Family Economics and Nutrition Review [Volume 9, Number 3]

              CENTER FOR NUTRITION POLICY AND PROMOTION
2 Expenditures on Children by Families, 1995
MarkLino
Joanne F. Guthrie
Research Summaries
SO The American Diet: Health and Economic Consequences
53 Influence of OASDI and SSI Payments on Poverty Status
of Families With Children
56 Improving Federal Efforts to Assess Hunger and Food Insecurity
58 Umited Financial Resources Constrain Food Choices
Regular Items
60 Charts From Federal Data Sources
62 Recent Legislation Affecting Families
63 Research and Evaluation Activities in USDA
65 Data Sources
66 Journal Abstracts
Poverty Thresholds
Cost of Food at Home
Consumer Prices
Dan Glickman, Secretary
U.S. Department of Agricultu re
Ellen Haas, Under Secretary
Food. Nutri tion, and Consumer Services
Eileen Kennedy, Executive Director
Center for Nutrition Policy and Promotion
Jay Hirschman, Director
utrition Policy and Analysis Staff
Editorial Board
Mohamed Abdei-Ghany
University of Alabama
Rhona Applebaum
0/ational Food Processors Association
Johanna Dwyer
ew England Medical Center
Jean Mayer USDA Human utrition Research Center
on Aging at Tufts University
Helen Jensen
Iowa State University
Janet C. King
\Ve~tern Human Nutrition Research Center
U.S. Department of Agriculture
C. J. Lee
Kentucky State University
Rebecca Mullis
Georgia State ·Univ.ersi ty
Suzanne Murphy
University of California-Berkeley
Donald Rose
Economic Research Service
U.S. Department of Agriculture
Ben Senauer
University of Minnesota
Laura Sims
University of Maryland
Retia Walker
Universi ty of Kentucky
Editor
Joan C. Courtless
Managing Editor
Jane W. Fleming
Family Economics and Nutrition Review is
written and published each quarter by the
Center for Nutrition Policy and Promotion,
U.S. Department of Agriculture, Washington, DC.
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oc1nc1 1v1 '"uu1uun r-u11cy ana t"romotlon
Feature Articles
2
21
33
Expenditures on Children by Families, 1995
MarkLino
Assessment of Energy Intakes in the U.S. Population, 1989-91
Howard Riddick
Dietary Patterns and Personal Characteristics of Women
Consuming Recommended Amounts of Calcium
Joanne F. Guthrie
Research Summaries
50 The American Diet: Health and Economic Consequences
53 Influence of OASDI and SSI Payments on Poverty Status
of Families With Children
56 Improving Federal Efforts to Assess Hunger and Food Insecurity
58 Limited Financial Resources Constrain Food Choices
Regular Items
60
62
63
65
66
67
68
69
Charts From Federal Data Sources
Recent Legislation Affecting Families
Research and Evaluation Activities in USDA
Data Sources
Journal Abstracts
Poverty Thresholds
Cost of Food at Home
Consumer Prices
Volume 9, Number 3
1996
I
2
Feature Articles
Expenditures on Children
by Families, 1995
By Mark Lino
Economist
Center for Nutrition Policy and Promotion
Since 1960, the U.S. Department of Agriculture has provided estimates of
expenditures on children from birth through age 17. This article presents
the most recent estimates for husband-wife and single-parent families using
data from the 1990-92 Consumer Expenditure Survey, updated to 1995 dollars
using the Consumer Price Index. Data and methods used in calculating
child-rearing expenses are described. Estimates are provided for major
components of the budget by age of child, family income, and region of
residence. Expenses on the younger child in a two-child, husband-wife
household for the overall United States averaged between $5,490 and
$12,550 per year, depending on the child's age and family income group.
Adjustment factors for number of children in the household are also
provided. Results of this study can be used in developing State child
support guidelines and foster care payments as well as in family
educational programs.
[]]
ince 1960, the U.S. Depart­ment
of Agriculture (USDA)
has provided estimates of
expenditures on children
from birth through age 17. These esti­mates
are used in setting child support
guidelines, foster care payments, and
in educational programs on parenthood.
This study presents the latest child­rearing
expense estimates, which are
based on 1990-92 expenditure data
updated to 1995 dollars. The study
presents these new estimates for husband­wife
and single-parent families. It briefly
describes the data and methods used in
calculating child-rearing expenses 1 and
then discusses the estimated expenses.
The estimates are provided for the United
States overall. To partially adjust for
price differentials and varying pattetns
of expenditures, the child-rearing
expense estimates for husband-wife
families are also provided for urban
areas in four regions (Northeast, South,
Midwest, and West) and rural areas
throughout the United States.2 For
single-parent families, estimates are
1The report "Expenditures on Children by Families:
1995 Annual Report" provides a more detailed
description of the data and methodology. To obtain
a copy, contact: USDA, Center for Nutrition Policy
and Promotion, 1120 20th Street NW, Suite 200
North Lobby, Washington, DC 20036 (Telephone
Number: 202-208-2417).
2Urban areas are defined as Metropolitan Statistical
Areas (MSA' s) and other places of 2,500 or more
people outside an MSA; rural areas are places of
less than 2,500 people outside an MSA.
Family Economics and Nutrition Review
Categories of Household Expenditures
Housing expenses include 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, major
appliances, and small appliances). It should be noted that for homeowners, housing expenses do not include mortgage principal
payments; such payments are considered in the Consumer Expenditure Survey to be part of savings. So, total dollars allocated to
housing by homeowners are underestimated in this report.
Food expenses include 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 include the net outlay on purchase of new and used vehicles, vehicle finance charges, gasoline and
motor oil, maintenance and repairs, insurance, and public transportation.
Clothing expenses include 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 include medical and dental services not covered by insurance, prescription drugs and medical supplies
not covered by insurance, and health insurance premiums not paid by employer or other organization.
Child care and education expenses include day care tuition and supplies; baby-sitting; and elementary and high school tuition,
books, and supplies.
Miscellaneous expenses include personal care items, entertainment, and reading materials.
provided only for the United States over­all
because of sample size limitations.
Expenditures on children are estimated
for the major budgetary components:
The CE has been conducted annually
since 1980 and interviews about 5,000
households each quarter over a 1-year
period. Each quarter is deemed an inde­pendent
sample by BLS, bringing the
total number of households in the 1990-
92 survey to about 60,000.
major sources of income, such as wages
and salaries, self-employment income,
and Social Security income. Quarterly
expenditures were annualized. The
sample consisted of 12,850 husband­wife
households and 3,395 single­parent
households and was weighted
Housing, food, transportation, clothing,
health care, child care and education,
and miscellaneous goods and services.
The box shown above describes each
expenditure component.
Source of Data
Data used to estimate expenditures on
children are from the 1990-92 Consumer
Expenditure Survey (CE), administered
by the Bureau of Labor Statistics (BLS).
The CE collects information on socio­demographic
characteristics and income
of households as well as expenditures.
From these households, husband-wife
and single-parent families were selected
for this study if: ( 1) they had at least
one child of their own, age 17 or under,
in the household, (2) they had six or
fewer children, (3) there were no other
related or unrelated people present in
the household except their own children,
and (4) they were complete income
reporters. Complete income reporters
are households that provide values for
to reflect the U.S. population of interest,
using BLS weighting methods. Although
based on 1990-92 data, the expense
estimates were updated to 1995 dollars
using the Consumer Price Index (CPI-U)
(1990 and 1991 expenditure and income
data were first converted to 1992 dollars;
then all 3 years of data were updated to
1995 dollars).
1996 Vol. 9 No.3 3
Methodology
The CE collects overall household
expenditure data for some budgetary
components (housing, food, transporta­tion,
health care, and miscellaneous
goods and services) and child-specific
expenditure data for other components
(clothing, child care, and education).
Multivariate analysis was used to
estimate household and child-specific
expenditures, controlling for income
level, family size, and age of the
younger child so estimates could be
made for families with these varying
characteristics. Regional estimates were
derived by controlling for region. The
three income groups of husband-wife
households (before-tax income under
$31,000, between $31,000 and $52,160,
and over $52,160 in 1992 dollars) were
determined by dividing the sample for
the overall United States into equal
thirds.
For each income level, the estimates
were for husband-wife families with
two children, with the younger child in
one of six age categories (0-2, 3-5, 6-8,
9-11, 12-14, and 15-17 years). House­holds
with four members (two children)
were selected as the standard since this
was the average size of two-parent families
in 1990-92. The focus was on the younger
child in a household since the older
child was sometimes over age 17.
It should be noted that the estimates are
based on CE interviews of households
with and without specific expenses; so
for some families, expenditures may be
higher or lower than the mean estimates,
depending on whether they incur the
expense or not. This particularly applies
to child care and education for which
about 50 percent of families in the study
had no expenditure. Also, the estimates
only cover out-of-pocket expenditures
on children made by the parents and not
4
by others such as grandparents or friends.
For example, the value of clothing gifts
to children from grandparents would
not be included in clothing expenses.
On the other hand, some of the expendi­tures
reported by parents may be gifts
for children other than their own.
Regional income categories are based
on the national income categories in 1992
dollars, updated to 1995 dollars using
regional CPI' s. The regional income
categories are not divided into equal
thirds for each region. As previously
mentioned, the three income categories
were calculated for the overall United
States by dividing the sample into equal
thirds.
After the various overall household
and child-specific expenditures were
estimated, these total amounts were allo­cated
amo~'g the four family members
(husband, wife, older child, and younger
child). The estimated expenditures for
clothing and child care and education
were only for children. It was assumed
that these expenses were equally allo­cated
to each child so the estimated
expenditures were divided by two (the
number of children in the household).
Because the CE did not collect expendi­tures
on food and health care by family
member, data from other Federal studies
were used to apportion these budgetary
components to children by age. Food
budget shares as a percentage of total
food expenditures, for the younger child
in a husband-wife household with two
children, were determined using the
1994 USDA food plans (8). These
shares were estimated by age of the
child and household income level. The
food budget shares were then applied to
estimated household food expenditures
to determine food expenses on children.
Health care shares as a percentage of
total health care expenses for the younger
child in a husband-wife household with
two children were calculated from the
1987 National Medical Expenditure
Survey (NMES) (5). These shares were
estimated by age of the child and applied
to estimated household health care
expenditures to determine expenses
on children.
Unlike food and health care, no research
base exists for allocating estimated
household expenditures on housing,
transportation, and miscellaneous goods
and services among individual house­hold
members. Two of the most common
approaches for allocating 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.
The method depends on development of
an equivalency measure; however, there
is no universally accepted measure.
Various methods have been proposed,
each yielding different estimates of
expenditures on children.3 Some of the
marginal cost approaches assume that
parents do not alter their expenditures
on themselves after a child is added to a
household. In addition, couples without
children often buy homes larger than
they need at the time of purchase in
anticipation of children. Comparing the
expenditures of these couples to similar
couples with children could lead to
underestimates of expenditures on
children.
3For a review of equivalency measures and
estimates of expenditures on children resulting
from them, see U.S. Department of Health and
Human Services, Administration for Children and
Families, 1990, Estimates of Expenditures on
Children and Child Support Guidelines ( 10).
Family Economics and Nutrition Review
For these reasons, the USDA uses the
per capita method to allocate housing,
transportation, and miscellaneous goods
and services among household members.
The per capita method simply allocates
expenses among household members in
equal proportions. Although the per capita
method has its limitations, these limita­tions
were considered less severe than
those of the marginal cost approach.
A major limitation of the per capita
method is that expenditures for an
additional child may be less than average
expenditures. Because of this, adjust­ment
formulas for cases of one child or
three or more children were devised for
use when estimating expenditures on
children for households of different
sizes. These formulas are discussed
later on. Transportation expenses result­ing
from employment activities are not
related to expenses on children, so these
costs were excluded from the estimated
household transportation expenses
using data from a 1990 study by the
U.S. Department of Transportation ( 11 ).
Although the USDA utilizes the per
capita approach rather than a marginal
cost approach in allocating housing,
transportation, and miscellaneous
expenditures to children in a household,
a USDA study (6) examined how these
expenses would be allocated using
different marginal cost approaches.
These approaches produced estimates
of expenditures on children for housing
and miscellaneous goods and services
below-and estimates of transportation
expenditures on children above-those
produced by the per capita method.
1996 Vol. 9 No.3
Figure 1. Estimated 1995 annual family expenditures on a child,
by before-tax income level and age of child1
Dollars
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
0-2 3-5 6-8 9-11 12-14 15-17
Age of child
0 Less than $33,700 • $33,700- $56,700 • More than $56,700
1U.S. average for the younger child in husband-wife families with two children.
Estimated Expenditures on
Children by Husband-Wife
Households
Estimates of family expenditures on
the younger child in husband-wife
households with two children for the
overall United States, urban regions
of the country, and overall rural areas
are presented in tables 2 through 7 on
pp. 14-20. Income levels of households
were updated to 1995 dollars using
the all-items category of the CPI-U, and
expenditures were updated using the
CPI for the corresponding item (that
is, the CPI's for housing, food, etc.).
Regional estimates were updated to
1995 dollars using the regional CPI's.
Given the large amount of information
in the tables, the following subsections
highlight the child-rearing expense
estimates for the younger child in a
two-child household for the overall
United States by income level, budget­ary
component, and age of the child, as
well as expense estimates by region.
Income Level
Estimated expenses on children vary
considerably by household income level
(fig. 1). Depending on age of the child,
the annual expenses range from $5,490 to
$6,560 for families in the lowest income
group (1995 before-tax income less
than $33,700), from $7,610 to $8,710
for families in the middle-income group
(1995 before-tax income between
$33,700 and $56,700), and from $11 ,320
to $12,550 for families in the highest
5
6
As a proportion of
total child-rearing
expenses, housing
accounts for the
largest share ...
income group (1995 before-tax income
more than $56,700). On average, house­holds
in the lowest group spend 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
income group, 14 percent. The range
in these percentages would be narrower
if after-tax income were considered,
since a greater proportion of income in
higher income households goes toward
taxes.
