 depicts this for families in the
middle-income group. This relationship
held across income groups even though
housing expenses, the highest child­rearing
expenditure, generally declined
as a child grew older. The decline in
housing expenses reflects diminishing
interest paid by homeowners over the
life of a mortgage. Payments on
principal are not considered part of
housing costs in the CE; they are
deemed to be a part of savings.
For all three income groups, food,
transportation, clothing, and health
care expenses related to child-rearing
generally increased as the child grew
older. Transportation expenses were
2002 Vol. 14 No.2
highest for a child age 15-17, when he
or she would start driving. Child care
and education expenses were highest
for a child under age 6. Most of this
expense may be attributed to child care
at this age. The estimated expense for
child care and education may seem
low for those with the expenses:
these estimates reflect the average
of households with and without the
expense.
Child-Rearing Expenses Are
Highest in the Urban West
Child-rearing expenses in the regions
of the country reflect patterns observed
in the overall United States; in each
region, expenses on a child increased
with household income level and,
generally, with the age of the child.
Overall, child-rearing expenses were
highest in the urban West, followed by
the urban Northeast and urban South.
Figure 4 shows total child-rearing
expenses by region and age of a child
for middle-income families. Child­rearing
expenses were lowest in the
urban Midwest and rural areas. Much
Expenditures on a child were
generally lower in the younger
age categories and higher in the
older age categories.
7
of the difference in expenses on a child
among regions was related to housing
costs. Total housing expenses on a
child were highest in the urban West
and urban Northeast and lowest in
rural areas. However, child-rearing
transportation expenses were highest
for families in rural areas. This likely
reflects the longer traveling distances
and the lack of public transportation in
these areas.
Children Are
"Cheaper by the Dozen"
The expense estimates on a child
represent expenditures on the younger
child at various ages in a husband-wife
household with two children. It cannot
be assumed that expenses on the older
child are the same at these various
ages. The method for estimating
expenses on the younger child was
essentially repeated to determine
whether expenses vary by birth order.
The focus was on the older child in
each ofthe same age categories as
those used with the younger child.
A two-child family was again used
as the standard.
On average, for husband-wife
households with two children,
expenditures did not vary by birth
order. Thus, annual expenditures on
children in a husband-wife, two-child
family may be estimated by summing
the expenses for the two appropriate
age categories reported in figure 1.
Although expenses on children did
not vary by birth order, they did differ
when a household had only one child
or more than two children. Depending
on the number of other children in the
household, families spent more or less
on a child-achieving a "cheaper-by­the-
dozen" effect as they have more
children. That is, the cost of two
children is less than double the
cost of one child.
8
Figure 4. 2001 family expenditures on a child, by region and age of child1
12,000
11 ,500
11 ,000
(/)
10,500
.....
.£2 0 10,000
0
9,500
9,000
8,500
8,000
0-2 3-5 6-8 9-11 12-14 15-17
Age of child
- - Urban Midwest '" Urban South tr Urban West
- •- Rural 'T- Urban Northeast
1Regional averages for the younger child in middle-income, husband-wife families with two children.
The method to estimate child-rearing
expenses was repeated for families
with one child and families with three
or more children. Compared with
expenditures for each child in a
husband-wife family with two children,
husband-wife households with one
child spent an average of 24 percent
more on the single child; those with
three or more children spent an average
of 23 percent less on each child.
Hence, family income is spread over
fewer or more children, subject to
economies of scale. As families have
more children, the children can share a
bedroom, clothing and toys can be
handed down to younger children, and
food can be purchased in larger and
more economical packages.
Expenditures on Children by
Single-Parent Families
The estimates of expenditures on
children by husband-wife families do
not apply to single-parent families, a
group that accounts for an increasing
percentage of families with children.
Therefore, separate estimates were
made of child-rearing expenses in
single-parent households for the overall
United States. CE data were used to do
so. Most single-parent families in the
survey were headed by a woman (90
percent). The method previously
described was followed; regional
estimates were not calculated for
single-parent families because of
limitations in the sample size.
Estimates cover only out-of-pocket
child-rearing expenditures made by the
single parent with primary care of the
child and do not include child-related
expenditures made by the parent
without primary care or made by
others, such as grandparents. The data
did not contain this information.
Overall expenses by both parents on a
child in a single-parent household are
likely greater than the USDA child­rearing
expense estimates.
Family Economics and Nutrition Review
Table 1. 2001 family expenditures on a child, by lower income single-parent
and husband-wife households 1
Single-parent Husband-wife
Age of child households households
0-2 $5,440 $6,490
3-5 6,150 6,630
6-8 6,910 6,710
9- 11 6,440 6,730
12- 14 6,920 7,560
15- 17 7,670 7,480
Total (0 - 17) $118,590 $124,800
1Estimates are for the younger child in two-child families in the overall United States.
Table 1 presents estimated expendi­tures
on the younger child in a single­parent
family with two children,
compared with those of the younger
child in a husband-wife family with
two children. Each family type was in
the lower income group, having before­tax
income less than $39,100. About
83 percent of single-parent families
and 33 percent of husband-wife
families were in this lower income
group. More single-parent than
husband-wife families, however, were
in the bottom range of this income
group, and had an average income
of$16,400, compared with $24,400
for husband-wife families. Although
average income varied for these
families, total expenditures on a child
through age 17 were, on average, only
5 percent lower in single-parent house­holds
than in two-parent households.
Single-parent families in this lower
income group, therefore, spent a larger
proportion of their income on children
than did their counterpart two-parent
families. On average, housing expenses
were higher for single-parent families
than for two-parent families, whereas
transportation, health care, child care
and education, and miscellaneous
expenditures on a child were lower
2002 Vol. 14 No.2
in single-parent than in husband-wife
households. Child-related food and
clothing expenditures were similar,
on average, for both family types.
For the higher income group of single­parent
families with 2001 before-tax
income of $39,100 and over,2 estimates
of child-rearing expenses were about
the same as those for two-parent house­holds
in the before-tax income group of
$65,800 and over. In 2001 dollars, total
expenses for the younger child through
age 17 were $250,260 for single-parent
families versus $249,180 for husband­wife
families. Child-rearing expenses
for the higher income group of single­parent
families, therefore, were also a
larger proportion of income than was
the case for husband-wife families.
Thus, expenditures on children do not
differ much between single-parent and
husband-wife households; what differs
is household income levels. Because
single-parent families have one less
potential earner than do husband-wife
families, on average, their total house­hold
income is lower, and child-rearing
expenses are a greater percentage of
income.
2The two higher income groups were combined
for single-parent families.
The same procedure was used to
estimate child-rearing expenses on an
older child in single-parent households
as well as by household size. On
average, single-parent households with
two children spent 7 percent less on the
older child than on the younger child
(in addition to age-related differences).
This contrasts with husband-wife
households whose expenditures on
children were unaffected by the
children's birth order.
As with husband-wife households,
single-parent households spent more
or less if there was either one child
or there were three or more children.
Compared with expenditures for the
younger child in a single-parent
household with two children, expendi­tures
for an only child in a single­parent
household averaged 35 percent
more; households with three or more
children averaged 28 percent less on
each child.
Other Expenditures on
Children
The USDA child-rearing expense
estimates consist of direct expenses
made by parents on children through
age 17 for seven major budgetary
components. The expenses exclude
costs related to childbirth and prenatal
health care and other expenditures,
especially those incurred after a child
turns age 18.
One of the largest expenses made on
children after age 17 is the cost of a
college education. The College Board
estimated that in 2001-2002, annual
average tuition and fees were $3,586 at
4-year public colleges and $14,456 at
4-year private colleges; annual room
and board was $4,956 at 4-year public
colleges and $5,704 at 4-year private
colleges (The College Board, 2001).
Other parental expenses on children
9
Child-Rearing Expenses Over Time
The estimates presented in this article
represent household expenditures on
a child of a certain age in 2001. Future
price changes need to be incorporated to
estimate these expenses over time. Thus,
a future cost formula was used, and the
results are presented in the graph below.
The estimated future expenditures are
on the younger child in a husband-wife
family with two children. The assump­tions
are that a child is born in 2001
and reaches age 17 in 2018 and that the
average annual inflation rate over this
time is 3.4 percent (the average annual
inflation rate over the past 20 years). The
result: total family expenses on a child
through age 17 would be $169,920 for
households in the lowest income group,
$231,470 for those in the middle, and
$337,690 for those in the highest income
group.
after age 17 could include those
associated with children living at home
or, if children do not live at home, gifts
and other contributions to them. A
1996 survey found that 4 7 percent of
parents in their fifties support children
over age 21 (Phoenix Home Life
Mutual Insurance Company, 1996).
USDA's estimates do not include all
government expenditures on children,
such as public education, Medicaid,
and subsidized school meals. Actual
expenditures on children (by parents
and the government), therefore, would
be higher than reported here. The
indirect costs of raising children­time
allocated to child rearing and
decreased earnings-are not included
in the estimates. Although these costs
are more difficult to measure than
direct expenditures, they can be just as
high, if not higher, than the direct costs
of raising children (Spalter-Roth &
Hartmann, 1990; Bryant, Zick, & Kim,
1992; Ireland & Ward, 1995).
10
Estimated annual expenditures on a child born in 2001, by income group, overall
United States1
$30 ,----------------------,
_--fl Total= $337,6902
$25 r------ ------------~~~~-
~ $20 1-----~---------..,..L~:.._=._.__._____ • _ - . 1 Total= $231,470
g$15 ~~ ---:-/
~ $10 1----:::o:~~ ........ -------
.--+- -·- ·-- .... .__.-.---....-
$5 1-------------------~
$0 ~~~~~~~~~~~~--~
...~..
~
Year
- •- Lowest •- Middle --s-- Highest
1Estimates are for the younger child in husband-wife families with two children.
2Total reflects expenses on a child through age 7.
References
Total= $169,920
Bryant, W.K., Zick, C.D., & Kim, H. (1992). The Dollar Value of Household
Work. College of Human Ecology, Cornell University, Ithaca, NY.
The College Board. (200 1 ). Trends in College Pricing 200 I. Retrieved April 2,
2002, from http://www.collegeboard.org.
Ireland, T.R., & Ward, J.O. (1995). Valuing Children in Litigation: Family and
Individual Loss Assessment. Tucson, AZ: Lawyers and Judges Publishing
Company, Inc.
Lino, M. (2002). Expenditures on Children by Families: 2001 Annual Report.
U.S. Department of Agriculture, Center for Nutrition Policy and Promotion.
Miscellaneous Publication No. 1528-2001. Available at www.cnpp.usda.gov.
Phoenix Home Life Mutual Insurance Company. (1996). Americans' Hopes,
Fears and Dreams. 1996 Phoenix Fiscal Fitness Survey.
