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JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 62, NO. 8
Major Article
Factors Related to the Number of Fast Food Meals
Obtained by College Meal Plan Students
Deirdre A. Dingman, DrPH; Mark R. Schulz, PhD; David L. Wyrick, PhD;
Daniel L. Bibeau, PhD; Sat N. Gupta, PhD
Abstract. Objectives: This study tested whether days on campus,
financial access through a meal plan, and health consciousness
were associated with number of meals that college students
obtained from fast food restaurants. Participants and Methods:
In April 2013, all students currently enrolled in a meal plan were
invited to participate in an online survey (N D 1,246). Students
were asked to report the total number of meals eaten in the past
week and where they obtained them. Results: Negative binomial
regression was used, and it was found that the number of meals
obtained from fast food restaurants was positively associated with
financial access and negatively associated with health consciousness. An association between days on campus and the number of
meals obtained from fast food restaurants was not found. Conclusions: Increasing levels of health consciousness and reducing
access to fast food restaurants through flex plans may reduce
college students’ consumption of fast food.
week,6 and some consume as many as 6 to 8.7 In one Vermont study, college students ate fast food 70% more often
than non–college-attending adults within the same
community.8
High rates of fast food patronage can be problematic
because the consumption of fast food meals has been associated with a diet that is high in calories, saturated fat,
sugar, and sodium,9 as well as body fatness, weight gain,
and increased body mass index (BMI).5,10,11 The link
appears to be a lack of compensation for the high calories
consumed from the restaurant meals. A typical fast food
meal contains more than 800 calories,12 which for most
adults exceeds 30% of their daily calorie needs (ie, if a person ate 3 times a day and required 1800 to 2000 calories a
day, they would consume 400 to 600 extra calories because
they did not adjust their later intake).13 For example, a
study of adolescents found that when they ate fast food,
they did not compensate for the excess calories later in the
day and had a net increase in calories, saturated fat, and
sugar compared with days that they did not eat fast food
meals.14 Gerend6 found that both male and female college
students ordered fast food meals that were in excess of 900
calories when they ordered from an online menu. It is possible that college-aged students will not make caloric compensations after eating fast food meals.
Although frequent consumption of fast food meals by
college students appears to put them at risk for obesity,
there are gaps in our knowledge of what predicts fast food
consumption among college students. One body of research
suggests that fast food availability as measured by proximity to the restaurants and geographical density of the restaurants is a main driver of fast food meal consumption.5,10,11
Research on primary schools and children15 and home environments and adults16 helped to establish this link. It is
highly plausible that the relationship or mechanism of
effect exists for college students because of fast food
Keywords: college students, fast food, meal plans, obesity
C
ompared with other adults, young adults (aged 20
to 39) consume the most fast food.1 Young adults
obtain about 15% of their calories from fast food
meals, whereas adults between the ages of 40 and 59 obtain
10.5% of their calories from fast food meals, and those
aged 60 and older only 6%.1 (As per the literature,2–5
throughout this article and in our study, we include pizza
restaurants in the category of fast food.) Studies specific to
college students, many of whom are in the 20 to 29 age
group, show that most consume at least 1 fast food meal a
Dr Dingman, at the time of the study, was with and Dr Schulz,
Dr Wyrick, and Dr Bibeau are with the Department of Public
Health Education, School of Health and Human Sciences, at The
University of North Carolina at Greensboro in Greensboro, North
Carolina. Dr Gupta is with the Department of Mathematics and
Statistics, College of Arts and Sciences, at The University of North
Carolina at Greensboro in Greensboro, North Carolina.
Copyright Ó 2014 Taylor & Francis Group, LLC
562
Fast Food Meals Obtained by College Meal Plan Students
restaurant availability while on campus, but empirical studies are lacking in this particular population.