Although families in the highest income
group spend slightly less than twice the
amount that families in the lowest income
group spend on a child, on average, the
amount varies by budgetary component.
In general, expenses on a child for goods
and services considered to be necessities
(such as food and clothing) do not
vary as much as those considered to
be discretionary (such as miscellaneous
expenses) among households in the
three income groups. For example,
clothing expenses on a child age 15-17
average $670 in the lowest income group
and $1,010 in the highest income group,
a 51-percent difference. Miscellaneous
expenses on the same age child average
$560 in the lowest income group and
$1 ,420 in the highest income group, a
154-percent difference.
Budgetary Component
As a proportion of total child-rearing
expenses, housing accounts for the
largest share; figure 2 shows this for
families in the middle-income group.
Based on an average for the six age
groups, housing accounts for 33 percent
of child-rearing expenses for a child in
Figure 2, Estimated family expenditures on a child through age
17, by budgetary share 1
Transportation 15%
Clothing
Health
care
and
education
Housing
Miscellaneous
Total Expenditures in 1995 dollars= $145,320
1 Estimates are for the younger child in middle-income (1995 before-tax income between
$33,700 and $56,700), husband-wife families with two children.
Family Economics and Nutrition Review
Figure 3. Estimated 1995 annual family expenditures on a child, by age and budgetary share 1
Percent
$7,610 $7,810 $7,870 $7,860 $8,580 $8,710
100
Miscellaneous
Child care & education
80 Clothing
Health care
60 Transportation
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 (1995 before-tax income between $33,700 and $56,700), husband-wife families with two
children.
the lowest and middle-income groups
and 37 percent in the highest income
group. Food is the second largest average
expense on a child for families regard­less
of income level, accounting for
20 percent of child-rearing expenses
for a child in the lowest income group,
18 percent in the middle-income group,
and 15 percent in the highest income
group. Transportation is the third largest
child-rearing expense, making up 14 to
15 percent of child-rearing expenses
across income levels.
Miscellaneous goods and services
(personal care items, entertainment, and
reading materials) is the fourth largest
expense on a child for families in all
income groups. Clothing accounts for
6 to 8 percent of expenses on a child
for families in the three income groups.
1996 Vol. 9 No.3
These estimates of children's clothing
expenses do not include clothing received
in the form of gifts or hand-me-downs.
Child care and education are 7 to 10
percent and health care, 5 to 7 percent
of child-rearing expenses across income
groups. For health care, these estimated
expenditures include only out-of-pocket
expenses and not that portion covered
by health insurance.
Age of Child
Expenditures on a child are lower in
the younger age categories and higher
in the older age categories. This held
across income groups (fig. 3 depicts
this for families in the middle-income
group) even though housing expenses,
the highest child-rearing expenditure,
generally decline as the child grows
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 part of savings.
Child-rearing food, transportation,
clothing, and health care expenses
generally increase over the age of a
child for all three income groups.
Transportation expenses are highest
for a child age 15-17, when he or she
would start driving. Child care and
education expenses are highest for a
child under age 6. Most of this expense
may be attributable to child care at this
age. The estimated expense for child
care and education may seem low for
those with the expense. However, as
previously discussed, the estimates
reflect the average of households with
and without the expense.
7
Region
Child-rearing expenses in the various
regions of the country reflect patterns
observed in the United States overall.
In each region, expenses on a child
increase with income level of the house­hold
and, generally, with age of the child.
Overall child-rearing expenses are
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 are lowest in the urban
Midwest and rural areas. Much of the
difference in expenses on a child among
regions is related to housing costs. Total
housing expenses on a child are highest
in the urban West and urban Northeast
and lowest in rural areas. However,
child-rearing transportation expenses
are highest for families in rural areas.
This likely reflects the longer distances
that must be traveled and the lack of
public transportation in these areas.
Adjustments for Older Children
and Household Size
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.
Expenses may vary by birth order. To
determine whether a difference exists,
the extent of this difference, and how
the expenditures may be adjusted to
estimate expenses on an older child,
the method described on pp. 4-5 was
repeated, with the focus being on the
older child in each of the same age
categories as used with the younger
child. A family with two children was
again used as the standard. Household
income and region of residence were
not held constant, so fmdings are
applicable to all families.
8
Figure 4. Estimated 1995 annual family expenditures on a child,
by region and age 1
Dollars
10,000
9,500
9,000
8,500
8,000
7,500
7,000
6,500
-A -
0
A
0
0
0·2 3·5 6-8 9-11 12-14 15-17
Age of child
Urban Midwest
. -11--
Rural Urban South Urban Northeast Urban West
"" --4- -->!<- n
1U.S. average for the younger child in middle-income, husband-wife families with two children.
For the urban West, the middle-income group had a 1995 before-tax income between $33,500
and $56,400; for the urban Northeast, between $33,500 and $56,300; for the urban South,
between $33,800 and $56,900; for the urban Midwest, between $33,800 and $56,900; and
for rural areas, between $34,000 and $57,200.
It was found that, on average, husband­wife
households with two children spend
about the same amount on a younger
and older child (except for differences
caused by age). So, the figures in tables
2 through 7 reflect expenditures on
either child in a two-child family. 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. For
example, annual expenditures on children
ages 9-11 and 15-17 in a husband-wife
family in the middle income group for
the overall United States would be
$16,570 ($7,860 + $8,710). It should
be noted that for specific budgetary
components, annual expenses on an
older child vary, compared with those
on a younger child. Families spend
more on clothing and education for an
older child, but less on transportation.
The estimates should also be adjusted if
a household has only one child or more
than two children. Families will spend
more or less on a child depending on
the number of other children in the
household and economies of scale. To
derive these adjustments, multivariate
analysis was used to estimate expendi­tures
for each budgetary component
controlling for household size and age
of the younger child, but not household
income level and region of the country,
so the results are applicable to all families.
Family Economics and Nutrition Review
Expenditures on Children Over Time
Since 1960, the U.S. Department of Agriculture (USDA) has been providing estimates of
expenditures on children from birth through age 17. The original estimates were based
on the 1960 Consumer Expenditure Survey. The figure below examines how these
expenditure estimates have changed over time at 5-year intervals. Depicted are the
average total expenditures on a child from birth through age 17 in a middle-income
husband-wife family. Expenditures are in nominal (not adjusted for inflation) dollars.
Expenses to raise a child to age 18 have dramatically increased, from $25,230 in
1960 to $145,320 in 1995. Even when adjusted for inflation and converted into 1995
dollars, real expenditures on children have risen-from approximately $129,900 in
1960. Among factors causing this increase are new components of child-rearing
costs, particularly child care. In 1960, child care expenses were negligible as many
mothers were not in the labor force. In 1995, child care expenses were among the largest
expenditures made on preschool children by middle-income families.
The original intent of USDA's research on expenditures on children was primarily
educational: expenditure estimates on child-rearing were to be used in financial planning
guides and budgeting programs. Although still used for this purpose, the child-rearing
expense estimates have gained new applications, such as in developing State child
support guidelines and foster care payments. These new uses of the child-rearing
expense estimates reflect the changing structure of families with children in the
United States and thus, the importance of the ongoing nature of this area of research.
Total expenditures on a child for the first 18 years of life1
1
Not adjusted
for inflation
$160,000
140,000
120,000
100,000
80,000
60,000
40,000
20,000
$145,320
0 L-------------~--------------------------
1960 65 70 75 80 85 90 95
Average expenditures for a middle-income husband-wife family, not adjusted for inflation.
1996 Vol. 9 No.3
These expenditures were then assigned
to a child using the method previously
described. Compared with expenditures
·for each child in a husband-wife, two-child
family, husband-wife households
with one child spend an average of 24
percent more on the single child, and
those with three or more children spend
an average of 23 percent less on each
child.
Therefore, to adjust the figures in tables
2 through 7 to estimate annual overall
expenditures on an only child, 24 percent
should be added to the total expense
for the child's age category. To estimate
expenditures on three or more children,
23 percent should be subtracted from
the total expense for each child's age
category, and these totals should be
summed. As an example of adjustments
needed for different numbers of children,
the total expenses for a middle-income
family in the overall United States on a
child age 15-17 with no siblings would
be $10,800 ($8,710 x 1.24) and the total
expenses on three children ages 3-5,
12-14, and 15-17 would be $19,330
(($7,810 + $8,580 + $8,710) x .77). For
a particular budgetary component, the
percentages may be more or less. As
family size increases, costs per child
for food decrease less than for housing
and transportation.
Expenditures by Single-Parent
Families
The estimates of expenditures on children
by husband-wife families do not apply
to single-parent families, which account
for an increasing percentage of families
with children. Therefore, separate
estimates of child-rearing expenses in
single-parent households were made
using the CE data. Most single-parent
families in the survey (90 percent) were
headed by a woman.
9
The method used in determining
child-rearing expen es for two-parent
households was followed. Multivariate
analysis was u ed to estimate expendi­tures
for each budgetary component,
controlling for income level, household
size (a single parent with two children
was used as the tandard), and age of
the younger child (the same age categories
as u ed with children in two-parent
families).
Income group of single-parent house­holds
(before-tax income under $31,000
and $31 ,000 and over in 1992 dollars;
these income groups were inflated to
1995 dollars in the table) were selected
to correspond with the income groups
used in estimating child-rearing expendi­tures
in husband-wife households.
This income includes child support
payments. The two higher income
groups of two-parent families (income
between $31 ,000 and $52, 160 and over
$52,160 in 1992 dollars) were combined
because only 17 percent of single­parent
households had a before-tax
income of $31 ,000 and over. The
sample was weighted to reflect the
U.S. population of interest.
Children's clothing and child care and
education expenditures were divided
between the two children in the one­parent
household. For food and health
care, household member shares were
calculated for a three-member house­hold
(single parent and two children,
with the younger child in one of the
six age categories) using the USDA
food plans and the 1987 NMES findings.
These shares for the younger child in a
single-parent family were then applied
to estimated food and health care expendi­tures
to determine expenses on the
younger child in each age category.
10
Housing, transportation, and miscellaneous
expenditures were allocated among
household members on a per capita
basis. Transportation expenses were
adjusted to account for nonemployment­related
activities in single-parent families.
Income and expenses were updated to
1995 dollars.
Child-rearing expense estimates for
single-parent families are in table 8,
p. 20. For the lower income group (1995
before-tax income less than $33,700), a
comparison of estimated expenditures
on the younger child in a single-parent
family with two children with those of
the younger child in a husband-wife
family with two children is presented
in table 1, p. 12; as previously discussed,
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
fell in the bottom range of this lower
income group. Average income for
single-parent families in the lower
income group is $14,100, compared
with $21 ,000 for husband-wife families
in this income group. However, total
expenditures on a child through age 17
are, on average, only 5 percent lower
in single-parent households than in
two-parent households.
Single-parent families in this lower
income group, therefore, spend a larger
proportion of their income on children.
On average, housing expenses are
higher, whereas transportation, health
care, child care and education, and
miscellaneous expenditures on a child
are lower in single-parent than in
husband-wife households. Child­related
food and clothing expenditures
are similar, on average, in single-parent
and in two-parent families.
... total expenditures
on a child through
age 17 are, on average,
only 5 percent lower
in single-parent
households than
in two-parent
households.
Family Economics and Nutrition Review
Estimating Future Costs
The estimates presented in this study represent household expenditures on a child of a certain age in 1995. To estimate these
expenses for the first 17 years, future price changes need to be incorporated in the figures. To do this, a future cost formula is
used such that:
CJ = Cp(J + i)n
where:
CJ = projected future annual dollar expenditure on a child of a particular age
Cp = present ( 1995) annual dollar expenditure on a child of a particular age
i =projected annual inflation (or deflation)
n = number of years from present until child will reach a particular age
An example of estimated future Estimated annual expenditures on a child born in 1995, by income group1
expenditures on the younger child
in a husband-wife family with two Income group
children for each of the three income Year Age Lowest Middle Highest
groups for the overall United States
is presented. The example assumes
a child is born in 1995, reaching 1995 <1 $5,490 $7,610 $11,320
age 17 in the year 2012, and the 1996 1 5,790 8,020 11,930
average annual inflation rate over 1997 2 6,100 8,450 12,580
this time is 5.4 percent (the average 1998 3 6,570 9,140 13,510
annual inflation rate over the past
1999 4 6,920 9,640 14,240
20 years) (9). As can be seen, total
family expenses on a child through 2000 5 7,300 10,160 15,010
age 17 would be $176,420, $238,840, 2001 6 7,870 10,790 15,770
and $346,980 for households in the 2002 7 8,290 11 ,370 16,620
lowest, middle-, and highest income 2003 8 8,740 11 ,990 17,520
groups, respectively. In 1995 dollar
2004 9 9,260 12,620 18,350
values, these figures would be
$106,890, $145,320, and $211 ,830. 2005 10 9,760 13,300 19,340
2006 11 10,290 14,020 20,380
Inflation rates other than 5.4 percent 2007 12 12,330 16,130 23,060
could be substituted into the formula 2008 13 13,000 17,000 24,310
if projections of these rates vary in the
2009 14 13,700 17,920 25,620
future. Also, it is somewhat unrealistic
2010 15 14,220 19,170 27,620
to assume that households remain in
one income category as a child grows 2011 16 14,990 20,210 29,110
older. For most families, income rises 2012 17 15,800 21 ,300 30,690
over time. In addition, such projections Total $176,420 $238,840 $346,980
assume child-rearing expenditures
change only with inflation, but parental I Estimates are for the younger child in husband-wife families with two children for the overall United
expenditure patterns also change over States.
time.