Spalter-Roth, R.M., & Hartmann, H.I. (1990). Unnecessary Losses: Costs to
Americans of the Lack of Family and Medical Leave. Washington, DC: Institute
for Women's Policy Research.
U.S. Department of Health and Human Services, Administration on Children,
Youth, and Families, Children's Bureau. (200 1 ). The AFCARS Report. Retrieved
April25, 2002, from http://www.acf.dhhs.gov/programs/cb/publicationlafcars/
june200l.pdf.
Family Economics and Nutrition Review
Andrea Carlson, PhD
U.S. Department of Agriculture
Center for Nutrition Policy and Promotion
Jean Kinsey, PhD
University of Minnesota
Carmel Nadav, PhD
Venturi Technology Partners
2002 Vol. 14 No.2
Consumers' Retail Source of Food:
A Cluster Analysis
The popular impression that only half of our food comes from retail grocery
stores is based on food expenditure data. However, the U.S. Department of
Agriculture's Continuing Survey of Food Intakes by Individuals, 1994 shows
that 72 percent of the amount of food (measured in grams) consumed by
Americans comes from grocery stores. Using cluster analysis, we grouped
consumers based on where they obtained their food and found that half were
"Home Cookers"-purchasing 93 percent of their food from grocery stores. By
comparison, the "High Service" consumers, which represented 10 percent of
the sample, purchased 43 percent of their food from restaurants. This research
quantifies the different shopping behaviors exhibited by groups of people in the
United States and discusses some of the demographic differences among the
clusters. The results are of interest to consumers, nutrition counselors, food
retailers, and policymakers who deal with retail food, low-income diets, or food
safety.
I n economic analysis of consumer
behavior, substituting expenditure
for quantity is a common practice.
For example, expenditure is often sub­stituted
for quantity when estimating
the percentage change in the amount
consumed when income changes by
1 percent (Engel function). This sub­stitution
is often used because expendi­ture
data rather than quantity are more
frequently available. And from a
business perspective, expenditures
are more closely related to sales-the
indicator (or metric) most used by
businesses to measure demand for their
products. Tracking consumers' food
consumption behavior with expenditure
data is no exception: the percentage
of income spent on food is a common
measure of economic well-being both
for individual households and for
nations.
The percentage of personal disposable
income spent on food by American
consumers decreased from 25 to 11
percent between 1960 and 1997 (Putnam
& Allshouse, 1996). The composition of
those expenditures changed noticeably,
with a decreasing proportion of each
food dollar being spent on food from a
retail food store called "food at home."
Food-away-from-home expenditures,
according to the food service and
restaurant sector, grew from 26 to 45
percent of each food dollar between
1960 and 1994; by the end of 1995, the
amount reached 4 7 percent (Putnam
& Allshouse, 1996). In recent years,
expenditures on food away from home
have approached 50 percent (Putnam
& Allshouse, 1996).
The rapid rise in food-away-from-home
expenditures is reflected in another
metric: the high growth in sales at
commercial food service establishments
relative to the growth in sales in retail
food stores. Between 1987 and 1999,
inflation-adjusted sales in eating and
drinking establishments grew an
average of2.2 percent; similar sales in
11
retail food stores, however, decreased
an average 0.1 percent (Food Institute,
1997).
Focusing on the proportion of the food
dollar that is spent in places other than
a grocery store leads to the common
belief that Americans eat almost half
of their food away from home. The
amounts of food consumers eat at home
or away from home, however, varies
considerably from the expenditure
proportions reported in the literature.
Expenditures in food service establish­ments
reflect higher costs of labor
(about 30 percent of the menu price),
entertainment, and service.
In contrast, we reported in 1998 that
when food consumption is measured in
grams, the amount of food purchased
from retail stores is 72 percent of all
food consumed (Carlson, Kinsey, &
Nadav, 1998). Another 14 percent of
food (in grams) was consumed from
carryout establishments (e.g., fast-food,
pizza, and sandwich shops) and other
restaurants combined. The remaining
14 percent came from other sources­other
people and gifts, cafeterias,
vending machines, coffee or food on
a common tray in an office, bars and
taverns, home gardens or hunting and
fishing, and public programs. When
food consumption is measured by
expenditure, the amount of food (g)
consumed away from home is 4 7
percent, almost twice as much as
that consumed from restaurants,
carryouts, and other establishments.
Our earlier research also found that
where people purchase their food did
not necessarily predict where they
consumed their food. For example,
l 0 percent of food purchased in stores
was not consumed at home, while 24
percent of carryout food was consumed
at home (Carlson, Kinsey, & Nadav,
1998). Rising household incomes and
fewer hours for household labor foretell
a rising value of time and, in turn,
12
predict that consumers will purchase
more labor services in their pursuit of
food(Kinsey, 1983). Even within a
grocery store, sales of ready-to-eat
foods-including those that must be
heated-are rising while sales for basic
ingredients are falling.
Studies in the 1970's and 1980's found
that higher incomes led consumers to
spend more money on meals eaten out
but did not necessarily lead consumers
to eat more meals away from home
(Prochaska& Shrimper, 1973). A similar
conclusion from other research sug­gests
that households with wives who
work part-time increased their expendi­tures
on food away from home more
so than did households where wives
worked full-time even though both
households had the same income
(Kinsey, 1983).
As women's time in the labor market
expands from zero to part-time,
increases in income may expand the
opportunity to eat out. But as employ­ment
becomes full-time, less time is
available to eat out or cook at home.
Thus, continued increases in income
are not further associated with in­creased
expenditures on food away
from home. In fact, increases in income
may even decrease expenditures on
food away from home as consumers
substitute fast-foods or take-out foods
for more leisurely dining away from
home (Kinsey, 1983). These findings
suggest that the traditional labels of
"food at home" and "food away from
home," as well as the use of expenditure
as the metric for quantity, do not
provide a complete understanding
oftoday's consumer.
The research reported here investigates
the amount of food (g) that consumers
reported eating in 1994 from various
retail sources and examines the common
characteristics of consumers whose
retail sources of food vary from the
average. We used data from the USDA
Continuing Survey of Food Intakes by
Individuals, 1994 (CSFIT) (USDA, 1994).
We examined two questions: (1) What
are the unique characteristics of people
who shop for food in different types
of establishments? (2) How can this
information be used by managers of
these establishments and public
policymakers? To answer these
questions, we used cluster analysis to
group consumers by the retail source of
their food and to describe their common
shopping and eating habits.
Data and Methods
The CSFII is conducted by the Agricul­tural
Research Service (USDA, 1994).1
We used data from 1994 because they
were the most recent data available
when this study began. The CSFII
data provide a better picture of overall
consumption behavior than do data
collected at the market level where
sales are the unit of measure. The
CSFII reports all food eaten by 5,589
individuals in 2,540 households in the
United States. Each individual reports
food intake for 2 nonconsecutive days,
yielding more than 150,000 observa­tions
on individual food items. For
every food item, the respondent also
lists the source from which the food
was obtained and how much was
eaten. The sources of food used in
this analysis include stores, carryout
restaurants, restaurants, other people,
bars and taverns, cafeterias, common
coffee pots or trays, vending machines,
mail order, public programs, and home­grown
or caught food (see box). The
response rate for the CSFII is 80 percent
for the first day and 7 6 percent for the
second day. Sample weights are used
in this analysis, and the results are
generalizable to the population.
1These data are available from the U.S.
Department of Commerce, Technology
Administration, National Technical Service,
5285 Port Royal Road, Springfield, VA
221 61 , (703) 487-4650, http://www.ntis.gov.
Family Economics and Nutrition Review
Analysis
The first step in our analysis was
to calculate the percentage of food,
measured in grams, each person
consumed from each source. Cluster
analysis is used to place the adult
sample2 into groups based on where
they obtained their food. In this case,
the cluster variables are the percentage
of food (g) adults consumed that come
from various sources. For example, if
one person's diet contains 80 percent
offood from stores, 5 percent from
carry out restaurants, 1 0 percent from
restaurants, and the remaining 5 percent
from cafeterias, cluster analysis uses
these percentages to place that person
into a group with others who have
similar consumption patterns.
This analysis uses the "k-means"
method of clustering that is used by
SAS F ASTCLUS. This method is one
of the better techniques available for
clustering large data sets where the
goal is to divide respondents into
manageable and meaningful groups to
describe behavior (Hartigan, 1985; SAS
Institute, 1989). K-means selects the
centers of the initial clusters from the
first observations in the data set and
then assigns the other observations to
the nearest cluster. When an observa­tion
is added to the cluster, k-means
recalculates the mean of the cluster
variables, and this mean becomes the
new cluster-center. If this recalculated
cluster-center changes another cluster
that is closest to an observation already
in the cluster, then k-means moves that
observation to the closest cluster and
recalculates the center of its new
cluster. The process continues until
the number of changes is very small.
2Because children's eating behaviors are
somewhat dictated by their parents, children
are not included in the cluster analysis.
2002 Vol.14No.2
Categories of Food Sources
Store: supermarket, grocery store, warehouse, convenience store, drug store,
gas station, bakery, deli, seafood shop, ethnic food store, health food store,
commissary, produce stand, and farmers' market.
Carryout: traditional hamburger, chicken, and carryout pizza restaurants; and
other restaurants where customers order, pick up, and pay for food at a counter.
Restaurants: any other establishment where the food is served at the table by
restaurant staff.
Other People: food received as a gift or while a guest in someone's home.
Bars and Taverns: a location the respondent classified as a bar or tavern rather
than as a restaurant, carryout restaurant, or cafeteria.
School and Non-School Cafeterias: Most non-school cafeterias are based
in offices. For most of the analysis, school and non-school cafeterias are
separated but are often put together in summary tables.
Common Coffee Pot or Food Tray: office coffee pots, food platters at a
reception or in an office, and potluck dinners.
Vending Machines: food purchased from vending machines located within
stores, restaurants, cafeterias, offices, or other locations.
Mail Order: food received from a mail order catalog or club that sends food out
regularly, such as a fruit-of-the-month club.
Public Programs: a combination of several CSFII categories including child
and adult care centers, day care centers in private homes, soup kitchens,
shelters, food pantries, Meals on Wheels, other community food programs,
and residential care facilities.
Home-Grown or Caught: food that is grown or gathered by the respondent or
someone the respondent knows; meat and fish procured by hunting or fishing.
13
Representing 75 percent of the
adult sample, six of the nine
clusters get more food from
stores than any other source ...
14
The resulting clusters are based on 2
nonconsecutive days of dietary recall.
Thus, if an individual had been sampled
on a different day, he or she might have
ended up in a different cluster. How­ever,
because this data set is designed
to be nationally representative, similar
clusters would form on any day, except
major national holidays.
To reduce the bias towards observa­tions
that appear at the beginning of
the data set, we used a technique
recommended by SAS (SAS Institute,
1989). In the first pass, the SAS
procedure forms 50 clusters and saves
the cluster centers in a file. Over half
of these clusters have fewer than five
observations, and the centers are
ignored. The remaining 24 centers form
the "seeds" in the next iteration to form
24 new clusters. In the third iteration,
the center of the smallest cluster is
removed, and the SAS procedure forms
23 new clusters from all observations.
