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Factors Influencing Healthy Eating

Habits Among College Students: An
Application of the Health Belief Model

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Health Marketing Quarterly, 26:145–164, 2009
Copyright # Taylor & Francis Group, LLC
ISSN: 0735-9683 print=1545-0864 online
DOI: 10.1080/07359680802619834

Factors Influencing Healthy Eating Habits

Among College Students: An Application
of the Health Belief Model

SAMEER DESHPANDE, MICHAEL D. BASIL, and DEBRA Z. BASIL

University of Lethbridge, Lethbridge, Alberta, Canada

Poor eating habits are an important public health issue that has
large health and economic implications. Many food preferences
are established early, but because people make more and more
independent eating decisions as they move through adolescence,
the transition to independent living during the university days is
an important event. To study the phenomenon of food selection,
the heath belief model was applied to predict the likelihood of
healthy eating among university students. Structural equation
modeling was used to investigate the validity of the health belief
model (HBM) among 194 students, followed by gender-based
analyses. The data strongly supported the HBM. Social change
campaign implications are discussed.

KEYWORDS health belief model, healthy eating, university

students

Poor nutrition and obesity are among the most important health issues facing
society today, not only in terms of health, but also health care expenses
(Goel, 2006; Rashad & Grossman, 2004). There are a variety of predictors
of obesity including genetics, physical activity, and food consumption (Goel,
2006). There are other outcomes of food choice and nutrition that also
have an independent effect on health including some types of cancer, cardi-
ovascular disease, and diabetes (Nicklas, Baranowski, Baranowski, Cullen,

The authors wish to acknowledge financial support from the University of Lethbridge’s
Faculty of Management and the University of Lethbridge Centre for Socially Responsible
Marketing. The authors also thank the three anonymous reviewers of the 2007 Society for
Consumer Psychology Conference for their valuable comments.
Address correspondence to Sameer Deshpande, University of Lethbridge, 4401 University
Dr., Lethbridge, AB T1K 3M4, Canada. E-mail: sameer.deshpande@uleth.ca

145
146 S. Deshpande et al.

Rittenberry, & Olvera, 2001). For these reasons, food selection is an

important consumer behavior with many long-term consequences to the
individual in the form of health and longevity and to society in the form of
health costs.
Some research has shown that the most important factors predicting food
selection among adults are: taste, cost, nutrition, convenience, pleasure, and
weight control, in that order (Glanz, Basil, Maibach, Goldberg, & Snyder
1998). Many studies have shown that people often establish these tastes
and habits while they are relatively young (Birch, 1999). Evidence suggests
early establishment of habits and preferences occurs for a variety of behaviors
including media use (Basil, 1990) and music listening (Holbrook & Schindler,
1994), as well as food choice (Birch, 1999). Therefore it is advisable to begin
establishing good eating habits when people are as young as possible. Impor-
tantly, however, for the very young many food decisions are controlled by
parents and preschools (Nicklas et al., 2001). Therefore, food choice for the
youngest age groups may be constrained by a number of factors.
An especially important time of life for food choice is when people step
out independently for the first time and begin to make all of their own food
decisions. For many people, this is the transition to college life. The transition
to college or university is a critical period for young adults, who are often
facing their first opportunity to make their own food decisions (Baker,
1991; Marquis, 2005) and this could have a negative impact on students’
eating behaviors (Marquis, 2005; Rappoport, 2003).
Previous literature has extensively discussed factors that influence eating
behaviors among college students. However, application of a behavioral
model such as the health belief model (HBM) has received less attention. Only
three studies were found that applied HBM in the college eating context
(Garcia & Mann, 2003; Von Ah, Ebert, Ngamvitroj, Park, & Kang, 2004;
Wdowik, Kendall, Harris, & Auld, 2001). These studies examined avoiding
dieting, a combination of eating and exercise, and diabetic students, respec-
tively. The present study provides valuable insights into how health beliefs
impact eating behaviors for college students—a population at the crucial stage
of transitioning into independent nutritional practices.

EATING BEHAVIOR OF COLLEGE STUDENTS

Numerous studies have shown that college students often have poor eating
habits. Students tend to eat fewer fruits and vegetables on a daily basis
and report high intake of high-fat, high-calorie foods (Brevard & Ricketts,
1996; Driskell, Kim, & Goebel, 2005; Racette, Deusinger, Strube, Highstein,
& Deusinger, 2005). According to the American College Health Association
(2006), a 2004 study revealed that only 7.3% of students ate five or more
servings of fruits and vegetables daily. The transition to college life often
 Healthy Eating Habits Among College Students 147

worsens dietary habits among students (Grace, 1997) which could contribute
to weight problems especially during the first year of college or university
(Anderson et al., 2003) and continue during later years of life (Centers for
Disease Control, 1997; Racette et al., 2005).