Fast food availability in a home or school environment is
an environmental factor that may contribute to fast food
meal consumption and obesity. Bonne-Heinoen et al16
found a positive relationship between the number of fast
food restaurants within a 0.5 mile radius of a person’s
home and the number of times a person had eaten at a fast
food restaurant in the past week, whereas others have found
that nearness to 1 or more fast food restaurants is associated
with weight gain, percent body fat,15 and BMI.17,18 Some
researchers use fast food restaurant proximity and density
as a measure of exposure and find that exposure to fast food
restaurants at home and work increase the risk for obesity.18
Another factor that has been associated with the number
of fast food meals consumed by people in general and college students specifically is the financial accessibility of
fast foods. The affordability of foods is associated with
meal choice and foods sold from fast food outlets tend to
contain ingredients that are cheaply available such that
meals sold there are also inexpensive.19 However, fast food
access through meal plans is a newer phenomenon.20 Driskell et al7 found that cost was one of the main factors influencing dining choice in a sample of college students, and
college students interviewed by Nelson et al20 noted that
the low cost of meals as well as access through meal plans
were reasons to dine at fast food restaurants. Nelson et al20
did not quantitatively examine the use of meal plan dollars;
however, a recent study regarding secondary schools found
that students enrolled in school lunch programs that accept
debit cards consumed higher calorie diets than those that do
not accept debit cards.21 College meal plans offer similar
prepaid cards, which allow students to pay for a fast food
meal with a swipe. These plans increase a cardholder’s
financial access to meals in 2 ways: first, there is no time of
purchase financial outlay, and second, the dollars on the
card will go further when spent on cheaper meals.
“Flex dollars,” as the external meal allowances are
sometimes called, marry 2 of the most prominent factors
related to fast food consumption: cost and convenience,7,22 and are available at many colleges. The campus where the current study was conducted provides
access to 6 on-campus and 2 off-campus fast food restaurants and allows students to purchase meals from them
with their meal plan flex dollars. This arrangement is
similar to other large or mid-sized universities. These
university meal plans typically include a fixed number of
unlimited dining hall meals, per week or semester, and
varying amounts of flex dollars. It is possible to purchase
a meal plan that does not include any prepaid dining hall
meals (ie, a plan with only flex dollars). Flex dollars can
be spent in the dining hall or at participating restaurants
on or near campus. Flex dollars are a means of financial
access to fast food meals and may be a factor related to
consumption of them for college students. To our knowledge, no studies have examined access to fast food specifically through university meal plans and the amount of
VOL 62, NOVEMBER/DECEMBER 2014
flex dollars on university meal plans. We consider flex
dollars as a proxy for financial access in our study.
A third factor that may be associated with the number of
fast food meals that college students and other adults consume is individual level of health consciousness, or how
much a person adheres to dietary guidance on limiting calories and other nutrients that may be harmful in excess (eg,
saturated fat, added sugar).9 Ellison et al23 found that
adults, including college students, who are health conscious
(ie, limit fat and calories and regularly read food labels) are
less likely to consume high amounts of calories at restaurants. It is possible that health conscious people would also
limit their consumption of fast food meals, as a recent
national survey found that 86% of adults thought food
served at fast food restaurants was either “not too good for
you,” or “not at all good for you.”24
The goal of our research was to test whether the number
of fast food meals obtained within the last week was associated with (1) the number of days spent on campus in the
last week (we chose this measure because each time a student is on campus he or she is in an environment with high
fast food restaurant availability (6 restaurants within 0.33
square miles), (2) financial access (as indicated by the
amount of flex dollars on a purchased meal plan), or (3) the
students’ level of health consciousness.
We hypothesized that students who spent more time on
campus and students with more financial access through
flex dollars would obtain a greater total number of meals
from fast food restaurants than other students. By contrast,
we hypothesized that students with higher levels of health
consciousness would obtain fewer meals from fast food restaurants than other students. With regard to days on campus
and flex dollars, we expected these to be associated with
fast food meals obtained from on-campus restaurants. We
did not expect days on campus or flex dollars to influence
fast food meals obtained off campus because we expected
that both factors (ie, a cluster of restaurants and meal plan
access) were unique to the campus environment. To test
these hypotheses, we analyzed total fast food meals, oncampus fast food meals and off-campus fast food meals
separately.