This process continues until there are
five clusters. The process is described
in more detail elsewhere (Carlson,
Kinsey, & Nadav, 1998; MacQueen,
1967).
The second step compared each cluster
with the rest of the sample to address
the two research questions. Because
most of the data were categorical, this
study used three nonparametric tests:
the chi-squared, the Kolmogrov­Smimov
test, and the Kruskal-Wallis
test (described in detail elsewhere)
(Siegel, 1956). These tests measure
differences in distributions of variables
among different subgroups. The chi­squared
test was used as an initial test
for differences. Differences between the
observed versus expected distributions
were confirmed by the other two tests.
The Kolmogrov-Smimov test was used
to measure differences between two
clusters in the distribution of categori­cal
variables that cannot be ranked
(e.g., race) and the Kruskai-Wallis test
for differences in categories that can be
ranked (e.g., age, income, and educa­tion).
For these tests, we divided the
continuous variables into categories.
For example, the categories for age
were 19-30,31-40,40-50, 50-60, 60-64,
and 65+; for education, less than high
school, high school degree or GED,
some college, 4-year degree, and
professional or graduate study.
Results and Discussion
Nineteen clusters formed around the
various sources of food. Several
sources, such as carryout, had more
than one cluster form around it. This
paper will discuss only nine of these
clusters, some with names based on the
unique characteristics of the cluster:
Working Family, Young Professional,
Manager, and City Office. In other
cases, the names are based on where
the people in the cluster shopped:
Home Cookers, Carry out, High Service,
Office, and Students and Faculty.
Sociodemographic
Characteristics of the Sample
Almost half(49 percent) of the adult
sample was in the Home Cookers
cluster (table 1 ), followed by those in
the Working Family cluster (11 percent),
and High Service cluster ( 10 percent).
Fewer adults were in the other clusters:
Carryout, Office, Manager, Young
Professional, City Office, and Students
and Faculty (from 3 percent to a low of
0.6 percent).
Age, Race, and Gender. With an
average age of 51, people in the Home
Cookers cluster were significantly
older than the rest of the adult sample
(tables 1 and 2). However, the standard
deviation for their age was the largest
(17.9, not shown), indicating a bigger
spread in age than was the case for
the other clusters. Three clusters­Students
and Faculty, Carryout, and
Young Professional-had the youngest
members (mean age of37, 36, and 31,
Family Economics and Nutrition Review
Table 1. Statistically significant demographic characteristics of select clusters of consumers based on where they purchased
food
Cluster
Home Cookers
Working Family
Carryout
Young Professional
High Service
Office
Manager
City Office
Students and Faculty
Percent of
adults1
49
11
3
0.7
10
2.5
2.0
1.0
0.6
Age, race,
and gender
Older••
Younger••
Younger than
Working Family**
Fewer White•
Younger than
Carryout••
More White**
More men•
More Asian/Pacific
and "other''**
Fewer females*
Income and
education
Lower income••
Less college••
More "some college"*
Higher income••
More college and
graduate study**
Higher income••
More college••
Higher income••
More college/university••
More college and
graduate••
1 Percents do not add to 100, because all clusters are not shown in the table.
Occupation and
employment
Fewer professional/
technical, and
manager/proprietor••
More not employed**
More full- and part-time**
More full- and part-time•
More full-time••
More professional/
technical, and
manager/proprietor•
More full-time••
More full-time**
More professional/
technical, and
manager/proprietor•
More full-time••
More full-time••
More full- and part-time*
Region, urban, and
household size
Larger households**
More Northeast••
More central city•
More central city•
More Northeast••
* p<.05; ** p<.01: The distribution between the cluster and the rest of the adult sample is significantly different based on the Kruskai-Wallis test.
respectively). Whereas significantly
more Whites were in the High Service
cluster, fewer Whites were in the
Carryout cluster, and more Asian/
Pacific Islanders and others were in
the Students and Faculty cluster.
The High Service cluster had signifi­cantly
fewer women ( 46 percent), 3
3Differences are in the distributions between
the cluster and the total adult sample. The p­values
do not indicate how these distributions
differ, only that they are different.
2002 Vol. 14 No.2
compared with the remainder of the
adult sample. The Young Professional
cluster also had relatively few women
(35 percent), but the difference from the
adult sample was not significant. The
Young Professional cluster, however,
represented only 0.7 percent of the
total sample; thus, the small size of
this cluster may have contributed to
the lack of statistical significance.
Income, Education, and Employment.
Mean income among the clusters
ranged from $32,554 to $49,072.
Compared with the rest of the sample,
the Home Cookers cluster had a
significantly lower income; three
clusters had a higher income: High
Service ($42, 767), Young Professional
($48,507), and Manager ($49 ,072).
Although people in the Working
Family and Carryout clusters earned
a household income close to the
Home Cookers' income ($36,466 and
15
Table 2. Basic sociodemographic characteristics of select clusters of consumers based on where they purchased food
High school
Adult Center city degree Household
Cluster sample Women resident or more Employed size Age Income
-----------------------------------------Percent ---------------------------------------- ----------------------- Mean ------------------------------
Entire Adult Sample 100 49.8 33.3 76.6 57.5
Home Cookers 49.0 51 .4 33.4 71.0 46.5
Working Family 10.0 47.8 31.4 82.7 65.7
Carryout 11.0 45.2 40.9 82.6 78.3
Young Professional 3.0 34.8 30.4 91.3 95.7
High Service 0.7 . 45.5 35.1 85.6 62.1
Office 2.4 55.7 39.2 76.0 73.4
Manager1 2.0 45.6 45.6 82.5 77.2
City Office 0.7 52.2 52.2 82.6 91.3
Students and Faculty 1.0 68.8 21 .9 90.6 87.5
11ncludes a high concentration of professionals, technical workers, managers, and proprietors.
$34,555, respectively), the distribution
of incomes in the Working Family
and Carryout clusters did not differ
significantly from the rest of the
sample.
Educational patterns tended to follow
income patterns. Whereas the Home
Cookers cluster had a significantly
lower educational level, compared with
the total sample, several other clusters
had higher levels of education: Young
Professional, Students and Faculty,
High Service, Manager, and Working
Family. The Young Professional and
Students and Faculty cluster each had
more people with 4-year college
degrees and graduate or professional
degrees. About 83 percent each of
the members of the Working Family,
Carryout, City Office, and Manager
clusters graduated from high school
or received more education. Of these,
only the Manager cluster, with more
members receiving college and
university degrees, had a distribution
that was significantly different from
the sample. Although not significantly
different from the rest of the sample,
16
76 percent of those in the Office cluster
had a high school degree or more.
Occupation and Employment. The Home
Cookers cluster, compared with the
High Service and Manager clusters,
had significantly fewer people in
professional/technical occupations or
who worked as managers/proprietors.
Compared with other clusters, the Home
Cookers cluster was significantly more
likely to have unemployed members­and
a concentration of unemployed
people (including retirees). Whereas
only 47 percent of the people in the
Home Cookers cluster were employed,
most ofthe people in the Young
Professional cluster were employed
(96 percent). A little more than three­fourths
of those in the Manager cluster
were employed (77 percent).
Region, Urbanization, and Household
Size. Two clusters, Carryout as well as
Students and Faculty, were more likely
than other clusters to reside in the
Northeast. Two clusters, Manager and
City Office, had a higher percentage
of people living in center cities, 46 and
2.9 48.3 $35,298
2.9 51.4 32,554
3.2 41.8 36,466
3.2 36.0 34,555
3.4 30.8 48,507
2.8 48.3 42,767
3.0 49.0 39,824
2.7 46.8 49,072
2.8 41.5 35,963
3.2 36.8 44,361
52 percent, respectively. Household4
size among all the clusters ranged
from an average of 2.7 to 3.4. Only
the distribution for the Working Family
cluster differed significantly from the
rest of the sample. The Carry out and
Young Professional also appeared to
have larger households (3 .2 and 3 .4,
respectively), but the distributions
were similar to the remainder of the
adult sample.
Food Sources
Representing 75 percent of the adult
sample, six of the nine clusters get more
food from stores than any other source:
Home Cookers (93 percent), Office (73
percent), Working Family (70 percent),
Students and Faculty (54 percent),
Manager (53 percent), and High Service
( 47 percent) (table 3).
When using grams of food rather than
expenditure as a measure of consumer
buying behavior, we found that stores
4This analysis did not include children, but we
did examine the number of children present in
the households of the adult respodents.
Family Economics and Nutrition Review
Table 3. The percentage share of food source for select clusters of consumers
based on where they purchased food
Cluster Food store Restaurant Carryout Vending Cafeteria1
Home Cookers 93.1 2.5 1.1 0.3 0.1
Working Family 69.6 3.3 22.0 0.3 0.2
Carryout 34.8 3.7 57.3 0.1 0.2
Young Professional 33.8 8.2 40.4 14.2 0.8
High Service 46.8 42.8 5.0 0.4 0.4
Office 72.6 4.2 3.8 0.7 14.7
Manager 52.7 7.3 4.3 1.0 28.1
City Office 27.9 7.0 7.3 2.6 52.8
Students and Faculty 54.2 8.3 6.8 1.1 25.0
1Both school and non-school cafeterias are combined.
Notes: Bold numbers identify the behavior around which a cluster was formed.
Totals do not add to 100, because not all sources of food are shown.
appear to play a much more important
role for most consumers. A second
observation is that both carryout
restaurants and cafeterias have more
than one cluster purchasing foods (g)
from them, indicating major differences
between the customers using these
point-of-purchase sources. Three
clusters formed around carryout food:
Working Family, Carry out, andY oung
Professional. There are also differences
in the shopping patterns, especially
in the amount of food obtained from
carryout restaurants, 22 to 57 percent.
In addition, the Young Professional
cluster is the only cluster discussed
in this paper with a relatively high use
of vending machines (14 percent).
Similarly, four clusters formed around
cafeterias as a source of food. The
Office, Manager, and City Office
clusters formed around non-school
cafeterias, while the Students and
Faculty cluster formed around school
cafeterias (breakdown not shown).
Except for City Office, these clusters
all get at least half of the remaining
food from stores, and make use of
restaurants and carryout restaurants,
though in different proportions.
2002 Vol.14No.2
Market Profiles
When we examined consumption within
markets (e.g., stores), we found that
Home Cookers, the largest cluster,
consumed 59 percent of all food (g)
obtained from stores (fig. 1 ). The next
two biggest clusters, Working Family
and High Service, consumed 10 and
6 percent, respectively, of all food
obtained from this source. This pattern
of larger clusters representing larger
portions of this market continued.