1996 Vol. 9 No. 3 11
Table 1. A comparison of estimated 1995 expenditures on a child by
lower income single-parent and husband-wife families1
Single-parent Husband-wife
Age of child households households
0-2 $4,650 $5,490
3-5 5,220 5,610
6-8 5,900 5,740
9- 11 5,510 5,770
12- 14 5,940 6,560
15- 17 6,640 6,460
Total (0 - 17) $101,580 $106,890
1Estimates are for the younger child in two-child families in the overall United States with 1995 before­tax
income less than $33,700.
For the higher income group of single­parent
families (1995 before-tax income
of $33,700 and over), child-rearing
expense estimates are about the same
as those for two-parent households in
the before-tax income group of $56,700
and over; total expenses for the younger
child through age 17 are $213,240 for
single-parent families versus $211,830
for husband-wife families in 1995 dollars.
Child-rearing expenses for the higher
income group of single-parent families,
therefore, also consume a larger propor­tion
of income than in husband-wife
families. It appears that expenditures
on children do not differ very much
between single-parent and husband-wife
households. What differs is household
income levels. As single-parent families
have one less potential earner, on average,
their total household income is lower and
child-rearing expenses are a greater
percentage of this income.
Estimates only cover out-of-pocket child­rearing
expenditures made by the parent
with primary care of the child and do
not include child-related expenditures
12
made by the parent without primary
care or others, such as grandparents.
Such expenditures could not be estimated
from the data. Overall expenses by both
parents on a child in a single-parent
household are likely greater than this
study's estimates.
To determine the extent of the difference
in expenditures on an older child in
single-parent households, the previous
procedure was essentially repeated with
the focus being on the older child. A
family with two children was used as
the standard. On average, single-parent
households with two children spend
7 percent less on the older than on the
younger child (in addition to differences
caused by age). This contrasts with
husband-wife households that spend
about the same amount on the older
and younger child.
As with husband-wife households, more
or less is spent if a single-parent house­hold
has only one child or three or more
children. To determine these differences,
multivariate analysis was used to
estimate expenditures for each budget­ary
component controlling for house­hold
size and age of the younger child.
These expenditures were then assigned
to a child using the previous method.
Compared with expenditures for the
younger child in a single-parent, two­child
family, single-parent households
with one child spend an average of 35
percent more on the single child, and
those with three or more children spend
an average of 28 percent less on each
child.
Other Expenditures on Children
Expenditures on a child estimated in this
study are composed of direct parental ex­penses
made on a child through age 17
for seven major budgetary components.
These direct expenditures exclude costs
related to childbirth and prenatal health
care. In 1991, these particular health
care costs averaged $4,720 for a normal
delivery and $7,826 for a cesarean
delivery (3). These costs may be
reduced by health insurance.
One of the largest expenses made on
children after age 17 is the cost of a
college education. The College Board
(2) estimates that in 1995-96, average
annual tuition and fees are $2,760 at
4-year public colleges and $10,514 at
4-year private colleges; annual room
and board is $3,847 at 4-year public
colleges and $4,535 at 4-year private
colleges. For 2-year colleges in 1995-96,
average annual tuition and fees are
$1 ,405 at public colleges and $6,564
at private colleges; annual room and
board is $3,997 at 2-year private colleges
(no estimates are given for 2-year public
colleges). Other parental expenses on
children after age 17 include those
associated with children living at home
or, if children do not live at home, gifts
and other contributions to them.
Family Economics and Nutrition Review
The estimates do not include all govern­ment
expenditures on children. Examples
of excluded expenses would be public
education, Medicaid, and school meals.
The actual expenditures on children
(by parents and the government) would .
be higher than reported in this study,
especially for the lowest income group.
Indirect costs involved in child rearing
are also not included in the estimates.
Although these costs are typically more
difficult to measure than direct expendi­tures,
they can be substantial. The time
involved in rearing children is consider­able.
In addition, one or both parents
may need to cut back on hours spent
in the labor force to care for children,
thus reducing current earnings and
future career opportunities. The indirect
costs ?f child rearing may very likely
exceed the direct costs. For more on
these indirect costs, see Bryant et al.
(1), Ireland and Ward (4), and Spalter­Roth
and Hartmann (7).
1996 Vol. 9 No. 3
References
1. Bryant, W.K., Zick, C.D., and Kim, H. 1992. The Dollar Value of Household
Work. College of Human Ecology, Cornell University, Ithaca, NY.
2. The College Board. 1995. News from the College Board. September 25 issue.
3. Health Insurance Association of America. 1994. Source Book of Health Insurance
Data, 1994 ed. Washington, DC.
4. Ireland, T.R. and Ward, J.O. 1995. Valuing Children in Litigation: Family and
Individual Loss Assessment. Lawyers and Judges Publishing Company, Inc.,
Tucson, AZ.
5. Lefkowitz, D. and Monheit, A. 1991. Health Insurance, Use of Health Services,
and Health Care Expenditures. National Medical Expenditure Survey Research
Findings 12. U.S. Department of Health and Human Services, Public Health Service,
Agency for Health Care Policy and Research Publication No. 92-0017.
6. Lino, M. and Johnson, D.S. 1995. Housing, transportation, and miscellaneous
expenditures on children: A comparison of methodologies. Family Economics
Review 8( 1):2-12.
7. Spalter-Roth, R.M. and Hartmann, H.I. 1990. Unnecessary Losses: Costs to
Americans of the Lack of Family and Medical Leave. Institute for Women's Policy
Research, Washington, DC.
8. U.S. Department of Agriculture, Agricultural Research Service. 1994. Cost of
food at home. Family Economics Review 7(4):45.
9. U.S. Department of Commerce, Bureau of the Census. 1995. Statistical Abstract
of the United States: 1995 (115th ed.).
I 0. U.S. Department of Health and Human Services, Office of the Assistant Secretary
for Planning and Evaluation. 1990. Estimates of Expenditures on Children and
Child Support Guidelines.
11. U.S. Department of Transportation, Federal Highway Administration. 1994.
1990 Nationwide Personal Transportation Study.
13
Table 2. Estimated annual expenditures* on a child by husband-wife families, overall United States, 1995
Child care
Transpor- Health and Miscel-
Age of child Total Housing Food tation Clothing care education laneoust
Income: Less than $33,700 (Average=$21,000)
0-2 $5,490 $2,100 $780 $700 $370 $370 $630 $540
3-5 5,610 2,080 870 680 360 360 710 550
6-8 5,740 2,010 1,120 790 410 410 420 580
9-11 5,770 1,810 1,340 860 450 450 250 610
12-14 6,560 2,020 1,410 970 760 450 180 770
15-17 6,460 1,630 1,520 1,300 670 480 300 560
Total $106,890 $34,950 $21 '120 $15,900 $9,060 $7,560 $7,470 $10,830
Income: $33,700 to $56,700 (Average=$44,800)
0-2 $7,610 $2,840 $930 $1 ,050 $440 $490 $1,030 $830
3-5 7,810 2,820 1,080 1,020 430 470 1,140 850
6-8 7,870 2,750 1,370 1 '130 470 540 730 880
9-11 7,860 2,550 1,620 1,200 520 580 480 910
12-14 8,580 2,760 1,630 1,310 880 590 350 1,060
15-17 8,710 2,370 1,810 1,660 790 620 600 860
Total $145,320 $48,270 $25,320 $22,110 $10,590 $9,870 $12,990 $16,170
Income: More than $56,700 (Average=$84,800)
0-2 $1 1,320 $4,520 $1 ,240 $1,470 $580 $560 $1 ,550 $1,400
3-5 11 ,540 4,490 1,400 1,440 570 540 1,690 1,410
6-8 11 ,500 4,420 1,690 1,550 620 620 1 '160 1,440
9-11 11,430 4,230 1,960 1,620 670 670 810 1,470
12-14 12,270 4,440 2,060 1,730 1,120 670 620 1,630
15-17 12,550 4,050 2,170 2,100 1,010 710 1,090 1,420
Total $211 ,830 $78,450 $31 ,560 $29,730 $13,710 $11 ,310 $20,760 $26,310
"Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the Consumer Price Index. The figures represent
estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate expenses for two
children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total expense for the
appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total expense for each
appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed.
t Miscellaneous expenses include personal care items, entertainment, and reading materials.
14 Family Economics and Nutrition Review
Table 3. Estimated annual expenditures* on a child by husband-wife families, urban West, t 1995
Child care
Transpor- Health and Miscel-
Age of child Total Housing Food tation Clothing care education laneous,*
Income: Less than $33,500 (Average=$20,900)
0-2 $6,080 $2,520 $850 $770 $360 $320 $630 $630
3-5 6,210 2,510 940 750 350 300 710 650
6-8 6,370 2,470 1,210 850 390 350 420 680
9-11 6,490 2,330 1,450 920 440 380 250 720
12-14 7,210 2,500 1,510 1,030 730 390 180 870
15-17 7,180 2,150 1,640 1,360 650 410 300 670
Total $118,620 $43,440 $22,800 $17,040 $8,760 $6,450 $7,470 $12,660
Income: $33,500 to $56,400 (Average=$44,600)
0-2 $8,200 $3,240 $1,000 $1,120 $430 $430 $1,050 $930
3-5 8,420 3,230 1,150 1,100 420 410 1,160 950
6-8 8,500 3,190 1,460 1,200 460 470 740 980
9-11 8,570 3,050 1,730 1,270 510 510 480 1,020
12-14 9,250 3,220 1,730 1,390 860 520 360 1,170
15-17 9,400 2,870 1,920 1,730 760 540 610 970
Total $157,020 $56,400 $26,970 $23,430 $10,320 $8,640 $13,200 $18,060
Income: More than $56,400 (Average=$84,400)
0-2 $11,780 $4,800 $1,290 $1 ,550 $560 $510 $1 ,590 $1,480
3-5 12,020 4,780 1,450 1,530 540 490 1,730 1,500
6-8 12,000 4,750 1,750 1,630 600 550 1,190 1,530
9-11 11,980 4,610 2,040 1,690 650 590 830 1,570
12-14 12,770 4,780 2,140 1,810 1,080 600 640 1,720
15-17 13,100 4,430 2,250 2,170 980 630 1,120 1,520
Total $220,950 $84,450 $32,760 $31,140 $13,230 $10,110 $21,300 $27,960
*Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures
represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate
expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total
expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total
expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed.
tThe Western region consists of Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington,
and Wyoming.
*Miscellaneous expenses include personal cam items, entertainment, and reading materials.
1996 Vol. 9 No.3 15
Table 4. Estimated annual expenditures* on a child by husband-wife families, urban Northeast, t 1995
Child care
Transpor- Health and Miscel-
Age of child Total Housing Food tation Clothing care education laneous*
Income: Less than $33,500 (Average=$20,900)
0-2 $5,750 $2,520 $880 $580 $380 $360 $510 $520
3-5 5,870 2,500 980 560 370 340 580 540
6-8 6,090 2,470 1,250 660 420 390 330 570
9-11 6,230 2,330 1,490 730 470 420 190 600
12-14 7,030 2,500 1,560 850 790 430 140 760
15-17 6,930 2,150 1,680 1 '170 700 450 220 560
Total $113,700 $43,410 $23,520 $13,650 $9,390 $7,170 $5,910 $10,650
Income: $33,500 to $56,300 (Average=$44,500)
0-2 $7,830 $3,240 $1,030 $940 $450 $480 $870 $820
3-5 8,030 3,220 1 '180 920 440 460 970 840
6-8 8,190 3,190 1,500 1,020 490 520 600 870
9-11 8,290 3,050 1,770 ' 1,090 540 560 380 900
12-14 9,020 3,220 1,770 1,200 920 570 280 1,060
15-17 9,130 2,870 1,970 1,540 820 590 480 860
Total $151,470 $56,370 $27,660 $20,130 $10,980 $9,540 $10,740 $16,050
Income: More than $56,300 (Average=$84,300)
0-2 $11,340 $4,790 $1,320 $1,360 $590 $560 $1 ,350 $1,370
3-5 11,590 4,780 1,490 1,340 570 540 1,480 1,390
6-8 11,620 4,740 1,790 1,440 630 610 990 1,420
9-11 11,660 4,600 2,090 1,510 680 650 680 1,450
12-14 12,520 4,770 2,180 1,630 1,150 660 520 1,610
15-17 12,740 4,420 2,300 1,980 1,040 690 900 1,410
Total $214,410 $84,300 $33,510 $27,780 $13,980 $11 '130 $17,760 $25,950
*Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures
represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate
expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total
expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total
expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed.
tThe Northeast region consists of Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and
Vermont.
iMiscellaneous expenses include personal care items, entertainment, and reading materials.