METHODS
Subjects and Procedures
This study took place on the campus of a large, southeastern public university with a 2012 enrollment of over
18,000 students. The majority of students on the campus
are female (65%) and white (61%), with an additional 23%
of students identifying as black and 16% as another race or
ethnicity (Hispanic, American Indian, Asian, multiracial).
Twenty-four percent of enrolled students live in campus
housing.
The university provides access to several food venues
that accept meal plan flex dollars. This includes 6 on-campus fast food restaurants, 2 off-campus fast food restaurants, 5 other on-campus venues (eg, the university dining
563
Dingman et al
hall, convenient stores, mini-market), and 1 off-campus sit
down/table restaurant. Before beginning the study, the
research team received approval for all study materials and
methods from the university’s Internal Review Board.
At the start of the second week of April 2013, we invited
students currently enrolled in a university meal plan to
complete a brief, Web-based survey (N D 5,441). The survey was available for 3 weeks, and as an incentive students
could enter a drawing for 1 of 5 $100 gift cards. We
received 1,246 surveys (24% response rate). The response
rate by meal plan type was similar to rates of meal plan
enrollment (eg, 32% of meal plan students were enrolled in
the unlimited dining hall plan and 29% of the students who
completed the survey had the unlimited meal plan). The
main purpose of the survey was to identify where the students obtained the meals that they consumed the week
before; therefore, we excluded 191 persons who did not
provide any venue information about their meals. We
included only cases where the student recorded at least 1
meal per day and no more than 10 meals per day (ie, a total
of 7 to 70). This led to the removal of 82 additional cases.
Our final sample size for analysis was 973. The majority of
respondents were female (81%), self-identified as white
(54%), black (31%), or Latino, Asian, and other (15%),
were full time students (97%), and lived in campus housing
(81%). The majority of students were 18 (15%), 19 (30%),
20 (25%), and 21 (16%) years old, with a range of 18 to 64.
Measures
Dependent Variables
We asked students to report the number of breakfast,
lunch, dinner, and other meals they had eaten in the past
7 days, not including times when they only had a beverage.
Students were then asked follow-up questions about how
many of these meals came from each of 9 different venues.
This study focused on 2 venues: “fast food place that serves
mostly fried foods, burgers, or chicken,”3,16 and “pizza restaurant with delivery or counter service.” We created 3 variables to indicate the number of fast food meals obtained in
total, from on-campus venues and from off-campus venues.
Predictor Variables
We hypothesized that days on campus (ie, fast food restaurant availability), flex dollars, and health consciousness
would be associated with the number of meals obtained
from fast food restaurants.
Number of days on campus. We asked students,
“During the past 7 days, how many days did you spend
time on campus (0 to 7 days)?” (We were unable to use
multiple campuses with varying levels of fast food availability for this preliminary study; therefore, we varied dose
by measuring the number of days a student was in this environment with close proximity to a number [6 within 0.33
564
square miles] of fast food restaurants. Our study is similar
to others25,26 in that it assumes that the sample was in fact
exposed to the restaurants when they were in the particular
environment.)
Number of flex dollars on the meal plan. We operationalized financial access as the number of flex dollars on a
purchased meal plan, which ranged from $100 to $1,050
across 9 available meal plans. We rescaled this variable as
hundreds of dollars (ie, each unit increase D $100 not $1).
Health consciousness. We operationalized (dietary)
health consciousness using a modified version of Ellison
et al’s health consciousness scale.23 The original scale contained 3 items. It asked respondents to rate how much each
of 3 statements is like them (ie, “I try to monitor the number
of calories I eat in a day,” “I try to avoid high levels of fat in
my diet,” and “I spend time looking at nutritional labels
when shopping for my food.”) Due to recommendations for
Americans to specifically limit saturated fat intake,9 we
added 1 item, “I try to avoid high levels of saturated fat in
my diet.” Responses ranged from 0 “not at all like me,” to 3
“exactly like me.” We averaged all 4 health consciousness
items (a D .88).