"Other Groups" are clusters that
formed but are not discussed in this
paper. Each of these clusters in "Other
Groups" had fewer than 100 observa­tions;
thus, statistical analysis may
be misleading.
For restaurants, carryout restaurants,
and cafeterias, the largest market share
belonged to the cluster or clusters
which formed around that source. For
example, the High Service cluster, which
formed around restaurants, represented
58 percent of the restaurant's market
share. For carryout restaurants, the
Working Family, Carry out, andY oung
Professional clusters consumed over
three-fifths (61 percent) of all food
obtained from that market. Whereas
. .. Home Cookers, the largest
cluster, consumed 59 percent
of all food (g) obtained from
stores.
17
Figure 1. Percentage of food consumed from selected sources, by cluster
Store
...
Students& Faculty (1%)
-Other Groups (18%)
*--Manager (1%)
-High Service (6%)
T""CT""CTT"T-r-i)
-Working Family (10%)
t-- riort1e Cookers (59%)
Carryout
~~!'~!~~--~~~~---Students & Faculty (1%)
~~---otherGroups (15%)
-~===========:::_'City .. ManOagffeicre ( 1(1%%) )
-High Service (7%)
.. lliliiillllllilllf==:Office(1
PI Young P%ro)f essional (4%)
-Carryout (23%)
H ttt• '
-Working Family (34%)
Home Cookers (13%)
Restaurant
~High Service (58%)
Office (2%)
~ /T rTT"""...----:Young Professional (1%)
Carryout (2%)
+--Working Family (6%)
~----------------~
Home Cookers (20%)
Cafeteria
Note: 'Other groups' are clusters with fewer than 1 DO observations; these clusters are not discussed in this paper but are needed to complete the market profile.
18 Family Economics and Nutrition Review
the High Service cluster consumed 7
percent of the food in this market, the
Young Professional cluster consumed
less, 4 percent. However, the High
Service cluster is a much larger cluster.
For the Carry out market, 70 percent of
all food obtained here was consumed
by three clusters: Working Family
(34 percent of the grams offood con­sumed),
Carry out (23 percent), and
Home Cookers (13 percent). As
expected, the Students and Faculty,
Managers, Office, and City Office
clusters consumed 83 percent of the
food in the school and non-school
cafeteria market. No other cluster
consumes a large part of their food
from this source, indicating the
cafeteria market is fairly focused
on these four clusters.
Conclusion
Americans who report in detail what
food they eat, where they eat it, and
where they buy it provide us with an
alternative picture of food consumption
based on the quantity of food (g)
consumed. This varies from the more
common picture based on food expendi­tures
and sales. While it is true that
Americans obtain food from many retail
and home-grown sources, 75 percent
of the adult population purchased
over half of their food measured in
grams from retail food stores. Thus
we have a very different picture from
the one presented by the use of food
expenditure data. This alternative
picture allowed us to ask two
questions, what are the unique
characteristics of people who shop
for food in different establishments,
and how can this information be used
by these establishments and by public
policymakers?
An examination of the data to determine
the importance of each cluster to each
type of retail vendor shows that,
2002 Vol. 14 No. 2
among the people in our sample, Home
Cookers purchase 59 percent of all the
grams of food that were sold in retail
stores, 20 percent of restaurant food,
and 13 percent of the food from
carryout establishments. The clusters
most likely to be consumers of carry out
food were the Young Professional,
Working Family, and Carryout. People
in these groups tend to be younger,
employed, and have some college
education.
Policymakers can use this information
to determine how policies will affect
different market segments: stores,
restaurants, cafeterias, or carryout
establishments. Owners and marketers
of these establishments can determine
where else their customers are obtain­ing
food and design an appropriate
marketing strategy.
Future research needs to address
the effect that the choice of where to
obtain food has on the quality and
healthfulness of the diet. Identifying
the consumers who are the first to make
changes to their shopping habits, as
well as identifying their preferences,
will help retailers and those who design
public food policy to serve consumers
better.
19
References
Carlson, A., Kinsey, J., & Nadav, C. (1998). Who Eats What, When and From
Where? Minneapolis, MN: The Retail Food Industry Center, University of
Minnesota. Working Paper Series.
Food Institute. (1997). U.S. Food Service Industry Segments. Food Institute
Review, 44, 3.
Hartigan, J.A. (1985). Statistical Theory in Clustering. Journal of Classification,
2, 63-76.
Kinsey, J. (1983). Working wives and the marginal propensity to consume food
away from home. American Journal of Agricultural Economics, 65, 10-19.
MacQueen, J.R. ( 1967). Some Methods for Classification and Analysis of
Multivariate Observations. Paper presented at the Fifth Berkeley Symposium on
Mathematical Statistics and Probability, Berkeley, CA.
Prochaska, F., & Shrimper, R. (1973). Opportunity cost of time and other
socioeconomic effects on away-from-home-food consumption. American Journal
of Agricultural Economics, 66, 595-603.
Putnam, J.J., & Allshouse, J.E. (1996). Food Consumption, Prices, and
Expenditures, 1970-94. U.S. Department of Agriculture, Economic Research
Service. Statistical Bulletin No. 928.
SAS Institute, Inc. (1989). SASISTAT User 's Guide, Version 6 (4th ed.). Cary, NC:
SAS Institute, Inc.
Siegel, S. (1956). Nonparametric Statistics for the Behavioral Sciences. New York:
McGraw-Hill.
U.S. Department of Agriculture, Agricultural Research Service. (1994). Continuing
Survey of Food Intakes by Individuals (CSFII).
20 Family Economics and Nutrition Review
Vivica Kraak, MS, RD
David L. Pelletier, PhD
Jamie Dollahite, PhD, RD
Cornell University
2002 Vol. 14 No.2
Food, Health, and Nutrient
Supplements: Beliefs Among
Food Stamp-Eligible Women and
Implications for Food Stamp Policy
Several U.S. professional organizations that develop research-based dietary
recommendations for the public support the position that most nutrients can and
should be obtained by consuming a balanced diet. This position differs from the
widespread and growing use of supplements by the public and changes in public
policy currently under consideration, such as the proposal to allow nutrient
supplements to be purchased with food stamps. This study investigated the
attitudes and beliefs of a diverse sample of food stamp-eligible women concerning
the relationship among food, health, nutrient supplementation, and associated
lifestyle factors; these findings were then related to ongoing policy dialogue. The
findings suggest the need to clarify the policy goals, conduct a more systematic
examination of potential strategies for achieving those goals, and broaden the
set of explicit criteria used when considering supplement-related policies in this
population.
M any U.S. organizations that
develop research-based
national dietary recommenda­tions
support the position that nutrients
required by healthy people can be
obtained by consuming a balanced
diet (Pelletier & Kendall, 1997). The
American Dietetic Association main­tains
that "the best nutrition strategy for
promoting optimal health and reducing
the risk of chronic disease is to obtain
adequate nutrients from a wide variety
offoods" (Hunt, 1996). The Food
Guide Pyramid and the Dietary
Guidelines for Americans, 2000 also
support this perspective by promoting
a food-based approach for U.S.
consumers to achieve optimal health
(Johnson & Kennedy, 2000). The use
of supplements, 1 however, is a growing
trend, which suggests that Americans
are becoming more receptive to non­food
sources of nutrition for health
promotion.
A recent biannual nationwide survey
conducted by the American Dietetic
Association (2002), which tracks
public attitudes, beliefs, knowledge,
and practices related to food, nutrition,
and health, found that nearly half ( 49
percent) of the adults surveyed took
supplements daily, and more than a
third (38 percent) believed that taking
supplements is necessary to ensure
1Nutrient supplements are defined by the U.S.
Department of Health and Human Services
(DHHS), Office of Dietary Supplements as a
formulation containing at least one or more
of a variety of vitamins and minerals used to
supplement the diet by increasing the total
dietary intake. Dietary supplements, a
broader class of products, include a vitamin,
mineral, amino acid, herb, or other botanical
intended for ingestion in the form of a capsule,
powder, soft gel, or gel cap, and which is not
represented as a conventional food or as a sole
item of a meal in the diet (Office of Dietary
Supplements, 1999).
21
good health. The high prevalence of
supplement use has been confirmed in
other national surveys (Balluz, Kieszak,
Philen, & Mulinare, 2000; Bender,
Levy, Schucker, & Yetley, 1992;
Slesinski, Subar, & Kahle, 1995;
Subar & Block, 1990). Further analyses
suggest that users of nutrient supple­ments
tend to have higher incomes and
education and more healthful lifestyles
than do nonusers (Nayga & Reed,
1999; Neuhouser, Patterson, & Levy,
1999), although supplement use also ·
is associated with having one or more
health problems (Bender et a!., 1992;
Newman et a!., 1998). Many studies
have reported that vitamin and mineral
intakes from food tend to be higher
among supplement users than nonusers,
but analysis of data from the 1989-91
Continuing Survey ofFood Intakes by
Individuals revealed that this relation­ship
can vary across sociodemographic
groups and is influenced by the
motivations and beliefs for using
supplements (Pelletier & Kendall,
1997).
In 1995 and 1999, Congress considered
legislation to permit food stamp
recipients to use their benefits to
purchase dietary supplements (H.R.
104-236 and S.1307, respectively)
(Thomas, 2000). This legislation was
opposed by many organizations that
monitor public health and hunger,
including the American Academy of
Pediatrics; American Heart Associa­tion;
USDA; and the Food, Research,
and Action Center (Pelletier & Kendall,
1997; Porter, 1995; Skolnick, 1995).
These organizations voiced a range of
concerns: Most important was that a
policy change would depart from the
original intent of the Food Stamp
Program (FSP), and supplements would
not provide the calories needed or full
range of nutritional benefits by children
to avoid health problems and maximize
learning potential in school (Porter,
1995). The proposed change was also
seen as an attempt by a billion-dollar
22
supplement industry to widen its market
(Skolnick, 1995). USDA's position on
this issue was stated in these terms:
Because vitamins and minerals
occur naturally in foods, a good
diet will include a variety of foods
that together will supply all the
nutrients needed ... . Because
these products serve as deficiency
correctors or therapeutic agents
to supplement diets deficient in
essential nutrition rather than as
foods, they are not eligible for
purchase with food coupons.
(Porter, 1995)
Those favoring the proposed legislation
maintained that the bill would expand
dietary choices by giving food stamp
recipients the option of improving their
diet through additional nutrients. The
Council for Responsible Nutrition, a
trade organization representing the
food supplement industry, testified in
Congress:
When critical food choices
are necessary, spending a few
cents a day for a vitamin and
mineral supplement may
actually be the best and most
economical choice available
to a person at nutrition risk.
(Dickinson, 1998)
Thus, supporters framed the issue in
terms of improving nutrition and
maintaining personal choice.
A report prepared by USDA at the
request of Congress examined issues
related to this proposal (U.S. Depart­ment
of Agriculture [USDA], 1999).