16 Family Economics and Nutrition Review
Table 5. Estimated annual expenditures* on a child by husband-wife families, urban South,t 1995
Child care
Transpor- Health and Miscel-
Age of child Total Housing Food tation Clothing care education laneous*
Income: Less than $33,800 (Average=$21,100)
0-2 $5,550 $2,070 $750 $700 $400 $420 $700 $510
3-5 5,670 2,050 840 680 390 400 780 530
6-8 5,810 2,010 1,090 780 440 460 470 560
9-11 5,910 1,870 1,320 850 490 490 290 600
12-14 6,670 2,050 1,380 970 810 500 210 750
15-17 6,630 1,690 1,500 1,300 710 530 350 550
Total $108,720 $35,220 $20,640 $15,840 $9,720 $8,400 $8,400 $10,500
Income: $33,800 to $56,900 (Average=$45,000)
0-2 $7,730 $2,790 $910 $1,060 $470 $550 $1,140 $810
3-5 7,940 2,780 1,050 1,040 460 530 1,250 830
6-8 8,010 2,740 1,340 1,140 510 600 820 860
9-11 8,050 2,600 1,590 1,210 570 640 540 900
12-14 8,740 2,770 1,600 1,330 940 650 400 1,050
15-17 8,950 2,420 1,790 1,670 840 680 700 850
Total $148,260 $48,300 $24,840 $22,350 $11,370 $10,950 $14,550 $15,900
Income: More than $56,900 (Average=$85,200)
0-2 $11,370 $4,370 $1,190 $1,480 $620 $640 $1,700 $1,370
3-5 11,600 4,350 1,360 1,460 600 610 1,840 1,380
6-8 11,580 4,320 1,640 1,570 660 690 1,290 1,410
9-11 11,530 4,170 1,920 1,630 720 740 909 1,450
12-14 12,350 4,350 2,010 1,750 1,180 750 710 1,600
15-17 12,710 3,990 2,120 2,110 1,070 770 1,250 1,400
Total $213,420 $76,650 $30,720 $30,000 $14,550 $12,600 $23,070 $25,830
·Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures
represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate
expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total
expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total
expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed.
trhe Southern region consists of Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi,
North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.
*Miscellaneous expenses include personal care items, entertainment, and reading materials.
1996 Vol. 9 No.3 17
Table 6. Estimated annual expenditures* on a child by husband-wife families, urban Midwest,t 1995
Child care
Transpor- Health and Miscel-
Age of child Total Housing Food tation Clothing care education laneous;
Income: Less than $33,800 (Average=$21,100)
0-2 $4,970 $1,860 $710 $610 $350 $340 $610 $490
3-5 5,100 1,840 800 590 340 330 690 510
6-8 5,250 1,810 1,040 700 380 370 410 540
9-11 5,340 1,670 1,260 760 430 410 240 570
12-14 6,070 1,840 1,320 880 720 410 170 730
15-17 6,000 1,480 1,440 1,210 630 430 290 520
Total $98,190 $31,500 $19,710 $14,250 $8,550 $6,870 $7,230 $10,080
Income: $33,800 to $56,900 (Average=$45,000)
0-2 $7,110 $2,590 $870 $970 $410 $460 $1,020 $790
3-5 7,310 2,570 1,010 950 400 440 1,130 810
6-8 7,390 2,530 1,290 1,060 450 500 720 840
9-11 7,430 2,390 1,540 1,120 500 540 470 870
12-14 8,120 2,560 1,550 1,240 840 550 350 1,030
15-17 8,250 2,210 1,730 1,580 750 570 590 820
Total $136,830 $44,550 $23,970 $20,760 $10,050 $9,180 $12,840 $15,480
Income: More than $56,900 (Average=$85, 1 00)
0-2 $10,670 $4,150 $1,160 $1,400 $540 $540 $1,540 $1,340
3-5 10,920 4,140 1,310 1,380 530 520 1,680 1,360
6-8 10,890 4,100 1,590 1,480 580 590 1,160 1,390
9-11 10,880 3,960 1,870 1,550 640 630 800 1,430
12-14 11,650 4,130 1,950 1,670 1,060 640 620 1,580
15-17 11,980 3,780 2,070 2,030 960 670 1,090 1,380
Total $200,970 $72,780 $29,850 $28,530 $12,930 $10,770 $20,670 $25,440
•estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures
represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate
expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total
expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total
expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed.
trhe Midwest region consists of Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and
Wisconsin.
*Miscellaneous expenses include personal care items, entertainment, and reading materials.
18 Family Economics and Nutrition Review
Table 7. Estimated annual expenditures* on a child by husband-wife families, Rural areas,t 1995
Child care
Transpor- Health and Miscel-
Age of child Total Housing Food tation Clothing care education laneous*
Income: Less than $34,000 (Average=$21 ,200)
0-2 $5,020 $1 ,570 $720 $810 $370 $420 $620 $510
3-5 5,130 1,550 810 790 360 400 700 520
6-8 5,270 1,520 1,050 890 400 450 410 550
9-11 5,380 1,370 1,270 960 450 490 250 590
12-14 6,140 1,550 1,330 1,080 760 500 180 740
15-17 6,070 1 '190 1,450 1,410 670 520 290 540
Total $99,030 $26,250 $19,890 $17,820 $9,030 $8,340 $7,350 $10,350
Income: $34,000 to $57,200 (Average=$45,300)
0-2 $7,170 $2,310 $880 $1,170 $440 $540 $1,030 $800
3-5 7,360 2,290 1,020 1,150 420 520 1,140 820
6-8 7,440 2,250 1,300 1,250 470 590 730 850
9-11 7,480 2,110 1,550 1,320 520 630 470 880
12-14 8,200 2,290 1,550 1,440 890 650 350 1,030
15-17 8,350 1,920 1,740 1,790 790 670 600 840
Total $138,000 $39,510 $24,120 $24,360 $10,590 $10,800 $12,960 $15,660
Income: More than $57,200 (Average=$85,700)
0-2 $10,760 $3,900 $1 '160 $1,600 $570 $630 $1,560 $1,340
3-5 11,000 3,880 1,320 1,580 560 610 1,690 1,360
6-8 10,990 3,850 1,600 1,680 610 690 1,170 1,390
9-11 10,960 3,700 1,870 1,750 670 730 810 1,430
12-14 11 ,780 3,880 1,960 1,870 1,120 740 630 1,580
15-17 12,090 3,520 2,070 2,240 1,010 770 1,100 1,380
Total $202,740 $68,190 $29,940 $32,160 $13,620 $12,510 $20,880 $25,440
*Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the regional Consumer Price Index. The figures
represent estimated expenses on the younger child in a two-child family. Estimates are about the same for the older child, so to calculate
expenses for two children, figures should be summed for the appropriate age categories. To estimate expenses for an only child, multiply the total
expense for the appropriate age category by 1.24. To estimate expenses for each child in a family with three or more children, multiply the total
expense for each appropriate age category by 0.77. For expenses on all children in a family, these totals should be summed.
tRural areas are places of fewer than 2,500 people outside a Metropolitan Statistical Area.
*Miscellaneous expenses include personal care items, entertainment, and reading materials.
1996 Vol. 9 No.3 19
Table 8. Estimated annual expenditures* on a child by single-parent families, overall United States, 1995
Child care
Transpor- Health and Miscel-
Age of child Total Housing Food tation Clothing care education laneoust
Income: Less than $33,700 (Average=$14,100)
0-2 $4,650 $1,890 $860 $660 $340 $180 $390 $330
3-5 5,220 2,140 910 580 360 270 530 430
6-8 5,900 2,280 1,150 670 420 310 490 580
9-11 5,510 2,190 1,330 480 420 400 230 460
12-14 5,940 2,190 1,330 550 720 420 290 440
15-17 6,640 2,320 1,450 870 840 420 220 520
Total $101 ,580 $39,030 $21,090 $11,430 $9,300 $6,000 $6,450 $8,280
Income: $33,700 or more (Average=$51,100)
0-2 $10,590 $4,060 $1,330 $2,000 $480 $410 $960 $1,350
3-5 11,360 4,320 1,410 1,920 500 550 1,210 1,450
6-8 12,110 4,450 1,690 2,020 580 640 1,130 1,600
9-11 11,710 4,360 2,040 1,830 580 760 660 1,480
12-14 12,440 4,370 2,000 1,900 960 810 940 1,460
15-17 12,870 4,500 2,110 2,060 1,100 800 760 1,540
Total $213,240 $78,180 $31,740 $35,190 $12,600 $11,910 $16,980 $26,640
*Estimates are based on 1990-92 Consumer Expenditure Survey data updated to 1995 dollars using the Consumer Price Index. The figures
represent estimated expenses on the younger child in a single-parent, two-child family. For estimated expenses on the older child, multiply
the total expense for the appropriate age category by 0.93. To estimate expenses for two children, the expenses on the younger child and older
child-after adjusting the expense on the older child downward-should be summed for the appropriate age categories. To estimate expenses
for an only child, multiply the total expense for the appropriate age category by 1.35. To estimate expenses for each child in a family with three
or more children, multiply the total expense for each appropriate age category by 0.72-after adjusting the expenses on the older children downward.
For expenses on all children in a family, these totals should be summed.
tMiscellaneous expenses include personal care items, entertainment, and reading materials.
20 Family Economics and Nutrition Review
1996 Vol. 9 No.3
Assessment of Energy Intakes in
the U.S. Population, 1989-91
By Howard Riddick
Nutritionist
Center for Nutrition Policy and Promotion
The 1989-91 Continuing Survey of Food Intakes by Individuals was used
to assess food energy intakes of subgroups within the U.S. population. For
adolescents and adults, especially females, the average reported energy
intakes were well below the Recommended Energy Allowances (REA)
established by the National Research Council-not consistent with the
increase in the proportion of individuals found to be overweight. Energy
intakes as a percent of the REA ranged from 97 percent for children ages
1-3 to 73 percent for females ages 25-50. A ratio of reported energy intakes
(EI) to an estimate of resting energy expenditure (REE) based on self­reported
body weight, gender, and age was calculated to assess potential
energy underreporting. Males ages 51 and over and females ages 25-50
and 51 and over had EI/REE ratios below 1.2, indicating energy under­reporting
(1 ). Lower EI/REE ratios were characteristic of individuals in
higher weight-status categories. Very sedentary lifestyles may partly explain
the low EI/REE ratios. National studies of daily activity levels would be critical
to understanding the importance of inactivity versus underreporting. Future
studies of food intake surveys should incorporate some assessment of
energy reporting.
ational surveys of dietary
intakes provide estimates
of food and nutrient intakes
that help direct policy
decisions related to food assistance
programs, nutrition education efforts,
food safety, and diet/health relationships.
Accurate assessment of energy intake is
important for several reasons. First, the
number of servings recommended for
the Pyramid food groups is based on
the level of kilocalories needed (22).
For example, a minimum of 6 bread
group servings is recommended at the
1 ,600-kilocalorie level, whereas 11 bread
group servings are recommended at the
2,800-kilocalorie level (22). Second,
energy intake is one of several factors
(diet, genetics, level of activity) associ­ated
with the development of obesity, a
major public health problem that is
increasing dramatically in the United
States (12, 20). Finally, the intake of
energy is associated with the intake of
foods and food components. If estimates
of food energy are biased, estimates of
other dietary parameters may also be
affected.
21
Measuring dietary intakes of individuals
living in the community (rather than in
institutions), however, is an inherently
difficult process. Direct measures, such
as collection of duplicate portions, are
intrusive and affect behavior ( 13 ).
Indirect measures depend on the self­reporting
skills of individuals who must
remember or record all foods eaten in a
day along with an estimate of the quantity
consumed. The descriptions given by
the individual must then be assigned
food codes that most closely match the
description. Representative nutrient
composition values are then calculated
for the foods.
Until recently, dietary methods were
often validated by comparing results
from one method with those from
another method believed to be more
accurate. One study employing unobtru­sive
observation and weighing of foods
eaten found small intakes overreported
and large intakes underreported by 24-
hour recalls (6). The development of
the doubly-labeled water technique1 has
provided an objective, external test of
the validity of dietary assessments of
food energy. The doubly-labeled water
technique and supervised feeding of
diets have shown that self-reported
dietary intakes underestimate energy
intake by as much as 20 to 25 percent
or more, especially among obese
respondents (2, 5, 11, 13, 14, 17).
However, these techniques assess only
energy intake, not the intake of foods
or nutrients.
1ln the doubly-labeled water method, subjects
consume water that has both the hydrogen and
oxygen molecules labeled as stable isotopes.
Monitoring the elimination rate of labeled
hydrogen in water and the elimination rate of
labeled oxygen in water and carbon dioxide
permits the calculation of energy expenditure.
22
If the cause of energy underreporting is
primarily in estimating the quantity of
food portions eaten, the estimates for
many food components may be under­estimated.
lf omitted foods such as soft
drinks or candy are the primary cause
of underreporting, the estimates for food
components such as fat and food energy
might be low, but estimates for vitamins,
minerals, and major food groups might
be reasonable. Further complicating
the impact of low energy reporting on
estimates of nutrients and other food
components is the possibility that
certain nutrient-dense foods might
be overreported.
This paper examines the level of energy
reporting in a national survey in relation
to recommended levels of consumption
for population subgroups.
Methodology
The sample is composed of individuals
ages 1 and over surveyed in USDA's
1989-91 Continuing Survey of Food
Intakes by Individuals (CSFII) ( 19 ).
Along with household and individual
characteristics, each individual was
targeted to have one 24-hour recall and
a 2-day dietary record to assess dietary
intake. This study includes individuals
with a complete 24-hour recall who
were not bedridden, did not indicate
they were on a weight loss diet, and for
females, were not pregnant or lactating.
The 24-hour recall was chosen for this
study because the primary interest was
in evaluating mean intakes, and the
2-day dietary record is no longer in use
by USDA. In addition, the sample size
for the 24-hour recall was larger than
that for all 3 days.
Independent samples of all-income
households and low-income households
(households at or below 130 percent of
the poverty level) were combined during
the weighting process. The survey
design for both samples was a multi­stage
national probability sample of
households in the 48 conterminous
States and Washington, DC. For each
household sampled, all individuals
were eligible for the survey. The overall
response rate for individuals completing
the 24-hour recall was 57.6 percent.
Response rate is important in evaluating
survey results because those not partici­pating
may have different characteristics
and behavioral patterns from those
who do participate. The application of
weighting factors helps reduce but does
not eliminate the potential for bias.
Weighting factors were applied to:
Adjust for non-response; adjust for over­sampling
of low-income households;
match population characteristics; and to
equalize interviews over the 12 months
of the year and the 7 days of the week.