Control Variables
To examine financial access specific to the meal plan flex
dollars, we controlled for income and asked students how
many hours they worked each week for pay (“none,” “10 or
less,” “11 to 20,” “21 to 32,” “more than 32”). We recoded
work hours at the mean (ie, 0 D 0, 1 D 5, 2 D 15, 3 D 26)
and capped it at 4 D 33, as only 2% of our sample chose
this category. We used work hours as an interval variable.
To examine the amount of flex dollars, separate from other
factors that may be related to the meal plans, we included
variables indicating the number of years a student had been
enrolled at the university, the number of dining hall meals
(nonflex) included on their meal plan (ie, meal allowance)
and whether or not the student lived on campus. (We controlled for campus housing in order to partial out its association with days on campus. In a partial correlation analysis,
the relationships between days on campus and on-campus
fast food restaurant meal purchases and days on campus
and off-campus fast food restaurant meal purchases were
significant but attenuated when controlling for living in
campus housing. The bivariate relationship between days
on campus and total fast food restaurant meal purchases
was not significant.) We asked students the number of years
they had been enrolled (0 to 5C years), to select their meal
plan type, and to indicate their living arrangement. We created a meals per week variable that ranged from 0 to 24
meals per week (24 per week is 3.5 meals per day) and a
dummy variable indicating whether the student lived in
campus housing (campus housing D 1). Years of enrollment was included because as years increase, residential
students receive more flexibility in which meal plan they
JOURNAL OF AMERICAN COLLEGE HEALTH
Fast Food Meals Obtained by College Meal Plan Students
can purchase, but all residential students must purchase a
meal plan. With time, students are able to purchase plans
that have less dining hall meals and more flex dollars.
We controlled for stress because it has been associated
with overeating and consuming calorically dense meals.25
To measure stress, we used an item from the National College Health Association.26 We asked, “In the past 7 days,
how would you rate the overall level of stress you have
experienced?” (0 D no stress to 4 D tremendous stress).
We modified the question to ask about the past 7 days
instead of the past year. Studies have also shown differences in fast food consumption by race27 and sex.4 We asked
students to identify their sex (Female D 1). Lastly, we
asked students with which race or ethnicity they identified
(“black or African American,” “white or European American,” “Latino[a],” “Asian,” and “other”). We used white as
the referent category in our regression models and grouped
Latino(a), Asian, and other into the other category based on
low percentages in each.
Statistical Analysis
We completed analyses with the statistical software program IBM SPSS Statistics version 20 (IBM Corp., Armonk,
New York). We provide descriptive statistics, including
means (SD) and medians, for our main study variables, and
bivariate correlations between our predictor and dependent
variables.
The number of meals obtained from fast food restaurants
was a count variable. The data were over dispersed (ie, the
mean did not equal the variance), making them a better fit
for a negative binomial distribution rather than the Poisson
distribution.28 The dependent variable was log transformed
during the regression analysis. We exponentiated or back
logged the betas for easier interpretation (eg, an exp(b) of
1.15 indicates a 15% increase in the number of meals
obtained for every unit increase in the related factor; the
exp(b) is the incident rate ratio).
RESULTS
The median total number of meals obtained from fast
food restaurants was 3 (range D 0 to 32). Table 1 displays
additional information on the meals obtained as well as
descriptives for our main study variables.
We present the bivariate correlations in Table 2. Days
on campus was positively associated with fast food
meals obtained on campus (r D .11, p < .001) and negatively associated with those obtained off campus (r D ¡.23, p < .001). Given these opposite associations, there was no bivariate relationship between days on campus and total fast food meals obtained. The amount of flex dollars on a meal plan was positively associated with fast food meals obtained in all situations and health consciousness was negatively associated with number of fast food meals. We tested whether days on campus, flex dollars, and health consciousness were associated with the number of meals that college students obtained from fast food restaurants with 3 negative binomial regression models. We used the following as covariates: race, sex, residential status (campus housing), stress level, hours worked for pay, meal allowance, years of enrollment, and total meals eaten in the past 7 days either on campus, off campus, or both. We present the exponentiated betas, SEs, and confidence intervals in Table 3. Days on Campus We found no significant association between the number of days spent on campus and the outcome variables (ie, total fast food meals (exp ... Purchase answer to see full attachment

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