Among other findings, the report noted
vitamin and mineral intake from food
differs little across income levels, food
stamp recipients tend to have nutrient
profiles that are comparable to non­recipients,
and a third (35 percent) of
food stamp recipients already purchase
supplements with other income sources.
The current policy, therefore, may not
restrict individual choice as some have
suggested.
There is a paucity of research elucidat­ing
attitudes, beliefs, and supplement­use
practices oflow-income, ethnically
diverse Americans. One study sug­gested
that food stamp recipients are
less likely to take dietary supplements
than are nonrecipients. However, it
analyzed neither the reasons for this
practice nor the relationship to nutri­tional
quality of the diets, health status,
socioeconomic circumstances, or other
contextual factors (Nayga & Reed,
1999). The purposes of the present
research were to investigate the atti­tudes
and beliefs toward supplement
use among food stamp-eligible women
to understand better the potential
effects of policy changes in this
population and to relate these fmdings
to the earlier policy dialogue about
this issue, including the discussion
of policy goals, strategies, and criteria
for selecting among them.
Methods
Study Sites and Sampling
The purpose of this research was to
clarify the perspectives about nutrient
supplement use rather than to obtain
population-level estimates of the
distribution of particular beliefs.
Qualitative methods were used by
two researchers trained in qualitative
research techniques (Miles &
Hubberman, 1994) to elucidate
attitudes and beliefs of food stamp­eligible
women concerning food,
health, and nutrient supplements.
Member checks and peer debriefing2
2A member check involves obtaining feedback
from respondents on the interpretation of the
data following the analysis; peer debriefing
involves discussing the analysis and interpreta­tion
of the data with other researchers (Miles &
Hubberman, 1994).
Family Economics and Nutrition Review
were techniques used by both
researchers to enhance the reliability
and credibility of the data (Kraak,
Pelletier, & Dollahite, 2000).
Three study sites were selected to
provide ethnic and regional variation
among food stamp-eligible individuals
who were nutrient supplement users
or nonusers. A purposeful sample was
obtained at each study site and was
based on ethnicity (African American,
White, Latina, and Asian), eligibility
for food stamps (current recipient
and/or former recipient), and use of
supplements (user or nonuser). Each
case was reviewed and classified
according to the usual supplement-use
habits. For instance, women were
categorized as users if they occasion­ally
used supplements whenever the
supplements were needed or when they
remembered to take them. By contrast,
women were categorized as nonusers
if they took a prenatal multivitamin/
mineral only during pregnancy, as
advised by their physician, but did not
use supplements preceding or following
their pregnancy. The interviews were
conducted in urban locations including
New York; San Francisco, San Jose,
and Oakland, California; and Fort
Smith, Arkansas.
With the assistance of the Cooperative
Extension staff in each site, were­cruited
72 individuals--6 from each
ethnic group in each location. Efforts
were made to recruit participants who
were food stamp-eligible adult women,
at least 18 years old, who had received
or were receiving food stamps, and
were not pregnant or breastfeeding. The
final sample consisted of24 individuals
in New York (NY), 25 in California
(CA), and 23 in Arkansas (AR).
Participants in NY were drawn from
the Expanded Food and Nutrition
Education Program (EFNEP). Those
in CA and AR were drawn either from
the EFNEP and Food Stamp Nutrition
Education Program (FSNEP) or
2002 Vol. 14 No.2
contacted with the assistance of
organizations serving the population
that met the sampling criteria.
The age range for the 72 participants
was 19 to 75 years. Thirty-eight of the
final sample used supplements, 34 did
not; 37 were food stamp recipients, 34
were not; and 1 respondent was unclear
about her use of supplements. The
final sample consisted of 19 Whites,
16 African Americans, 20 Latinas,
and 17 Asian Americans. Most inter­views
were conducted in English
among bilingual interviewees; in
interviews with three Asian partici­pants,
a bilingual interpreter was used.
Eligibility for EFNEP in the participat­ing
States required a family income
less than or equal to 185 percent of the
poverty level; whereas, eligibility for
FSNEP was less than or equal to 130
percent of the poverty level. Specific
questions about income were not asked,
but participants were asked to identify
all of the food assistance programs they
knew they were eligible for and had
participated in. Some EFNEP partici­pants
may have been ineligible to
receive food stamp benefits. Current
or former food stamp recipients made
up 38 percent of the sample in NY, 52
percent in CA, and 65 percent in AR.
Interview Guide, Data Collection
Methods, and Analysis
Qualitative methods were used for
data collection and analysis (Miles &
Hubberman, 1994). A semi-structured,
open-ended interview guide was used to
elicit participants' views and attitudes
concerning the following areas:
• attitudes about and participation
in food assistance and nutrition
education programs;
• eating habits;
• beliefs about the adequacy of food­based
nutrients in the average
American diet;
• beliefs about the general attributes
of a healthy person;
• perceptions about their own health
status;
• personal health concerns;
• health-promoting or health­detracting
behaviors;
• intentions to adopt health-promoting
behaviors;
• perceptions about the meaning of the
term supplement;
• specific supplement-use habits;
• influences promoting nutrient
supplement use;
• reasons for not using or
discontinuing supplements;
• beliefs about the benefits and
drawbacks of allowing the use of
food stamps to purchase nutrient
supplements in addition to food; and
• opinions about who-the
government or food stamp
recipients-should decide how food
stamps could be used if the policy
changed.
After receiving input from staff of the
Cooperative Extension program, we
pretested and modified the interview
guide for each site. Interviews were
taped and transcribed verbatim. Data
from the transcripts, demographic
information, and field notes were used
to analyze the qualitative data.
A consolidated summary was generated
from the ethnic- and geographically
based summaries of pertinent emergent
themes. An in-depth analysis of key
themes was undertaken in four specific
categories:
• Nutrient supplement users
receiving food stamp benefits
• Nutrient supplement users not
receiving food stamp benefits
• Nutrient supplement nonusers
receiving food stamp benefits
• Nutrient supplement nonusers not
receiving food stamp benefits
23
About one-half of the participants
described a supplement as a
substitute or a replacement for
food. About one-quarter of the.
participants described it as
something taken in addition to
the nutrients one could obtain
from food, and another quarter
expressed uncertainty about the
purpose or role of a supplement.
24
These categories emerged as more
important themes than the regional
and ethnic categories used to obtain
the heterogeneous sample. Emergent
themes were incorporated into a
conceptual framework describing the
attitudes, beliefs, and practices of the
women. Examples were chosen to
illustrate the breadth of results for
each question in the interview guide.
The research site (NY, CA, AR),
participants' ethnicity, supplement
status (user vs. nonuser), and food
stamp status (recipient vs. nonrecipient)
are indicated after each quote. In some
cases, approximate percentages are
provided to give a sense of the number
of women who expressed a certain
viewpoint, although population
representativeness should not be
inferred.
Results
Attitudes and Beliefs About the
Adequacy of Food-Based
Nutrients
Two major themes emerged from this
question: "Can the average person get
all the vitamins and minerals he/she
needs to be healthy, from the average
U.S. diet, without taking a multivitamin
and mineral pill?"
Theme 1 : Roughly 60 percent of
participants believe it is possible to get
all nutrients from food, but most people
do not do what is necessary to achieve
that goal because of one or more of the
following:
• fast-paced and stressful lifestyles
• ease and convenience of eating
''junk" food
• lack of attention paid to the diet until
chronic diseases develop
• lack of knowledge about what to
select and prepare to meet needs
• lack of precision in serving sizes to
eat according to the Food Guide
Pyramid
• personal preferences that influence
food choices that may not be
nutritious
• time and money required to make
wise decisions (especially
challenging for low-income working
mothers)
• the perception that healthful foods
are too expensive to afford on a
limited income
Theme 2: Less than one-quarter of
respondents said it is not possible for a
person to obtain all necessary nutrients
exclusively from food because certain
health conditions might require people
to take nutrient supplements. Also,
respondents had concerns about how
food is produced and processed with
special reference to nutrient losses, use
of pesticides, and food additives and/or
preservatives that were believed to
change the nutrient value of food.
Illustrations of the participants'
attitudes and beliefs about the adequacy
of food-based nutrients and the role of
nutrient supplements appear in the box
on page 25.
Perceptions Concerning the
Role of a Supplement
When participants were asked, "What
comes to mind when you hear the word
supplement?" the responses followed
three themes. About one-half of the
participants described a supplement as
a substitute or a replacement for food.
About one-quarter of the participants
described it as something taken in
addition to the nutrients one could
obtain from food, and another quarter
expressed uncertainty about the purpose
or role of a supplement.
Family Economics and Nutrition Review
Illustrative statements of people's attitudes and beliefs about adequacy of food-based nutrients and the role
of supplements
"Can the average person get all the vitamins and minerals he/she needs to be healthy from the average U.S. diet,
without taking a multivitamin and mineral pill?"
Time and money to make wise food choices and/or to prepare nutritious foods were lacking.
"Yes, if they eat right. If they have their diet balanced right, I believe they can, but most people don't do that.
It's our culture ... our society in America. You just slam food into your mouth and keep running. The way the
government has made it, people have to work to live, and they don't take the time out for themselves. It's really a
labor of love. You really have to dedicate every day, commit, and I'm thinking about this right now . .. 'How can
I bring a lunch to work that's more nutritious?' . .. A lot of people don't have the time or energy to commit that
way." CA, White, supplement user, former food stamp recipient
Food preferences influence food choices that may not provide all the nutrients people need.
"No and that's why I think l need to eat my vitantins because l don't get enough. This food guide program of so
much ofthis and that. ... I don't follow it. I get three servings of fruits and vegetables out offive . . .. I an1lucky
that I like them. Even ifl try, I am not very precise with my servings, and that is why I think I don't get all the
nutrients I need." CA, Latina, supplement user, non-food stamp recipient
Food production techniques affect nutrient availability.
"No, the good stuff [food] is too expensive because they [retailers] know it's good. Sometimes when they grow it
with that .... I don't know how to explain it, I don't know all the terminology of it but for it to grow faster, it
doesn't have all its nutrients, [and] half the time when people buy it, they don't cook it right . ... " AR, White,
supplement user, former food stamp recipient
Certain health conditions might require people to take supplements.
"No ... sometimes it is good to take vitamins ... you go to the doctor and he prescribes for you how much you
must take and how often ... some people need to take more because they don't have enough of something or
they've become anemic ... . "NY, White, supplement user, non-food stamp recipient
"What comes to mind when you hear the word supplement?"
A supplement is a substitute or replacement for food.
"It's like a second thing ... that supplies ... it's a replacement I would think .... it's like the fruits and
vegetables; you can get better vitamins from them than pills, but sometimes when you can't take all the foods that
you need, you can take a pill ... ; it's not the best thing but it helps." AR, Latina, supplement user, non-food
stamp recipient
A supplement adds extra to the nutrients obtained from food.