The average design effect2 was about
2.3, reflecting the ~omplex sampling
design and the weighting procedures
(19). Mean intakes based on a cell size
of 69 (30 times the average design
effect) or less may be less statistically
reliable than other estimates ( 19). The
significance level for the regression
analysis was set at 0.01 rather than 0.05
because of the complex survey design.
2The design effect is a measure of how much the
variance of estimates is increased compared with
a simple random sample.
Family Economics and Nutrition Review
For each individual, the energy in
kilocalories per day required to main­tain
basic bodily functions when at rest
(the Resting Energy Expenditure or
REE) was calculated using formulas
based on body weight in kilograms,
gender, and age ( 15 ). Body weights
and heights from the survey are self­reported
and may be more or less than
actual heights and weights (4, 16).
Overweight individuals tend to under­report
their weights, while underweight
individuals tend to overreport (16):
Because more individuals are over­weight
than underweight, a population
REE from self-reported weights will
tend to be lower than that using actual
weights.
The total food energy in kilocalories
(Energy Intake or EI) estimated by the
24-hour recall was divided by the esti­mated
REE to yield an EIIREE ratio.
The EIIREE ratio for a given age/sex
group reflects differences in self­reported
body weight and is indicative
of the general activity level. For example,
a ratio in the 1.5-1 .6 range represents a
light activity level, whereas a ratio of
1.3 is a minimum value that may not be
compatible with cardiovascular fitness
(15 ). Bingham has suggested that the
ratio should be on the order of 1.5 for
sedentary populations and that a popula­tion
ratio of 1.2 or under is evidence of
gross underreporting ( 1 ). The suggested
levels of EIIREE ratios are based on
what is known about variability in
energy intakes, REE, and levels of
physical activity. These ratio levels
might need to be adjusted as additional
research results become available.
1996 Vol. 9 No. 3
Table 1. Measures of energy intake: Mean intakes per individual in a
day, by age and gender, 1 day, CSFII 1989-91
Population
group
Children
1 - 3 years
4-6 years
7- 10 years
Males
11 - 14 years
15- 18 years
19-24 years
25-50 years
51 years and over
Females
11- 14 years
15- 18 years
19-24 years
25-50 years
51 years and over
n
757
719
912
466
332
473
2,159
1,510
396
381
584
2,714
2,320
kcal
1,262
1,559
1,875
2,252
2,591
2,559
2,324
1,947
1,891
1,700
1,700
1,611
1,467
%REA
97
87
94
90
86
88
80
85
86
77
77
73
77
EIIREEas
EIIREE % standard 1
1.61
1.63
1.56
1.49
1.40
1.40
1.25
1.19
1.43
1.17
1.24
1.15
1.12
91
86
88
88
84
84
78
78
85
73
78
74
74
1 EIIREE as % standard was calculated by dividing the EIIREE ratios found in this study by the EIIREE
ratios used by the NRC to establish the REAs and multiplying by 100.
Results
Mean daily intakes of energy are pre­sented
in several different forms by age
and gender in table 1, with the same
population groups used by the National
Research Council (NRC) to establish
the Recommended Energy Allowance
(REA) ( 15 ). Reported energy intake in
kilocalories peaked during the 15-18
age group for males and the 11-14 age
group for females and then declined
with age.
Almost all groups of children and
females had average intakes at approxi­mately
the 1 ,600-kilocalorie level
associated with the minimum number
of food group servings identified in the
Food Guide Pyramid. The exceptions
were children 7-1 0 years old and females
11-14 years old who had intakes between
the 1,600 and 2,200 levels. Among males,
the 11-14 and the 25-50 age groups
had reported energy intakes close to the
2,200-kilocalorie level at the midrange
of the Pyramid, whereas the 15-18 and
the 19-24 age groups had intakes
between the midrange of 2,200 and
23
the maximum of 2,800. The 51 and
over age group of males averaged about
2,000 kilocalories.
Reported energy intakes as a percent of
the REA ranged from a high of 97 per­cent
for children 1-3 years old to a low
of 73 percent for females 25-50 years
old. For all age groups examined, males
reported a higher proportion of their
REA than did females.
The EIIREE ratio was highest for children
and lowest for females. Children and
males 11-14 years old had ratios in the
1.5-1.6 range characteristic of sedentary
populations. Males 15-18 and 19-24
years old and females 11-14 years old
had ratios of about 1.4, still above the
1.3 minimum level cited in the NRC
report (15). Males 25-50 years old and
females 19-24 years old had ratios be­low
the NRC minimum but still above
the 1.2 minimum of Bingham. Males
51 years and over and females 15-18,
25-50, and 51 years and over had EI/REE
ratios below the 1.2 level cited by
Bingham as evidence of underreporting
(1).
The EI/REE ratios found in the CSFII
were compared with the EI/REE ratios
used by the NRC to establish the REA's
(see figure). The pattern of change rela­tive
to age and gender found in the
survey was similar to the NRC pattern.
However, the survey level appears
lower and the difference between males
and females appears greater. Between
females age 11-14 and 15-18, there was
a much sharper drop in the ratio in the
survey compared with the NRC.
24
EI/REE ratio used in establishing Recommended Energy Allowances
(REA) and as estimated by CSFII 1989-91 reported weights and
intakes
2.0 REA children '
1.8 REA, ma les
1.6 I "' CSFII children REA females
1.4 CSFII males
,II-
1.2
CSFII females
1.0
1-3 4-6 7-10 11-14
Converting the EIIREE ratio to a
percent of the ratio used by the NAS to
establish the REA's yields percentages
generally the same as the percentage of
the REA. The EIIREE percentage is
consistently lower than the REA per­centage
for children and males, with
no clear pattern for females. Differences
in the two measures may reflect differ­ences
in weight and activity patterns
assumed for the REA's compared with
the reported weights and/or kilocalorie
levels in the survey.
Measures of energy intake by weight
status are presented for children in table
2. The three Body Mass Index3 (BMI)
3Body Mass Index is calculated by dividing
weight in kilograms by the square of height in
meters.
15-18 19-24 25-50 51+
categories are based on the BMI levels
discussed in the report of the Dietary
Guidelines Advisory Committee (2 I).
As health indicators, the categories may
not be valid for children, but they do
provide a mechanism for energy intake
comparisons. For age groups 1-3 and
4-6, there was no clear pattern of energy
intake and weight status. Children 7-10
years old tended to exhibit lower EIIREE
ratios and percentages with higher
weight classes. Energy in kilocalories
and percent REA showed no clear pattern.
Children 7-10 years old in the highest
weight category had an EI!REE ratio at
the level (1.3) associated with minimal
activity.
Family Economics and Nutrition Review
Table 2. Measures of energy intake of children: Mean intakes per
individual in a day, by age and weight status,11 day, CSFII 1989-91
Age/Estimated EIIREE as
BMI category n kcal %REA EIIREE % standard2
Age 1-3
BMI <19 404 1,280 98 1.63 92
BM119- 25 196 1,299 100 1.61 92
BM1>25 157 I, 171 90 1.56 89
Age 4-6
BMI <19 472 1,544 86 1.63 86
BMI 19-25 165 1,620 90 1.64 87
BMI >25 82 1,530 85 1.53 81
Age 7-10
BM1<19 568 1,861 93 1.63 92
BMI19 -25 254 1,928 96 1.47 83
BMI >25 90 1,809 90 1.32 74
1 Weight status is derived from self-reported heights and weights.
2EIIREE as % standard was calculated by dividing the EIIREE ratios found in this study by the EIIREE
ratios used by the NRC to establish the REAs and multiplying by 100.
Among males (table 3, p. 26), there were
limitations in sample size for the under
19 BMI category. However, for all age
groups the over 25 BMI group had
lower EIIREE ratios and lower EIIREE
percentages than the 19-25 BMI group.
As with children, kilocalories and percent
REA showed no clear pattern relative
to weight status for males. For all age
groups, males in the over 25 BMI group
had EIIREE ratios close to or below the
1.2 level indicative of underreporting.
Among females (table 4, p. 27), EIIREE
ratios in the over 25 BMI category were
very low, at or below 1.0. EIIREE ratios
in the under 19 BMI category were
consistently at or above the 1.3 level.
Females in the 19-25 BMI category
generally had ratios around 1.2, except
1996 Vol. 9 No.3
those ages 11-14 who averaged about
1.4 and those ages 19-24 who averaged
about 1.3.
Adults in the top two BMI categories
were subdivided into income levels (the
number of subjects in the lowest BMI
category was too small for further sub­division)
(table 5, p. 28). At each of the
three income levels, both males and
females in the two age groups examined
had a similar pattern of lower EIIREE
ratios at higher BMI levels. For males
and females ages 25-50, the EIIREE
ratios were similar across the income
levels; however, for older males and
females, those with income at less
than 131 percent of the poverty level
appeared to have slightly lower ratios
in each weight class.
National studies of
daily activity levels
would be critical to
understanding the
importance of
inactivity versus
underreporting.
25
Table 3. Measures of energy intake of males: Mean intakes per individual
The relationship between the sufficiency in a day, by age and weight status,l1 day, CSFII 1989-91
of household food supplies (self-described)
and the EIIREE ratio is
Age/Estimated EIIREE as
presented in table 6, p. 28 by weight
BMI category n kcal % REA EI/REE % standard2
category for males and females ages 25
and over. Households could choose
among four levels of food sufficiency: Age 11- 14
"Enough of the kinds of food we want BMI <19 205 2,203 88 1.64 96
to eat"; "enough but not always what BMI 19-25 201 2,258 90 1.42 84
we want to eat"; "sometimes not
BMI >25 603 2,398 96 1.25 74
enough to eat"; or "often not enough to
eat." Because of sample size limitations,
the age groups were combined, as well Age 15-18
as households that indicated either BMI<19 453 2,221 74 1.38 83
sometimes or often not enough to eat. BMI 19-25 227 2,704 90 1.48 88
Both males and females in households
BMI >25 603 2,368 79 1.09 65
that sometimes or often did not have
enough to eat appeared to have lower
EIJREE ratios for both weight categories. Age 19-24
BMI <19 283 1,850 64 1.21 72
For each age group of children, males, BMI 19 ~ 25 289 2,632 91 1.49 89
and females, regression analysis ( 18)
BMI>25 156 2,511 87 1.24 74
was performed to test for statistical
significance between the EIIREE ratio
and weight status, income level, and Age 25-50
sufficiency of household food supplies. BMI <19 403 2,334 80 1.47 92
Weight status was tested by using BMI BMI 19-25 906 2,355 81 1.35 84
as a continuous variable, whereas in-
BMI >25 1,213 2,302 79 1.17 73
come and food sufficiency were tested
as categorical variables.
Age 51 and over
The overall equations were significant BMI <19 313 1,625 71 1.29 86
at the O.Ollevel of probability for all BMI 19-25 602 1,915 83 1.26 84
the age subgroups examined. As shown
BMI >25 877 1,978 86 1.12 75
in table 7, p. 29, the percent of variation
explained (R2) ranged from less than
I weight status is derived from self-reported heights and weights. 2 percent to around 9 percent. BMI was 2EIJREE as % standard was calculated by dividing the EIIREE ratios found in this study by the EIIREE
significant at the O.Ollevel for each ratios used by the NRC to establish the REAs and multiplying by I 00.
age group. Living in a household below 3Due to the small number of subjects, estimates may be less statistically reliable than other estimates.
131 percent of the poverty level was
significant only for males ages 15-18
and 51 and over and for females ages
51 and over. Living in households that
sometimes or often did not have enough
to eat was significant for males ages
11-14,25-50, and 51 and over; and for
females ages 25-50 and 51 and over.
26 Family Economics and Nutrition Review
Table 4. Measures of energy intake of females: Mean intakes per The level of R2 was lowest (under 2
individual in a day, by age and weight status, 1 1 day, CSFII 1989-91 percent) for children ages 1-3 and 4-6.
This may reflect less accurate reporting
Age/Estimated EIIREEas
of heights and weights for children,
BMI category n kcal %REA EIIREE % standard2 resulting in more errors in estimated
BMI and weight status classification (4).
Age 11- 14 The statistically significant regression
BMI <19 177 1,838 84 1.49 89 coefficients in table 7 are all negatively
BMT 19-25 175 1,967 89 1.43 86 related to the EIIREE ratio. For example,
BMI >25 443 1,735 79 1.14 68
for males ages 51 and over, a one-unit
increase in BMI is associated with a
decrease in the EIIREE ratio of 0.021,
Age 15-18 controlling for income status and house-
BMI <19 693 1,765 80 1.32 82 hold food sufficiency.
BMI 19-25 245 1,721 78 1.19 75
BMI >25 673 1,531 70 0.89 56 Discussion
The Recommended Energy Allowance
Age 19-24 (REA) is set to reflect the average need
BMI <19 73 1,806 82 1.49 92 of a population subgroup, unlike the
BMI 19-25 377 1,717 78 1.27 80 Recommended Dietary Allowances
BMI>25 134 1,569 71 0.96 60
(RDA) that are set high enough above
the estimated mean requirement to meet
the needs of practically all healthy
Age 25-50 individuals ( 1 5). For older children and
BMI <19 181 1,712 78 1.38 89 adults, especially females, the reported
BMI19 -25 1,402 1,616 73 1.20 78 energy intakes in this study were, on
BMI>25 1 '131 1,582 72 1.03 66
average, well below the REA. Energy
intakes consistently below requirements,
over time, will lead to a loss in weight.