"Something that gives you additional help, extra help .... it actually gives you more support for your body, the
necessary nutrients for your body because you don't have enough from the food." CA, Asian American,
nonsupplement user, non-food stamp recipient
There is uncertainty about the role or purpose of a supplement.
"It helps somehow [to] control the disease or something like that. ... It's for your memory, and you can go to
sleep easier. It's very good if that person is a woman and if she is pregnant .... [I]t is very good for her child . . .
and for the elderly. Oh, I don't know, I am not sure." CA, Asian American, nonsupplement user, non-food stamp
recipient
2002 Vol. 14 No. 2 25
Perceptions of Health Status
The participants were asked a series of
questions about what constitutes good
health, their perceived health status, and
any healthful or unhealthful activities
they engaged in. They were asked, "Do
you consider yourself to be healthy?"
(table 1). In general, the women
described health status along a
continuum of well-being, with roughly
equal numbers expressing these three
views: (1) they did not feel healthy,
(2) they were somewhat healthy but ·
could make changes to improve their
health, and (3) they were healthy.
The primary difference between the
non-food stamp recipients and the
current or former food stamp recipients
is that the latter group reported more
health problems, regardless of supple­ment
use. Some women said they were
not healthy because of chronic diseases
such as diabetes, hypertension, obesity,
asthma, and arthritis. Some also indi­cated
that they had epilepsy, anemia,
gastrointestinal problems, mental health
conditions related to depression, and
histories of substance abuse and
domestic violence.
Reasons for Using Nutrient
Supplements
Participants were asked whether they
consumed anything besides food, for
any reasons. Questioning was done to
probe for the range of possibilities of
supplement use. They were then asked
whether they took any vitamin or
mineral pills, and if they answered
"yes," they were asked what they took
(either generic or brand names were
offered), the dosage, and how often
they took the vitamin or mineral
supplement. They were also asked the
reason(s) for taking supplements, the
means by which they obtained them,
the estimated cost of the supplements,
how they were paying for them (e.g.,
out-of-pocket cash or insurance
reimbursement), and any other
26
information about dietary supplements
(e.g., herbs) that they and/or other
household members were taking.
The responses were categorized into
eight emergent themes that related to
1. Brands of supplements used by
adults
2. Supplement use by children
3. Reasons for use of single-nutrient
supplements
4. Dosage of supplements
5. Income constraints and patterns of
supplement use
6. Acquisition of supplements
7. Promotion of supplement use by
influential figures
8. Media influence on supplement use
Multivitamins/multiminerals were the
most common nutrient supplement
taken by the participants. Family
members usually took the same brand.
Some women and family members
took supplements with added nutrients
beyond a standard multivitamin
formulation.
Children were most often given either
multivitamins or nutrient supplements
containing specific micronutrients such
as vitamin C and zinc. Parents who did
not take supplements themselves often
ensured that their children took a daily
multivitamin.
"My husband doesn't [take
vitamins], but my kids take a
generic multivitamin with extra
vitamin C; ... off the top of
my head, I don't know [how
much vitamin C], but they
each take one of them. I just
assumed that it would be better
for them because they have so
many different choices, and
I just hear so much about
vitamin C being so important
for people ... that's why I
grabbed that one . . .. [I]t was
just something I thought they
needed, and of course, just
about everything I buy is
generic because when you are
on a low income like we are,
you have to stretch your dollars
as far as you can. Sometimes
it's hard, but I just thought .. .
they've all been healthy ... .
I've been pretty lucky." AR,
White, nonsupplement user,
current food stamp recipient
Single nutrient supplements were taken
either in addition to or instead of a
multivitamin and often for specific
reasons. Some women said it was
important to purchase a multivitamin
and mineral supplement if they thought
it would provide a positive benefit
such as improving their energy level,
managing stress, building up their
body reserves, preventing infections,
or managing chronic diseases. Some
participants were able to describe
why they were taking supplements as
illustrated in the example below. Others
were unable to describe clearly what
the supplements were supposed to do
for them.
"I take a lot of herbs. I take
Echinacea, calcium, magnesium
with zinc, and I take 1,000 mg
ofvitamin C every day. I [also]
take some beta-carotene."
[Interviewer: Why are you taking
the calcium, magnesium, and
zinc?] "Because it builds bones
.... I was a polio victim when I
was 3 months old and so I take it
to build up [my bones] ... and
then it's good for ... what do
you call it? Osteoporosis. The
vitamin C keeps colds out
because, as a diabetic, you can
contract anything quickly ....
[I]t stops the flu and colds and
stuff. I took it through the winter
and didn't have any problem.
AR, African American,
supplement user, non-food
stamp recipient
Family Economics and Nutrition Review
Table 1. Beliefs about personal health among food-stamp eligible women: "Do you consider yourself to be healthy?"
Perceived status
"I am not healthy . . . "
Illustrative statements
"Not me because I get so tired at the end of the day.
See, I work a lot, but I get so tired at the end of the day.
I don't know if this is normal. . . . It's like when my
husband come(s] home at night and he's trying even to
talk to me, I can't even open my eyes to talk to him."
"Oh, no, because I'm overweight. I've been that way
pretty much all my life, and I think it's not due to what
I eat. . .. it's because of what I like to do. I don't get
enough exercise, that's the biggest part. If I exercised,
I could be the size I wanted to be, but there never seems
to be enough time in my day to take that time out for me.
I eat stuff that's not considered healthy. I don't sit down
and eat junk food like potato chips, but I don't eat what
you would call good-for-you foods like fruits and vegetables.
We eat them, but I try to make it more a part of my kids'
[diet] than I do mine .... I think about them, but I don't
stop to think about myself."
"I am somewhat healthy . .. " "Yea, pretty much. I might contradict myself here because
I know that I'm overweight. ... I don't feel that it is
"I am healthy . . . "
2002 Vol. 14 No. 2
causing me to be really unhealthy where I am dragging ....
I could probably lose the weight and feel better."
"No, because I don't really eat right. I eat about one meal
a day sometimes, and then I will ... snack throughout
the day on chips and soda ... you know, junk food. I
don't eat right. . . . I consider myself to be somewhat
healthy . .. healthier than ... this is what I am trying to say.
If I took vitamins, I don't think that would change
anything ."
"Yea. I consider myself to be healthy. I eat the right types
of foods, I hardly ever get sick with the flu or anything
like that, and I exer.::ise."
"Yes ... I'm a little overweight, but it's okay .. . . I don't
have diabetes .... I haven't developed any of those
diseases. I don't have heart disease yet. I've been trying
real hard to keep it down. I'm trying to lose more weight."
Respondents' characteristics
NY, White, supplement user,
non-food stamp recipient
AR, White, nonsupplement user,
food stamp recipient
AR, Latina, supplement user,
food stamp recipient
CA, White, nonsupplement user,
food stamp recipient
AR, White, nonsupplement user,
food stamp recipient
NY, African American, supplement
user, food stamp recipient
27
" ... I thought I had ovarian
cancer but it was [endometriosis].
I'm starting to feel better now .. .
and I'm taking vitamins, which
I don't like to do . . .. I don't
like taking pills. I started 2
months ago. My nails are getting
stronger, I'm feeling healthier,
and my hair is growing faster.
I take them every day. I love it
because it is about $5 for a 30-
day supply. It's got the vitamin
E, the magnesium and zinc, the
herbal energy, and the rest of
them ... the value pack . .. . I
pay my own cash for them."
AR, White, supplement user,
former food stamp recipient
Many participants were not always
attentive to the dosage or brand of the
supplements taken: They admitted
taking less than what was recommended
or not taking the supplements daily.
Because these participants had limited
incomes, they wanted the supplements
to last longer.
"I take vitamin E for skin,
vitamin C, and calcium. On the
[vitamin E] bottle it says to take
one pill three times a day but I
only take one a day because I
can't afford to buy 'em for three
times a day." AR, African
American, supplement user,
current food stamp recipient
Most women living on limited incomes
either paid for supplements themselves,
received them through Medicaid or
MediCal when a prenatal multivitamin
or iron was prescribed, or received
them from friends or relatives who
would share their supplements or
purchase supplements for the partici­pants
when resources were low.
28
"The prenatal vitamins ...
when I ran out, I just didn't
take them [any] more .... They
gave them to me free at the
clinic ... through MediCal. ...
The kids take vitamin B,
vitamin C, and the little kid
vitamins .... I pay for them
out of my own pocket." CA,
African American,
nonsupplement user, food
stamp recipient
Friends, relatives, and/or physicians
most commonly recommended
supplements. Pharmacists, dentists,
and sales associates in health-food
stores were identified less frequently as
authorities encouraging supplement use.
No participant identified a nutritionist
or dietitian as a professional
recommending supplement use.
The media was cited less frequently
than were authoritative figures for
influencing supplement use and was
reported to have both a positive and
negative influence on women's use
of supplements. In some cases, the
media messages influenced them to try
something new. In other instances, the
media messages promoting supplement
use were disregarded, because the
woman questioned the benefit of the
products.
"I think they are just trying to
get you to buy the product ...
just like any commercial. For
some people, it might be a good
thing. I don't drink milk, so
maybe I could take some type
of calcium supplement. But if
you eat right and do everything
right, there is no need for that.
They just want your money."
CA, White, nonsupplement
user, current food stamp
recipient
One participant equated the side effects
of medications with the potential side
effects of nutrient supplements and
stated that she avoided them.
"Yea, we've seen [the TV
advertisements]. Well, they
show all those side effects ... ,
and that scares me . . . . [S]ide
effects scare me to death. I took
some antibiotics when I was
sick, and I had some real bad
side effects. [Interviewer: Is
that different from a vitamin?]
It's just the side effects that
scare me." AR, White,
nonsupplement user, current
food stamp recipient
Reasons Why Women Do Not
Take Nutrient Supplements
Several different themes were identified
to explain why women chose not to
take nutrient supplements. About one­quarter
of the participants believed it
was possible to get all the vitamins
and minerals one needs from food.
"I don't take any vitamins
because I get all the vitamins
I need from the fruits and
vegetables I eat." AR, White,
nonsupplement user, food
stamp recipient
Women and/or their children avoided
or discontinued supplement use for
reasons such as cost and the need to
prioritize expenses; side effects such
as nausea, dizziness, or constipation;
potential or perceived side effects;
and dislike of the taste by children.
"My kids will not take vitamins
.... [T]hey don't like the taste
. .. . [The vitamins] taste nasty
[or] have a funny taste ... . [I]t's
not like regular foods that you
can prepare differently." CA,
Latina, nonsupplement user,
current food stamp recipient
Family Economics and Nutrition Review
The women cited several reasons
for discontinued supplement use: a
multivitamin could overstimulate
the appetite, the supplements had
previously not produced the anticipated
effects, and for some women who
were already taking pills for medical
conditions, they did not want to take
more pills. A few did not think about
purchasing a multivitamin pill or
nutrient supplement while grocery
shopping.