Age 51 and over This is not consistent with recent studies
BMI <19 163 1,459 77 1.31 87 of weight status in the U.S. population
BMI19-25 1,029 1,498 79 1.19 80 ( 12, 20 ). For both children and adults,
BMI >25 1,128 1,434 75 1.01 67
the percentage of individuals classified
as overweight increased during the
1Weight status is derived from self-reported heights and weights.
period from 1976-80 to 1989-91. Either
2EIIREE as% standard was calculated by dividing the EIIREE ratios found in this study by the EIIREE
the REA is set too high or reports of
ratios used by the NRC to establish the REAs and multiplying by 100. energy intake are too low.
3Due to the small number of subjects, estimates may be less statistically reliable than other estimates.
1996 Vol. 9 No.3 27
The EI/REE ratios were consistently
below the levels used by NRC to estab­li
h the REA' s. For females and higher
weight individuals in particular, the ratios
were well below the recommended levels
and often below the minimum level
identified by NRC. Adult males and
females starting in the teen years had
ratios low enough to suggest major
underreporting--especially in the higher
weight groups. The lower ratios within
weight groups for adults in households
with restricted food supplies may indicate
lower actual intakes in addition to
underreporting.
A summary of studies using the doubly­labeled
water technique supports the
EI/REE ratios used by NRC. The mean
ratio was 1.67 and the mean minus two
standard deviations was 1.28 for the
105 adult males and females studied (7).
Males averaged 1.78 while females
averaged 1.62. Whether the activity levels
found in these small studies is repre­sentative
of the population remains a
question.
Table 8, p. 30, presents EIIREE ratios
for adult men and women using the same
age breaks and overweight definitions
used in the NHANES ill survey ( 3 ). For
all age groups of overweight females
(using a BMI of27.3 or above as the
criterion), both surveys found EI/REE
ratios considerably below the 1.2 level
indicating substantial underreporting.
In CSFII, overweight males (using a
BMI of 27.8 or above as the criterion)
had average ratios below 1.2 for all age
groups, whereas the NHANES ill found
only overweight males ages 60 or over
28
Table 5. The mean EIIREE ratio for adult males and females by age,
weight status, 1 and income level, CSFII 1989-91
Age/Estimated Household income as a percent of poverty level
BMI category <131 13 1 -350 >350
Males age 25 - 50
BMI 19-25 1.33 1.36 1.34
(n = 291) (n = 336) (n = 279)
BMI >25 1. 14 1. 16 1.18
(n = 363) (n = 475) (n = 375)
Males age 51 and over
BMI19-25 1.16 1.30 1.25
(n = 226) (n = 220) (n = 156)
BMI >25 1.02 1.14 1.14
(n = 273) (n = 322) (n = 282)
Females age 25 - 50
BMI 19- 25 1.18 1. 19 1.21
(n = 470) (n = 509) (n = 423)
BMI>25 0.97 1.06 1.0 I
(n = 530) (n = 390) (n= 2 11 )
Females age 51 and over
BMI19-25 1.13 1.21 1.21
(n = 434) (n = 346) (n = 249)
BMI >25 0.92 1.03 1.05
(n = 557) (n = 388) (n = 183)
1Weight status is derived from self-reported heights and weights.
Table 6. The mean EIIREE ratio for adult males and females by weight
status1 and household food sufficiency, CSFII 1989-91
Age/Estimated
BMI category
Males age 25 and over
BMII9-25
BMI >25
Females age 25 and over
BMI 19-25
BMI>25
Household food sufficiency
Enough of the Enough but not Sometimes or
kinds of foods always kinds of often not
wanted food wanted enough to eat
1.31 1.40 1.19
(n = 1,070) (n = 362) (n = 72)
1.15 1.17 0.80
(n = 1,508) (n = 507) (n = 73)
1.21 1.17 0.97
(n = 1,765) (n = 566) (n = 96)
1.03 0.98 0.90
(n = 1,508) (n = 633) (n = 114)
1Weight status is derived from self-reported heights and weights.
Family Economics and Nutrition Review
Table 7. The relationship between the mean EIJREE ratio and BMI,
income status, and household food sufficiency, CSFII 1989-91
Explanation
ofEIJREE
variation
Age/sex (R2)
Percent
Children
I - 3 years 1.5
4-6 years 1.6
7- 10 years 6.0
Males
11- 14 years 8.4
15- 18 years 5.3
19-24 years 5.5
25- 50 years 3.8
51 years and over 4.4
Females
11- 14 years 3.9
15- 18 years 5.4
19-24 years 9.1
25- 50 years 4.0
51 years and over 8.7
* PS 0.01.
were below this level. For adults ages
20 and over, the CSFII values were
about 85 percent of the NHANES III
values for males and about 90 percent
for females. Differences in 24-hour
recall protocols between the two surveys
have been identified ( 3 ). Another major
difference is the use of self-reported
heights and weights in CSFII compared
with the measured heights and weights
in the NHANES III survey. Overweight
individuals, especially overweight
females, have been found to under­report
their weights (16).
1996 Vol. 9 No.3
Household
income
<131%
BMI poverty level
Beta coefficient
-0.009* +0.000
-0.010* -0.043
-0.024* -0.040
-0.037* -0.112
-0.036* -0.247*
-0.037* -0.089
-0.024* +0.015
-0.021* -0.092*
-0.023* +0.030
-0.026* -0.043
-0.036* +0.074
-0.017* -0.001
-0.023* -0.086*
Implications for
Further Research
Sometimes
or often
not enough
to eat
-0.101
-0.117
-0.143
-0.267*
+0.444
-0.254
-0.155*
-0.187*
-0.106
-0.130
-0.165
-0.132*
-0.168*
Additional research is needed to under­stand
energy reporting. A critical
component is the activity level of
population subgroups from nationally
representative samples. Assessments
of general activity levels need to be
integrated into surveys of food energy
intakes. Since body weight is another
key component in estimating energy
needs, a study should be done to assess
the impact of using self-reported weights
on estimating the REE and the EIIREE
ratio.
... users of food
intake survey data
should assess
energy reporting
as a component of
their analysis.
29
Table 8. Mean EIIREE ratio by selected age groups for adult males and females by weight status,1 CSFll1989-91
Males Females Overweight males* Overweight females*
Age n EVREE n EVREE n
20-29 years 884 1.35 1,037 1.21 172
30-59 years 2,117 1.22 2,745 1.13 660
Over 60 years 1,064 1.20 1,734 1.14 264
Total over 20 years 4,065 1.24 5,516 1.15 1,096
1Weight status is derived from self-reported heights and weights.
* Overweight individuals were defined as BMI ~ 27.8 for males. and ~ 27.3 for females.
Methods to improve memory recall of
foods and quantities eaten need to be
explored. After cognitive testing and
a pilot study, the procedures used to
collect 24-hour recalls in CSFII 1989-91
have been modified to incorporate a
multiple-pass approach for CSFII
1994-96 (8). Portion size estimation
and the validity of standardized recipes
are especially critical for frequently
eaten foods. Representative weights
of foods such as bagels and muffins
may increase over time, and if food
codebooks and software fail to reflect
such changes, energy intakes will be
underestimated.
Psychological aspects of energy reporting
also need additional exploration ( 10 ).
Hebert found that higher scores on a
social desirability scale4 were associated
with lower energy reports with a 7 -day
dietary recall (9). Such a scale might be
used in studies of energy reporting to
develop a mechanism to help make
adjustments for underreporting.
4Social desirability is the tendency of an individual
to convey an image in keeping with social norms
and to avoid criticism in a "testing" situation (9).
30
A major question concerns the extent to
which energy underreporting is related
to the reporting of other dietary compo­nents.
A recent study used the 24-hour
urine nitrogen technique to divide a
group of individuals into "underreporters"
and "others" (1). Underreporters (n=34)
reported significantly less food energy,
protein, fat, and sugars than the others
(n=45) but similar levels of starch,
fiber, and vitamin C. This research,
which needs to be replicated, indicates
that overall estimates may be downward
biased for some, but not all, food
components.
EVREE n EVREE
1.00 204 0.98
1.13 867 1.01
1.10 545 0.95
1.10 1,616 0.99
Until further research is completed,
users of food intake survey data should
assess energy reporting as a component
of their analysis. The EI/REE ratio could
be used as an assessment tool and/or as
a control variable in a multivariate
analysis. Consideration' of the potential
impact of energy underreporting is most
critical for studies involving adult
females and for overweight individuals.
Family Economics and Nutrition Review
References
1. Bingham, S.A. 1994. The use of24-h urine samples and energy expenditure to
validate dietary assessments. The American Journal of Clinical Nutrition
59(Suppl):227S-231S.
2. Black, A.E., Prentice, A.M., Goldberg, G.R., Jebb, S.A., Bingham, S.A.,
Livingstone, M.B.E., and Coward, W.A. 1993. Measurements of total energy
expenditure provide insights into the validity of dietary measurements of energy
intake. Journal of the American Dietetic Association 93:572-579.
3. Briefel, R.R., McDowell, M.A., Alaimo, K., Caughman, C.R., Bischof, A.L.,
Carroll, M.D., and Johnson, C.L. 1995. Total energy intake of the US population:
The third National Health and Nutrition Examination Survey, 1988-1991. The
American Journal of Clinical Nutrition 62(Suppl): 1072S-1 080S.
4. Davis, H. and Gergen, P.J. 1994. Mexican-American mothers' reports of the
weights and heights of children 6 months through 11 years old. Journal of the
American Dietetic Association 94:512-516.
5. deVJjes, J.H.M., Zock, P.L., Mensink, R.P., and Katan, M.B. 1994. Underestimation
of energy intake by 3-d records compared with energy intake to maintain body
weight in 269 non obese adults. The American Journal of Clinical Nutrition 60:
855-860.
6. Gersovitz, M., Madden, J.P., and Smiciklas-Wright, H. 1978. Validity of the
24-hr dietary recall and seven-day record for group comparisons. Journal of the
American Dietetic Association 73:48-55.
7. Goldberg, G.R., Black, A.E., Jebb, S.A., Cole, T.J., Murgatroyd, P.R., Coward,
W.A., and Prentice, A.M. 1991. Critical evaluation of energy intake data using
fundamental principles of energy physiology: 1. Derivation of cut-off limits to
identify undercrecording. European Journal of Clinical Nutrition 45:569-581.
8. Guenther, P.M., DeMaio, T.J., Ingwersen, L.A., and Berlin, M. 1996. The multiple­pass
approach for the 24-hour recall in the Continuing Survey of Food Intakes by
Individuals (CSFII) 1994-96. The FASEB Journal10(3):A198.
9. Hebert, J.R., Clemow, L., Pbert, L., Ockene, I.S., and Ockene, J.K. 1995. Social
desirability bias in dietary self-report may compromise the validity of dietary intake
measures. International Journal of Epidemiology 24:389-398.
10. Heymsfield, S.B., Darby, P.C., Muhlheim, L.S., Gallagher, D., Wolper, C., and
Allison, D.B. 1995. The calorie: Myth, measurement, and reality. The American
Journal of Clinical Nutrition 62(Suppl):1034S-1041S.
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11. Johnson, R.K., Goran, M.I., and Poehlman, E.T. 1994. Correlates of over- and
underreporting of energy intake in healthy older men and women. The American
Journal ofClinical Nutrition 59:1286-1290.
12. Kuczmarski, R.J., Flegal, K.M., Campbell, S.M., and Johnson, C.L. 1994.
Increasing prevalence of overweight among US adults. Journal of the American
Medical Association 272(3):205-211.
13. Mertz, W. 1992. Food intake measurements: Is there a "gold standard"? Journal
of the American Dietetic Association 92( 12):1463-1465.
14. Mertz, W., Tsui, J.C., Judd, J.T., Reiser, S., Hallfrisch, J., Morris, E.R., Steele,
P.D., and Lashley, E. 1991. What are people really eating? The relation between
energy intake derived from estimated diet records and intake determined to
maintain body weight. The American Journal of Clinical Nutrition 54:291-295.
15. National Research Council, Subcommittee on the Tenth Edition of the RDAs,
Food and Nutrition Board. 1989. Recommended Dietary Allowances, 1Oth ed.
National Academy Press, Washington, DC.
16. Rowland, M.L. 1990. Self-reported weight and height. The American Journal of
Clinical Nutrition 52:1125-1133.
17. Schoeller, D.A. 1990. How accurate is self-reported dietary energy intake?
Nutrition Reviews 48( 10):313-379.
18. SPSS Inc. 1988. SPSS-X User's Guide, 3rd Edition. Chicago, IL.
19. Tippett, K.S., Mickle, S.J., Goldman, J.D., Sykes, K.E., Cook, D.A., Sebastian, R.S .,
Wilson, J.W., and Smith, J. 1995. Food and Nutrient Intakes by Individuals in the
United States, 1 Day, 1989-91. Continuing Survey of Food Intakes by Individuals,
1989-91, Nationwide Food Surveys Rep. No. 91-2. U.S. Department of Agriculture,
Agricultural Research Service.
20. Troiano, R.P., Flegal, K.M., Kuczmarski, R.J., Campbell, S.M., and Johnson,
C.L. 1995. Overweight prevalence and trends for children and adolescents. Archives
of Pediatrics and Adolescent Medicine 149: 1085-1091.
21. U.S. Department of Agriculture, Agricultural Research Service, Dietary
Guidelines Advisory Committee. 1995. Report of the Dietary Guidelines
Advisory Committee on the Dietary Guidelines for Americans, 1995.
22. U.S. Department of Agriculture, Human Nutrition Information Service. 1992.
The Food Guide Pyramid. Home and Garden Bulletin No. 252.