The Use of Food Stamp Benefits
to Purchase Nutrient
Supplements
The responses of participants were
divided into two groups concerning the
use of food stamps to purchase nutrient
supplements (table 2). The first group
consisted of a minority of participants
who believed that food stamps should
be used only for food because (1) the
monthly food stamp allowance was not
adequate to meet a household's food
needs especially in large families,
(2) recipients should eat vegetables
or fruits rather than take pills, and
(3) a vitamin pill would not alleviate
hunger or promote satiation as food
could. The second group believed
certain circumstances deserved
consideration so that needy families
could purchase nutrient supplements.
Several themes were identified to
characterize the view of both food
stamp recipients and nonrecipients
who said it was a good idea to allow
recipients to purchase a multivitamin
and mineral pill with their food stamp
benefits because it might (1) assist them
in getting what they need nutritionally
while living on a low income; (2) help
parents save pocket money that could
be used toward something else such as
buying children's clothes or school
supplies; and/or (3) improve food
stamp recipients' overall health.
2002 Vol. 14 No.2
In Arkansas, three food stamp
recipients expressed that taking a
multivitamin would be less expensive
than buying fresh fruit. Although they
would have preferred to purchase fruit,
they believed that taking vitamin C
or a multivitamin would be the most
practical and least expensive alternative
for low-income families.
Some said that changing the FSP policy
was a good idea if recipients could not
buy healthful food. However, others
said it was a good idea because they
believed that food stamp recipients
generally do not eat healthful foods.
Other attitudes and beliefs shared
concerning the benefits of supplements
included these:
• Food stamp recipients should take
one multivitamin instead of several
vitamin or mineral pills.
• It is feasible to use food stamp
benefits for supplements if
recipient makes wise budgeting
decisions.
• Supplement use would depend on
the person or family situation.
• Supplement use could set a good
example for children and might
stimulate other healthful habits
such as buying more healthful
foods.
• It is easier to take a pill than to eat
healthful food.
• Food stamp recipients need to be
convinced of the benefit of taking
a multivitamin and mineral pill
regularly.
A few food stamp recipients suggested
that the government offer a special
coupon to families each month that
could be used to purchase a designated
supplement-similar to providing
specific WIC commodities-but if
recipients did not use the coupon, they
would lose the benefit.
Most women living on limited
incomes either paid for
supplements themselves,
received them through Medicaid
or MediCal ... , or received them
from friends or relatives ... when
resources were low.
29
Table 2. Food stamp-eligible women's perceptions regarding the use of food stamps to purchase nutrient supplements
Perceived status
Group 1
"Food stamps are for
food only because .. . "
Group 2
"Food stamps could be
used to purchase
nutrient supplements
because ... "
30
Illustrative statements
"I would rather buy food, because I get hungry and I need
to eat . .. I like to eat. [A vitamin and mineral pill] won't
do [anything] for me . .. . [T]he welfare office does not give
you enough food stamps to have that luxury to also buy
vitamins. I only get $230 for my two daughters, and they
are thinking that's enough for food for the whole month
and it [isn't]! You really don't have that much money
coming in to afford to buy that. You would rather have
your k·id eat food than a vitamin; .. . it would not be bad
if a person receiving food stamps also had more income
coming in if that is what they want to do."
"You buy vitamins automatically with food stamps,
because you're buying your fruits and your vegetables
and stuff like that ... so it's really the same thing ."
"It would help because then that money I spend on my
calcium, I could spend on something else. My kid
always needs socks and underwear ... he's growing so
fast .. .. Yea, I would probably [take] vitamins and
[my son] would [take] vitamins, but vitamins and stuff
like that are just outrageous. You just can't afford it!
[If money wasn't an issue], I would probably buy [vitamins]
to make sure I was getting what I was supposed to and what
my body really needed, so that my body wouldn't break
down, and I wouldn't have so many health problems."
"I think that would be great, because a lot of people out
there can't shop, and it would be just as easy to take a pill
to stay healthier. Many times I've been low on food stamps,
cooked for the kids, and went hungry .... I could have
used that vitamin supplement."
"I think a lot of your healthier foods are more expensive
.... [l]f you go to buy your fruits, other than bananas and
apples and oranges, when you start buying for a family of
seven, you're talking several bags of each. I think that to be
healthier, you are going to have to spend more .... I think
it's too expensive to eat what they should eat."
Respondents' characteristics
CA, White, nonsupplement user,
current food stamp recipient
NY, African American, supplement
user, current food stamp recipient
AR, White, supplement user, current
food stamp recipient
AR, White, nonsupplement user,
current food stamp recipient
AR, White, nonsupplement user,
current food stamp recipient
Family Economics and Nutrition Review
Perceived Drawbacks to Using
Food Stamps to Purchase
Nutrient Supplements
Several participants shared some
possible drawbacks to allowing food
stamp recipients to use their benefits to
purchase supplements. They believed
recipients might purchase supplements
but not take them, might not give their
children adequate food ifhousehold
resources were spent on a supplement,
might not be able to absorb the
nutrients from a pill or may be allergic
to the supplement, or might abuse the
FSP by selling food stamp benefits or
nutrient supplements for cash. They
also thought that allowing recipients to
purchase supplements might reinforce
the perception that food is not needed if
vitamins are substituted and that taking
too many or high doses of supplements
may be harmful.
Decision making About the
Use of Food Stamps
Participants were asked their opinion
regarding who should decide how food
stamps are used--either the government
or recipients. Three themes emerged:
they believed food stamp recipients
should decide, the government should
decide, or the government and people
should work together to decide. More
than half of the food stamp recipients
indicated that the people rather than the
government should decide how food
stamps are used. Many acknowledged,
however, that the government's position
would be more heavily weighted
because it provides the benefits.
Discussion
The FSP-supplement proposal, far from
being a simple policy change, brings
two relatively new concerns to the
foreground with respect to the goals
of the FSP: (1) Should the goals of the
2002 Vol. 14 No.2
FSP be broadened to include health
promotion beyond that associated with
achieving equity in food intake? A
related question is whether the supple­ment
proposal is an appropriate strategy
for doing so. (2) Given the high preva­lence
of supplement use in the general
population, should food stamp recip­ients
have the same level of choice as
the general population regarding how
they obtain their nutrients (i.e., via
foods or supplements)? A related
question is whether the current FSP
policy constrains such choice. This
latter question reveals a concern for
consumer autonomy as distinct from
equity or health promotion. Autonomy
has not been one of the stated goals
of the FSP; for example, current
regulations do not permit the use of
food stamps to purchase prepared
food away from home.
While equity, health promotion, and
autonomy all are implicated in this
issue, much of the debate has empha­sized
only one or another of these
goals and has not examined the actual
strength of the trade-offs among them.
The findings from the present study
are synthesized below, in order to
shed light on these policy questions.
As shown in figure 1, women in this
study appear to hold an overall
philosophy regarding nutrient supple­ments
that is shaped by their beliefs
concerning the nutritional adequacy
of food, the inadequacy of actual
behaviors, perceived benefits and
experiences, the concept of supple­ments
itself, and their current supple­ment
practices. This philosophy
appears to be malleable and/or
negotiable depending upon such
factors as degree of self-reflection, the
clarification of existing information or
addition of new information (especially
from influential interpersonal sources),
or changes in the participants' health
status or income. In a few cases in this
study where participants believed their
diet was adequate to provide them
with all the nutrients they needed,
their general philosophy appeared
less malleable.
The most plausible prediction to be
derived from these findings is that
nutrient supplement use will increase in
this population as long as the dominant
narrative in their personal information
networks and other influential sources
is positive toward using nutrient
supplements. Conversely, information
from national authorities-as reported
in the media or through programs such
as FSNEP or EFNEP-concerning
adverse events, lack of efficacy, or false
advertising claims is unlikely to reach
this population efficiently, although it
may do so after an indeterminate lag
time. Supplement use is predicted to
increase under both the existing FSP
policy and revisions in the policy,
although it is likely to be more rapid
and extensive under a changed FSP
policy.
Implications for Policy Goals
In attempting to relate these predictions
to equity in food access, health
promotion, and personal autonomy,
we find it necessary to consider the
potential effect of increased use of
nutrient supplements on total household
expenditures, on the quality offood
intake itself, and on other health-related
behaviors. Moreover, it is necessary to
examine more carefully the meaning of
autonomy in light of the information
asymmetries noted in the preceding
paragraph.
Effect on Food Access. With regard
to household expenditures, the expecta­tion
derived from household economics
is that expenditures for supplements
would reduce the income available
for all other expenditures by an equal
amount. That is, it would be subtracted
from the total household budget not
exclusively from the household food
31
Figure 1. Conceptual framework for food, health, and nutrient supplements among low-income, food stamp-eligible women
Beliefs
Adequacy of
Food Itse lf
(majority view)
Perceived Benefits and
Personal Experiences
(variable)
energy, immune function,
illness prevention, s ide
effects, hard to swallow,
oor taste, children
(u ecified reasons)
Inadequacy of Actual
Behavior (majority view) Concept of
"Suppleme nt"
fust-paced society, income,
food prererences, disease,
perceived health, other
health-promoting behaviors,
knowledge, processed foods
replace ment/substitute
(majority view),
addition'complement,
W1Ciear
Influences Self-reflection, existing information, new information,
influential sources, change in pe rsonal circumstances,
sociocultural influences
budget because only a fraction ofFSP
households (25 to 40 percent) currently
purchase their entire food supply with
food stamps (USDA, 1999). Most
(60 to 75 percent) augment their food
stamps with other income sources,
indicating a substitutability between
food and non-food expenditures, and
they must do so to an even greater
extent when they purchase supplements.
This is true regardless of whether food
stamps or cash is used to purchase the
supplements.
A high-end figure of $5/month ( 17
cents/day for a mother and two children
as used by USDA [1999] and the
average food stamp household of2.4
persons in 1999 [with $338/month net
income plus $162 in food stamps]), for
example, would represent a !-percent
decrease in income available for all
other expenditures. If all of this were
subtracted from non-food expenditures,
there may be no effect on food expendi­tures.
If all of it were subtracted from
food expenditures (which average $224/
32
month for FSP households), the effect
could be a 2.4-percent reduction ($5)
in food expenditures.
Using a different set of assumptions and
methods, USDA estimated a low-end
effect of26 cents/month and high-end
effect of94 cents/month (0.4 percent)
reduction. One of the major reasons for
this difference (compared with the
present estimates) is that the USDA
method averages the effect across all
FSP households; whereas, the present
method emphasizes the potential effects
on smaller subgroups (USDA, 1999).
Notwithstanding these large differences
among estimates in percentage terms,
effects of this size do not appear to
constitute a significant threat to food
access, especially since households
would retain the option of foregoing
supplements in favor of purchasing
food.
However, the policy change could
have more serious implications for food
access if it were to lead eventually to
Philosophy Regarding
Supplements
(often malleable)
changes in the way benefit levels are
calculated. Specifically, ifthe base
assumption for future Thrifty Food Plan
calculations is that nutrient supplements
can be used to meet some or all of a
FSP recipient's vitamin and mineral
requirements, especially for those that
are relatively expensive from food
alone such as folate, this could lead to
significant reductions in benefit levels
and, subsequently, food access. This is
not a minor policy consideration.
Effect on Health Promotion. In theory,
a change in the FSP policy could affect
recipients' health in several ways. A
benefit is that it could compensate for
or enhance the vitamin and mineral
intake of recipients who have un­healthful
diets. A drawback is that it
could compromise the quality offood
choices and intake because of the
belief that nutrient supplements are an
effective substitute for food. Reports by
the USDA and Life Sciences Research
Office address the former possibility
in considerable detail (Life Sciences
Family Economics and Nutrition Review
Research Office, 1998; USDA, 1999),
and the present study does not add
further insight into the findings.
However, the present study does
suggest the danger that greater supple­ment
use in this population may lead
to compromises in the quality of food
choices and intake-especially ifthere
is an implied government endorsement
of supplement use as a result of a
change in food stamp policy.
Implications for Autonomy. The
majority of study participants expressed
the view that food stamp recipients
should not only make their own choices
regarding supplement use (citing
normative as well as pragmatic reasons)
but also that the government should
create the circumstances that would
support recipients' choices. While these
reasons have strong support from the
perspective of ethics and welfare
economics, respectively, this study
also reveals some countervailing
considerations that demand equal
attention.
First is the documentation of a wide
range of misconceptions concerning the
purpose and role of a supplement, the
nature of its benefits, and the degree to
which the health benefits of food and
supplements are substitutable. Even if
there is no change in the current policy
regarding supplements, these mis­conceptions
deserve attention in current
nutrition education programs for low­income
populations. Second is the
documentation that this population is
likely to face significant information
asymmetries because of the nature of
their influential information sources,
and will be unable to discover hidden
quality defects on their own such
as lack of efficacy and adverse
consequences.
Both of these situations suggest a
middle ground in which food stamp
recipients could exercise autonomy in
decisionmaking, but government should
2002 Vol. 14 No.2
take effective steps to correct potential
information failures. Such steps would
need to include the following: design­ing
a clear and effective education
initiative regarding the use of nutrient
supplements; regulating labeling,
advertising, and other forms of pro­motion
based on the messages that are
targeted for and understood by this
population; and evaluating the extent
to which an implicit government
endorsement of multivitamin and
mineral supplement use (and its
associated promotion by the supple­ment
industry and retailers) is general­ized
by members ofthis population to
include higher doses and/or other forms
of dietary supplements. (This latter
possibility was not investigated directly
in this study.) Finally, a policy change
regarding supplements would require a
variety of administrative changes to
define eligible items; inform manu­facturers,
retailers, and consumers of
these rules; and monitor and enforce
compliance with these rules.
Strategies for Improving Food
and Nutrient Intakes
If promoting the health oflow-income
Americans beyond that required for
achieving equity is deemed a worthy
policy goal, attention should then focus
on the most effective and appropriate
strategies to do so. Previous discussions
have explicitly noted the logical fallacy
of assuming that the most effective
and appropriate strategy necessarily
involves supplements or even the FSP
itself (Life Sciences Research Office,
1998). Instead, this earlier analysis
considered supplements, fortification,
a variety of other incentives, and
promotional or enabling strategies to
improve food and nutrient intake to
promote good health among food stamp
recipients and low-income people in
general. But even this is only a partial
list of the potential strategies for
pursuing one of the core public health
goals as outlined in Healthy People
2010 (U.S. Department ofHealth and
Human Services [DHHS], 2000).
Investigating the larger food environ­ment
of food stamp recipients would
be appropriate for the purpose of pro­moting
health and other food-system
goals such as improving access to and
the quality of supermarkets, supporting
the capacity of institutions that serve
low-income groups to purchase fresh
produce from local farmers, and
expanding the ability to use electronic
benefit transfer cards at farmers'
markets or for community-supported
agricultural schemes. A systematic
examination of potential strategies
(and an effort to reconcile health, food
security and food-system goals pursued
by other government programs) does
not appear to have been undertaken.
Conclusions
One version of the FSP-supplement
policy dialogue maintains that a change
in FSP policy would give program
participants the same freedom to use
nutrient supplements that other
Americans have and improve their
health and nutritional status at a lower
cost than is possible through careful
food selection. A decision to change
the FSP policy based on this narrative
would greatly overestimate the benefits
associated with a multivitamin and
mineral supplement in a population
where nutrient deficiencies are rare.
It would overlook the potential for
negative consequences (i.e., decreasing
the intake of nutrient-dense foods),
and it would neglect the imperfections
and asymmetries in the information
available to food stamp recipients and
the cost of government actions required
to correct this class of market failures
effectively.
A decision to change FSP policy further
suggests that the net effect of pro­ceeding
with the policy change in the
33
absence of effective actions to correct
for these market failures would be to
shift some additional costs or risks onto
an already disadvantaged population
for the sake of little additional benefit,
thereby raising serious ethical concerns.
This study reveals the need to conduct
a more systematic examination of the
potential strategies for improving the
nutritional health of food stamp-eligible
households and the importance of using
a more complete list of criteria when
attempting to identify the most effective
and appropriate goals and strategies.
Acknowledgments
This research was funded through the
Food and Nutrition Research small
grants program sponsored by the
USDA Economic Research Service
and administered by the University of
California at Davis. We are grateful to
the Cooperative Extension staff in New
York City; Fort Smith, Arkansas; and
San Francisco, San Jose, and Oakland,
California, for their generous assistance
in conducting this study.
34
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2002 Vol. 14 No. 2 35
Arbindra P. Rima!, PhD
Southwest Missouri State University
2002 Vol. 14 No. 2
Factors Affecting Meat Preferences
Among American Consumers
This study analyzed socioeconomic and nutritional factors affecting consumers'
preferences for meatless meals and, specifically, meals with less red meat.
Consumers' preferences were influenced by geographical location, racial and
ethnic background, family composition, and household income. Although females
were not statistically different from males in their preference for red meat, they
generally preferred more meatless meals. Similarly, older respondents preferred
more meatless meals and less red meat than did younger respondents. Meat was
less preferred, as well, among American households in the highest income group.
Advanced educational level of the respondents positively influenced the prefer­ence
for meatless meals and meals with less red meat, and nutritional concerns
among consumers also had a significant influence. Notably, compared with
concerns for vitamins and minerals, concerns for cholesterol, fat, and sugar had a
stronger effect on the preference for less red meat. Data such as those presented
here can provide useful descriptions of the distribution of health-influencing
behavior in our population.
A mericans are consuming less
red meat such as beef and more
non-red meats such as poultry.
In 1999 the per capita consumption
of red meat was 117.7 pounds, an 11-
percent drop since 1970 (U.S. Depart­ment
of Agriculture [USDA], 2001a;
USDA, 2001b). Poultry consumption,
however, increased 102 percent during
the same period (up to 68.3 pounds per
person). In general, trends in consump­tion
of animal products during the last
30 years involve more use of poultry,
fish, lowfat milk, yogurt, and cheese
and less use of red meat, whole milk,
eggs, butter, and lard (USDA, 2001a).
Although the decrease in the consump­tion
of red meat has been compensated
by an increase in the consumption of
poultry to a certain degree, overall
consumption of red meat has declined.
Price, income, taste, and preferences
are the key variables affecting the levels
of meat consumption (Putnam &
Gerrior, 1997).
Differences in retail price between beef
and poultry may explain some of the
decline in the consumption of red meat.
For example, per pound prices of retail
beef and poultry have remained at an
average of$3.70 and $1.50, respec­tively
(Bureau ofLabor Statistics,
2001). Changes in income have rela­tively
little or even a negative effect on
the demand for red meat. For example,
a report on food spending in American
households in 1997-98 revealed that
higher income groups, compared with
the middle-income groups, decreased
their total spending on beef (Blisard,
2001).
Besides relative prices and income,
many other factors played key roles
in changing the demand for red meat.
According to a report by the U.S.
Department of Agriculture's (USDA)
Economic Research Service (ERS)
(Putnam & Allshouse, 2001 ), consumer
concern about cholesterol and saturated
fat, inconsistent quality, and lack of
36
convenience in preparation are associ­ated
with the negative trend in beef
demand. Increasingly, associations
between consumption of red meat and
the onset of chronic disease have been
reported. Examples include links
between (1) metastatic prostate cancer
and intakes of red meat and dairy
products (Michaud et a!., 200 I) and
(2) colon and other types of cancer
and high consumption of red meat
combined with low intakes of dietary
fiber, fruits, and vegetables (Law,
2000).
Additional research has shown that
people reduce their risk for colon
cancer when they substituted lowfat
dairy products for high-fat versions,
margarine for butter, poultry for red
meat, and whole grains for refined
grains (Slattery, Boucher, Caan, Potter,
& Ma, 1998). These findings exemplify
the enormous body ofliterature linking
patterns of overall dietary intake with
increased risk for cancer and other
chronic diseases.
Specific dietary patterns that begin
during childhood-such as the con­sumption
of high-fat dairy products
and red meats-are likely to increase
age-specific rates of cancer and other
diseases in adult life; however, the risk
may be reversed with later dietary
change. For example, a reverse in
childhood dietary patterns is demon­strated
by more younger Americans
becoming vegetarians. About 15
percent of the 15 million U.S. college
students eat vegetarian meals during a
typical day (Walker, 1995). In a similar
study of 158 British undergraduate
students, more females than males had
avoided red meat. The main reason
given was related to concerns for health
and sensory factors (Santos & Booth,
1996).
Our study analyzed socioeconomic and
nutritional factors affecting consumers'
preferences for meatless meals and,
2002 Vol. 14 No.2
Table 1. Change in consumption of meatless meals and red meats
Response
"You are eating more
meatless meals than
you used to"
"You are eating less
beef, pork, or lamb than
you used to"
Strongly disagree
Somewhat disagree
Neither agree nor disagree
Somewhat agree
Strongly agree
n = 2,880.
specifically, meals with less red meat.
Nutritional concerns related to meat
were examined. A regression analysis
was performed to identify statistically
significant socioeconomic and demo­graphic
characteristics, as well as
nutritional concerns influencing
consumer preference.
Methods
Data and Sample
34.97
19.57
7.84
15.36
22.26
The data set used in this study was part
of a nationwide telephone survey of
2,880 U.S. households conducted by
the Gallup Organization in 1997 for the
National Peanut Association (National
Peanut Council, 1997). The survey
used a probability sampling method
and included adults onl