32 Family Economics and Nutrition Review
1996 Vol. 9 No. 3
Dietary Patterns and Personal
Characteristics of Women
Consuming Recommended
Amounts of Calcium
By Joanne F. Guthrie
Nutritionist
Center for Nutrition Policy and Promotion
Encouraging adequate calcium intakes by women is a current public health
objective. To obtain information that could be used to promote this objective,
this study examined dietary patterns and personal characteristics of women
consuming their Recommended Dietary Allowance (RDA) of calcium
compared with women who did not meet their RDA. The sample consisted
of 2,261 nonpregnant, nonlactating women who participated in USDA's
1990-91 Continuing Survey of Food Intakes by Individuals-Diet and
Health Knowledge Survey. Women whose diets met their RDA for calcium
consumed significantly more milk products, fruit, and grains, less regular­calorie
soda, and more of several essential nutrients, saturated fat, and
sodium than did other women. All other characteristics equal, women were
less likely to meet their calcium RDA from food sources if they were Black,
less than 25 years of age, ate more food away from home, reported avoidance
of all types of milk, and reported dietary intake in either the summer or fall.
Factors positively related to meeting the RDA from food sources were working
part time, taking vitamin-mineral supplements, reporting avoidance of whole
milk only, being aware of a relationship between calcium intake and health,
and reporting a higher number of milk group servings as being recommended
daily. Implications for design and targeting of messages promoting calcium
intake are discussed.
dequate calcium intake has
been identi~ed as an _impor­tant
factor m preventmg
osteoporosis and may also
play a role in the prevention of several
other health conditions, including some
other bone diseases, colon cancer,
hypertension, and pre-eclampsia during
pregnancy (26). Osteoporosis affects
25 million Americans, primarily women
(26). Annual direct medical costs
associated with osteoporosis in American
women have been estimated at $5.2
billion (29). Yet, data suggest that most
women's diets do not meet their current
Recommended Dietary Allowance (RDA)
for calcium ( 1 ). As a consequence,
improvement of calcium intakes has
received considerable emphasis as a
public health priority (6). The NIH
Consensus Development Conference
on Optimal Calcium Intake has
33
recommended development of health
education materials and programs to
promote increased calcium consumption.
Increasing calcium intake among
adolescents and adults is one of the
health objectives for the Nation
promoted by the U.S. Department of
Health and Human Services' Healthy
People 2000 (39). The American
Dietetic Association has made increasing
women's awareness of osteoporosis
and the lifestyle changes that can help
prevent it a major component of their
Nutrition and Health Campaign for
Women (20). Other public and private
groups are also working on projects to
promote dietary changes that would
increase calcium consumption ( 19, 24 ).
Amidst this emphasis on improving
calcium intakes, particularly those of
women, one concern that has been
raised is whether increasing calcium
intake is compatible with improving
overall dietary quality. If a healthful
diet is defmed as one that contains
adequate amounts of essential nutrients
while meeting guidelines for moderation
in consumption of such food compo­nents
as fat, saturated fat, cholesterol,
and sodium (9), previous research
indicates that diets that are rich in
calcium tend to be rich in other essential
nutrients as well. However, these diets
may be associated with excessive in­takes
of food components for which
moderation is recommended.
Examining the issue of overall nutrient
quality of higher-calcium versus lower­calcium
diets, Barger-Lux et a!. (2) and
Holbrook and Barrett-Connor ( 14) both
found that those with diets that were
more calcium dense (i.e., had more
calcium per 1,000 kilocalories (kcal)
of intake) also had diets that had higher
34
densities of several other essential
nutrients. However, Holbrook and
Barrett-Connor also found that the high­calcium
group's diet had a higher density
of saturated fat than other groups.
Similarly, Nowalk and Caggiula (27)
found that among a sample of middle­age
premenopausal women, those
whose diets met their RDA for calcium
consumed greater amounts of total and
saturated fat than those whose diets did
not. These studies were done with local
samples, and the results may not be
generalizable to the American
population. Nevertheless, they raise
the concern that programs encouraging
increased calcium intake may inadver­tently
result in increasing intakes of
food components for which moderation
is recommended.
Given that nutrition intervention is
intended to promote an overall healthful
diet, it is important, therefore, to examine
not only the calcium adequacy but the
overall diet quality of individuals before
planning nutrition education efforts.
Such an examination should provide
educators with information that would
be useful to them in developing dietary
guidance that would lead to overall
dietary improvement as well as
improved calcium intakes.
A knowledge of personal characteristics
associated with meeting or not meeting
the calcium RDA should also be useful
for targeting nutrition education efforts.
Previous research has indicated that
some personal characteristics seem to
be associated with low calcium intakes.
Data from several sources indicate that
Black women tend to consume lower
amounts of calcium than women of
other races (18, 40).
Analysis of dietary intake data collected
by the U.S. Department of Agriculture
in I 985-86 from a national sample of
women ages 19-50 indicated that, along
with race, other factors independently
associated with higher calcium intakes
included higher education, higher income,
being employed part time as opposed to
being employed full time or not at all,
being younger, being taller, being part
of a household that included a child or
children, being a participant in the Food
Stamp program, living in a central city
or suburban area as opposed to a non­metropolitan
area, living in the Midwest
or West as opposed to living in the
Northeast or South, and being a regular
supplement user (40). Both Lewis and
Hollingsworth (17) and Haines eta!.
( 13) found that, for women, eating a
higher proportion of food away from
home is associated with lower calcium
intakes.
Nutrition educators would benefit from
knowing how knowledge and attitudes
related to calcium and calcium-rich
foods influence food intake; however,
national survey data capable of linking
knowledge and attitudes to food and
nutrient consumption have only recently
become available. In a study of older
women living in the Midwest, Chapman
eta!. (5) found that women with low
calcium intakes were more likely to
dislike milk, to believe that it disagreed
with them, and to avoid drinking it.
Examining attitudes toward milk con­sumption
in a national data set would
provide an opportunity to assess how
generalizable these findings are to the
broader population of American women.
Family Economics and Nutrition Review
The purposes of this study are, there­fore,
to (I) examine overall food and
nutrient consumption patterns of women
whose 3-day diets meet or fail to meet
their calcium RDAs for overall diet
quality; and (2) identify socioeconomic,
demographic, knowledge, attitude, and
behavioral characteristics of women
whose diets, over a 3-day period, meet
the current calcium RDA for their age­sex
group, using data from the USDA's
1990-91 Continuing Survey of Food
Intakes by Individuals (CSFII) and Diet
and Health Knowledge Survey (DHKS).
These surveys are unique in that, to­gether,
they provide the only federally
collected data set capable of relating
knowledge and attitudes concerning
diet and health to actual dietary intake.
The results may be used to indicate
types of nutrition education messages
that may be most effective in promoting
adequate calcium intake and to target
groups of women mo t likely to have
lower-than-recommended calcium
intakes.
Methods
Data and Sample
The CSFII was designed to obtain a
nationally representative ample of
households in the 48 conterminous
United State and consist of an all­income
and a low-income sample. In
the all-income sample, all households,
including low-income households,
were eligible to be interviewed. For the
low-income sample, participation was
limited to individuals in households
with a gross income for the previous
month at or below 130 percent of the
Federal poverty thresholds ( 36 ).
1996 Vol. 9 No.3
For the 1990-91 CSFII, trained inter­viewers
visited each household and
obtained socioeconomic, demographic,
and health-related data on households
and their members. In addition, the
interviewers obtained I day of dietary
intake data, using the 24-hour recall
method, and household members were
asked to complete a record of foods
consumed on the 2 days following the
24-hour recall. Only those who pro­vided
the complete 3 days of dietary
data were considered for this study.
For the DHKS, one member of each
CSFII household was contacted about 6
weeks after dietary data were collected.
Ideally, the individual contacted was
the person who had identified himself
or herself as the household's main meal
planner/preparer. In some cases, inter­viewers
were unable to contact the main
meal planner/preparer; about 6 percent
of DHKS respondents were not the main
meal planner/preparer. Most interviews
were conducted by telephone; in-person
interviews were conducted when this
was not feasible.
DHKS respondents were asked a series
of questions on their knowledge, attitudes,
and practices related to diet and health.
Some questions that were particularly
relevant to calcium intake included
those on whether the respondents were
aware that there were any health problems
related to how much calcium a person
eats, whether they avoided certain
calcium-rich foods (all milk, whole
milk, or cheese), and how many servings
of milk products they believed they
should eat daily.
Given that nutrition
intervention is
intended to promote
an overall healthful
diet, it is important. ..
to examine not
only the calcium
adequacy but the
overall diet quality
of individuals before
planning nutrition
education efforts.
35
In 1990 and 1991, DHKS and 3-day
food intake data were obtained from
2,960 respondents. From these, female
meal planners age 18 years and over
were selected to form the analysis data
set. The small number of DHKS respon­dents
who were not meal planners were
excluded from the analysis because non­meal
planners likely have less control
over their food choices than meal planners.
Pregnant and lactating women were
also excluded because the purpose of
this analysis was to examine factors
influencing calcium intake over the
long-term and pregnancy and lactation
would be expected to create short-term
increases in calcium intake ( 4 ).
The final analysis data set consisted of
2,261 female meal planners. To adjust
for oversampling of low-income house­holds
and for differing response rates
among population subgroups, DHKS
sample weights were developed by
USDA in cooperation with Iowa State
University ( 34 ). Use of these weights
for descriptive statistics is recommended,
because the weighted sample more
closely resembles the actual U.S.
population (16); weighted data were
used in this study to calculate all
descriptive statistics.
Measures of Dietary Intake
Survey respondents reported amounts
of food consumed using common house­hold
measures. These amounts were con­verted
to their gram weight equivalents.
The results reported here represent the
average amounts consumed over the 3
days of dietary intake reported by survey
respondents. Foods are reported in
terms of major groups--e.g., milk and
milk products; and by selected sub­groups--
e.g., lowfat milks. Foods are
36
grouped by primary ingredient; for
example, a hamburger with onions is
placed in the meat group because meat
is its primary ingredient. Food group
consumption patterns are examined in
terms of average amounts consumed
over 3 days.
Energy (kilocalorie), fat, cholesterol,
and nutrient intakes were calculated
using USDA's Nutrient Data Base for
Food Consumption Surveys (34 ).
Nutrient intakes represent values from
food consumption only; although survey
participants answered questions on
supplement use, nutrient intake from
supplements was not quantified. Sodium
values represent naturally occurring
sodium, sodium added during food
processing, and an assumed amount
of sodium used in food preparation.
Sodium values do not include salt
added at the table.
In this study, nutrient intake is examined
as a percent of the individual's RDA
and in terms of nutrient density, defined
as the amount of a nutrient in the diet
per 1,000 kilocalories-a measure of
diet quality that controls for differences
in the absolute quantity. The National
Academy of Sciences has established
guidelines for recommended total intakes
of cholesterol, sodium, and potassium
(22). Here, cholesterol, sodium, and
potassium intakes are examined both
as total amounts consumed and in terms
of density. Fat and saturated fat intakes
are examined as percentages of total
kilocalories, a measure that controls for
differences in absolute quantity and also
corresponds to current dietary guidance.
Analysis of Food Consumption
Patterns and Diet Quality
Mean food group intakes, nutrient in­takes,
and fat, saturated fat, cholesterol,
sodium, and potassium intakes by meal
planners who met their RDA for calcium
were compared with the intakes of meal
planners who did not. For this analysis,
weighted data were used and statistical
tests were conducted using the SUDAAN
software package, which accounts for
the effects of the complex design of the
CSFII-DHKS surveys (32). T-tests were
used for comparing means of the two
groups.
Analysis of Personal
Characteristics Influencing
Calcium Intake
Differences in socioeconomic, demo­graphic,
and personal characteristics
between women who met their calcium
RDA and those who did not were
assessed using descriptive statistics.
T-tests were used to compare means of
continuous variables, and the chi-square
test was used to compare distributions
of categorical variables. Weighted data
were used and analyses were conducted
with the SUDAAN software package
(32).
A logistic regression analysis was used
to identify the personal characteristics
independently associated with the prob­ability
of a meal planner meeting her
RDA for calcium. In accordance with
recommendations for statistical analysis
of USDA food consumption survey
data, unweighted data were used for
this analysis (16). The analysis was
conducted using the SPSS-X statistical
software package (33).
Family Economics and Nutrition Review
Independent variables selected for the
analysis included race, RDA-based age
group, the self-reported height of the
individual and her body mass index (as
calculated from self-reported height and
weight), household income as a percent
of the Federal poverty level, Food Stamp
Program participation, education,
employment status, presence of children
in the household, region and urbaniza­tion
level of residence, whether the
individual was on a weight-loss diet,
use of vitamin and/or mineral supple­ments,
percent of total kilocalories
consumed away from home over the
3-day period, whether the individual
reported being aware of health problems
related to calcium, how many servings
of dairy products the individual believed
she should consume each day, and
whether the individual reported avoid­ing
all milk, whole milk only, or cheese.
Race was included because previous
research has indicated that it is associ­ated
with calcium intake; meal planners
were categorized as members of either
the White, Black, or "other" race groups
("other" includes Asians, Native
Americans, Pacific Islanders, and any
other races). Individuals were dichoto­mized
into two age groups-those
under 25 and those over 25 years of
age-because the Food and Nutrition
Board of the National Academy of
Sciences has established an RDA for
calcium that is higher for women 18
to 24 than for older women (23 ); the
higher RDA may affect their likelihood
of meeting recommended intake levels.
Income, Food Stamp Program participa­tion,
education, employment status
(full time, part time, not employed),
presence of children in the household,
region and urbanization level of
residence, and use of vitamin and/or
1996 Vol. 9 No.3
mineral supplements were also included
because previous research has indicated
their potential significance in influenc­ing
calcium intake.
The percentage of total kilocalories
consumed away from home over the
3-day period was used as a measure
of the importance of eating away from
home in the diet, since this has been
associated with lower calcium intakes
in some studies. The variables on aware­ness
of health problems related to calcium,
how many servings of dairy products
the individual believed she should
consume each day, and whether the
individual reported avoiding all milk,
whole milk only, or cheese have not
previously been studied in relation to
the calcium adequacy of women's diets
using a large national data set, because
they have only recently been added to
national food consumption surveys.
They were included because of the
potential usefulness of information
on their influence on calcium intake
for nutrition education.
Variables assessing temporal effects
on intake-season in which intake was
reported and whether weekend eating
was reported-were included as control
variables because previous research has
indicated that they can affect food con­sumption
(12). Another factor that
needs to be controlled is individual
differences in total energy intake, since
at higher caloric levels an individual
may be more likely to meet the calcium
RDA.
Unfortunately, the use of energy intake
as an independent variable in a multi­variate
equation is problematic because
within-individual variability in energy
intake introduces error that will produce
biased coefficients ( 3 ). Therefore, several
variables that proxy differences in
Women whose diets
met their ADA for
calcium consumed
more than three
times as much lowfat
milk as other women
and more than six
times as much skim
milk.
37
energy need were used as control
variables. These include: Self-reported
height and body mass index, as calcu­lated
from self-reported height and
weight. since larger individuals are
likely to consume more energy; being
on a weight-loss diet; and whether
individuals reported any days with
either lower-than-usual or higher­than-
usual dietary intakes.
Results
Description of Sample
Of the 2,261 women studied, 442 or 19
percent met their calcium RDA. After
applying survey weights to obtain a
population estimate, 21 percent of adult
female meal planners were estimated to
have diets that met their RDA for calcium.
The group that met its calcium RDA
was significantly less likely to include
younger women (table 1 ). Six percent
of meal planners with lower calcium
intakes were below 25 years of age;
only 2 percent of those with higher
calcium intakes were in that age group.
Women with higher calcium intakes
were significantly taller, averaging
64.7 inches in height, compared with
an average of 64.0 inches for the low
calcium group.
The educational level and employment
status of the two groups also differed
significantly. Twenty-two percent of
those with lower calcium intakes had
not completed high school, whereas 37
percent were high school graduates, and
41 percent had at least some college
education. Of those with higher calcium
intakes, 13 percent had not completed
high school, 35 percent were high
school graduates, and 52 percent had at
least some college education. Assessing
38
Table 1. Descriptive characteristics of women with diets meeting or not
meeting their RDA for calcium 1
Variable
Income as percent poverty
Body mass index (BMI)
Height in inches
How many dairy servings
should consume
Race
White
Black
Other
RDA age group
< 25 years
> 25 years
Education
< High school
High school graduate
At least some college
Employment status
Full time
Part time
Not employed outside home
Food Stamp household
Children present
Urbanization
City
Suburban
Nonmetropolitan
Dietary calcium
belowRDA
(n = 1,819)
345
25.2
64.0
2.2
Dietary calcium
RDA or above
(n = 442)
430
24.8
64.7
2.5
Significance
*
**
Percent
83 90
13 6
4 4
**
6 2
94 98
**
22 13
37 35
41 52
*
36 40
15 23
49 37
7 7
39 43
30 29
46 48
24 24
table continued
Family Economics and Nutrition Review
Table 1. Descriptive characteristics of women with diets meeting or not
meeting their RDA for calcium1 (cont'd)
Variable
Region
Northeast
Midwest
South
West
On weight loss diet
Take vitamin-mineral supplement
Percent food away from home
Aware of health problems
related to calcium
A void all milk
Avoid whole milk only
A void cheese
Season
Spring
Summer
Fall
Winter
Lower than usual reported intake
Higher than usual reported intake
Weekend day included in
3-day report
1Weighted data.
* p < .05.
** p < .01.
1996 Vol. 9 No.3
Dietary calcium
belowRDA
(n = 1,819)
Dietary calcium
RDAorabove
(n = 442)
Percent
21 22
23 28
37 31
19 20
6 7
35 42
22 20
65 76
17 7
47 65
17 11
26 26
26 22
24 25
25 28
29 27
14 13
55 62
Significance
**
**
**
*
employment status, 36 percent of
women with lower calcium intakes
were employed full time, 15 percent
were employed part time, and 49 per­cent
were not employed outside the
home. Forty percent of those with
higher calcium intakes were employed
full time, 23 percent part time, and 37
percent had no outside employment.
There were several differences between
the two groups in terms of knowledge
and attitudes related to calcium intake.
A significantly higher percentage of
women in the higher calcium group
were aware that there were any health
problems related to calcium intake.
They were also likely to believe they
should consume more servings from
the dairy group daily. They were more
likely to avoid whole milk only, but
less likely to avoid all milk or to avoid
cheese.
Food Group Consumption Patterns
Women whose diets met their RDA for
calcium consumed significantly more
milk and milk products than women
whose diets did not (table 2, p. 40). This
is not surprising, considering that milk
products are the major source of calcium
in the American food supply (8). Milk
products vary in their calcium concen­tration;
therefore, total intake of milk
products is reported both as grams and
as calcium equivalents (the amount in
grams of fluid whole milk that has the
same quantity of calcium as these milk
products).
39
Since the USDA/DHHS Food Guide Table 2. Mean consumption of major food groups and selected subgroups
Pyramid defines servings from the by women with diets meeting or not meeting their RDA for calcium1
Milk, Yogurt, and Cheese Group on the
basis of the calcium content of 1 cup of
Dietary calcium Dietary calcium milk (37), calcium equivalents can be
Food group belowRDA RDA or above
used to estimate intake of milk products
intakes (n = 1,819) (n = 442) Significance in relationship to Food Guide Pyramid
serving recommendations. Women in
Total milk and milk products (CaEq)2 the lower calcium group averaged an 159 559 **
intake of 159 calcium equivalents per
day from milk and milk products or Grams
approximately two-thirds of a serving
Total milk and milk products 129 463 **
from the Milk, Yogurt, and Cheese
Group. Women who met their calcium Whole milk 26 91 **
RDA obtained 559 calcium equivalents Lowfat milk 46 145 **
from milk products, or approximately Skim milk 19 121 **
2.3 servings, an amount within the 2-3 Cheese 10 20 **
servings per day recommended by the
Milk desserts 13 29 **
Food Guide Pyramid and slightly less
than the 2.5 servings per day that these Yogurt 5 20 **
women, on average, believed they Total vegetables 180 202
should consume. Dark green vegetables 11 17
Legumes 15 19
Women who met their calcium RDA
Total fruit 127 173 **
also consumed significantly more of all
of the subgroups within this category Citrus juices 45 51
that were examined. The differences Total grain products 206 281 **
were particularly striking for lowfat and Meat, poultry, fish, eggs, nuts 176 180
skim milks. Women whose diets met Fats and oils 14 16
their RDA for calcium consumed more
Sugars and sweets 15 22 *
than three times as much lowfat milk as
other women and more than six times as Total nonalcoholic beverages 798 705
much skim milk. Women whose diets Coffee 367 359
met their calcium RDA also consumed Tea 164 119
significantly more fruit, grain products, Regular sodas 146 99 **
and sugars and sweets than other Lo-cal sodas 82 78
women. Women who did not meet their
calcium RDA consumed more regular Total alcoholic beverages 31 40
sodas.
1Weighted data.
2caEq =calcium equivalents.
* p < .05.
** p < .01.
40 Family Economics and Nutrition Review
Nutrient Intakes
Women who met their calcium RDA
consumed significantly more kilocalories
than those who did not- I ,861 kcal/day
compared with I ,373 kcaVday-although
both of these levels are below the
average energy allowances recom­mended
for adult women (23). These
low intake levels may reflect some
underreporting, a problem that is known
to plague self-reported dietary intake
data (21). 1
When nutrient intakes were examined
as a percent of recommendations (RDA),
women whose diets met their calcium
RDA consumed significantly more of
all vitamins and minerals examined, as
well as protein (table 3). On average,
both groups met their RDAs for protein,
riboflavin, phosphorus, folate, thiamin,
niacin, vitamin C, and vitamin B-12.
Neither group met their RDA for zinc,
although the group who met their RDA
for calcium averaged 97 percent of their
zinc RDA, significantly higher than
those who did not meet the calcium
RDA, whose average intake of zinc
was 66 percent of their RDA. The
group who met their RDA for calcium
also met their RDAs for magnesium,
vitamin E, vitamin B-6, iron, and
vitamin A, but the other women did not.
Some of the nutrient intake differences
seen could reflect the higher average
caloric intakes of women whose diets
met their calcium RDA. However, when
the nutrient densities of the diets of the
two groups were compared, the women
1 See also the article by Riddick in this issue.
1996 Vol. 9 No.3
Table 3. Mean energy, nutrient intakes, and nutrient densities of
intakes, by women with diets meeting or not meeting their RDA for
calcium'
Variable Dietary calcium Dietary calcium
and belowRDA RDA or above
nutrient density (n = 1,819) (n = 442) Significance
Variable
Energy (kcal) 1,373 1,861 **
Percent RDA
Protein 114 156 **
Zinc 66 97 **
Magnesium 70 106 **
Iron 86 116 **
Phosphorus 103 173 **
Thiamin 106 149 **
Riboflavin 100 171 **
Niacin 118 148 **
Folate 105 156 **
Vitamin B-6 78 113 **
Vitamin B-12 186 279 **
Vitamin C 129 172 **
Vitamin A 97 170 **
Vitamin E 74 116 **
Nutrient density
(nutrient/1,000 kcal)
Protein (g) 41.9 43.0
Calcium (mg) 363.3 621.5 **
Zinc (mg) 5.9 6.6 **
Magnesium (mg) 148.8 166.4 **
Iron (mg) 7.8 8.1
Phosphorus (mg) 625.5 777.9 **
Thiamin (mg) 0.8 0.9
Riboflavin (mg) 0.9 1.2 **
Niacin (mg) 12.4 11.6 *
Folate (flg) 143.0 155.5 *
Vitamin B-6 (mg) 0.9 1.0 *
Vitamin B-12 (flg) 2.7 3.1
Vitamin C (mg) 58.8 57.3
Vitamin A (RE)2 593.1 766.5 **
Vitamin E (TE)3 4.3 5.2 *
1Weighted data.
2RE = retinol equivalents.
3-rE = tocopherol equivalents.
* p< .05.
** p< .01.
41
who met their calcium RDA were found
to have diets that were more nutrient
dense for zinc, magnesium, phosphorus,
riboflavin, niacin, folate, vitamin B-6,
vitamin A, and vitamin E, as well as
calcium (table 3). Therefore, many of
the differences in diet quality between
the two groups appear to be due to quali­tative
as well as quantitative differences
in intake.
Fat, Saturated Fat, and
Cholesterol Intakes
Women whose diets met their calcium
RDA averaged 33.7 percent kilocalories
from fat, compared with 34.3 percent
for other women; this difference was
not significant (fig. 1). Women whose
diets met their calcium RDA did con­sume
significantly more saturated fat
than other women, 12.5 percent,
compared with 11.6 percent. For both
groups, these intakes are above levels
recommended by the Dietary Guidelines
for Americans (38). Women whose
diets met their calcium RDA also con­sumed
significantly more cholesterol
than other women, although neither
group exceeded the 300 mg/day limit
recommended by the National Academy
of Sciences (fig. 2). On a density level,
there was no significant difference in
cholesterol intake between the two
groups, indicating that the difference
in absolute intake between the two
groups was primarily due to the higher
reported caloric intakes of the women
who met their calcium RDA.
42
Figure 1. Mean percent calories from fat and saturated fat by
women with diets meeting or not meeting their RDA for calcium 1
%kcal
40
34.3
30
20
10
0 L____! ___ _
1Weighted data.
•• p < .01.
Total fat
Dietary calcium below RDA
(n = 1,819)
• Dietary calcium RDA or above
(n = 442)
11.6 12.5
Saturated fat**
Figure 2. Mean daily cholesterol intakes and cholesterol
densities of women with diets meeting or not meeting their
RDA for calcium 1
Mean daily
cholesterol intake**
(mg/day)
Mean cholesterol
density
(mg/1 ,000 kcal)
1 Weighted data.
** p < .01.
0 50
[J Dietary calcium below ADA
(n= 1,819)
• Dietary calcium ADA or above
(n = 442)
100 150 200 250 300
Milligrams cholesterol
Family Economics and Nutrition Review
Sodium and Potassium Intakes
On an absolute level (mg/day), women
whose diets met their calcium RDA
consumed more sodium than did other
women; their total intake was above the
2,400 mg limit recommended by the
National Academy of Sciences (fig. 3).
On a density level, the difference was
reversed; women with lower calcium
intakes had significantly higher sodium
densities than women who met their
RDA for calcium. The difference in
absolute intake and sodium density is
probably due to the higher caloric
intakes of women who met their RDAs
for calcium. If the recommended limit
of 2,400 mg of sodium is divided by
the average Recommended Energy
Allowances (REAs) for women estab­lished
by the National Academy of
Sciences (23), women under age 51,
with a mean REA of 2,200 kcal!day,
should consume no more than 1,091 mg
sodium per 1 ,000 kcal, and women ages
51 and above, with a mean REA of
1,900 kcal/day, should consume no
more than 1,263 mg sodium per 1,000
kcal, in order to meet this recommenda­tion.
Mean sodium densities of both
women with lower and higher calcium
diets were well above those limits.
Women with higher calcium intakes
also had higher potassium intakes, but
there was no significant difference in
the potassium density of the diets of
the two groups. Neither group met the
National Academy of Sciences intake
recommendation of 3,500 mg of potas­sium
daily. In order to meet the potassium
recommendation, women consuming
their average recommended energy
allowance would have to consume at
least 1,591 to 1,842 mg potassium per
1,000 kcal, depending on their age.
Women whose diets met their calcium
RDA had potassium densities that fell
within this range, but other women did
no