Determinants of Eating Behavior

Previous studies have shown a link between demographic and psycho-
graphic characteristics with dietary behavior of college students. Driskell
et al. (2005) revealed few differences among lower and upper level students
in terms of their dietary habits, suggesting that habits established in the first
year or two likely carry forward into later college years. However, where a
student lives seems to affect his or her dietary habits and diet-related health
(Brevard & Ricketts, 1996). Students living off-campus reported a higher
percentage of energy from protein. Similarly, serum triglyceride level and
the ratio of total cholesterol to high-density lipoprotein were also higher
among students living off-campus. The authors conclude that students living
off campus are choosing different foods than those living on campus.
Gender differences also exist (Racette et al., 2005). Female college
students tend to eat more fatty foods than male students, although their fruit
and vegetable consumption tends to remain similar. As discussed earlier,
according to Brevard & Ricketts (1996), residence on or off campus made
a difference, but it also interacted with gender. Higher energy from protein
was more prevalent among men living off campus than on campus. For
women, higher serum triglyceride and ratio of total cholesterol to high-
density lipoprotein was found among those who lived off campus. Horacek
& Betts (1998) clustered male and female college students by dietary intake
differences. Four clusters were found: students influenced by internal
(hunger and taste) and external cues (friends and media), by budget, by
health, and neither of the factors. Males tended to be equally represented
in all the four clusters with a somewhat higher percentage in the cues group,
while female students tended to cluster in the cues group (55%) followed by
health factors (28%). In a study by Mooney & Walbourn (2001), females
avoided certain foods for their concern for weight, health and ethical reasons
(especially when avoiding meat) more significantly than males. Marquis
(2005) similarly reported that females were more significantly motivated by
convenience, pleasure, price, and weight concerns than male students. We
can thus conclude that the dietary intake of male and female college students
is influenced by different factors.
Motives influencing eating behaviors among college students have been
studied as well. House, Su, and Levy-Milne (2006) investigated what benefits
college students believed result from a healthy diet. In this study, students at a
Canadian university reported healthy eating to be helpful in providing a
healthy appearance (in terms of weight, skin, physique, and so forth),
148 S. Deshpande et al.

providing positive feelings, and preventing disease. Although the results in

this study were based on a focus group finding with 15 students (9 students
were studying to be dieticians) there are nonetheless similarities with studies
conducted among general adults (Steptoe, Pollard, & Wardle, 1995). Horacek
& Betts (1998) found that taste, time sufficiency, convenience, and budget
influenced students’ eating habits in that order. These seem to act more as
barriers to healthy eating as revealed from the focus group (House et al.,
2006). One could assume that these barriers may be more influential than
benefits given the prevalence of eating habits among college students.
Other factors associated with poor eating habits among college students
include a higher perception of stress (Cartwright, Wardle, Steggles, Simon,
Croker, & Jarvis, 2003), and low self-esteem (Huntsinger & Luecken, 2004).
Previous studies have also reported a low level of nutrition knowledge (Barr,
1984; Van den Reek & Keith, 1984). Lack of indepth nutrition knowledge has
been attributed to reliance on sources that provide inadequate information
on nutrition (Thomsen, Terry, & Amos, 1987).

The Health Belief Model

Although studies have investigated demographic and psychographic charac-
teristics of healthy eating among college students, research is lacking in
terms of comparing the effectiveness of these predictors in a single model
such as the HBM. The HBM, developed in the 1950s (Rosenstock, 1974), is
a expectancy-value model. It has been employed in a variety of public health
settings over the years. The HBM postulates that when an individual per-
ceives a threat from a disease (measured by susceptibility to the disease
and the severity of disease), and perceived benefits from preventive action
exceed barriers then the individual is likely to take preventive action. In
the HBM, demographic characteristics and cues to action moderate the
effects of the above mentioned predictors.
While three studies were found to apply the HBM to eating among
college students, their findings were less useful to the current study because
of differences in the nature of the sample or the dependent variables. One
study (Wdowik et al., 2001) applied HBM to understand how diabetic
students manage their problem and did not address the general student
population. The two student groups may differ from each other in their
perceptions of healthy diet. For example, the diabetic student population
may perceive benefits and barriers of healthy diet differently from general
student population. A second study (Garcia & Mann, 2003) employed the
model to understand how students resist dieting, not how they approach
healthy eating. Finally, a third study (Von et al., 2004) investigated the influ-
ence of HBM variables on physical activity and nutrition behavior among
other behaviors. Unfortunately, they combined physical and nutrition beha-
viors as a single measure, although the two behaviors conceptually differ.
 Healthy Eating Habits Among College Students 149

The applicability of the HBM has been reported in predicting healthy

eating among general adults (for example, Kloeblen & Batish, 1999; Sapp
& Jensen, 1998), especially nutrition behaviors (see Chew, Palmer, & Kim,
1998). However, these findings may be less generalizable to the college
student population given the differences between students and the general
adult population in terms of lifestyle, income, social environment, and food
choices available on the campus. The current study will attempt to extend the
HBM’s applicability to predicting nutrition behavior among college students.
In the present study, the HBM has been extended in accordance with the Sapp
& Jensen (1998) study to include additional variables relevant to the eating
behaviors of adults. These variables include perception of current dietary
quality, perceived importance of eating a healthy diet, and environmental
variables.

Self-Efficacy
Self-efficacy has been added to the model as well. Self-efficacy is the
individual’s perception that he or she is able to perform the advocated
behavior (Bandura, 1977). Self-efficacy has been shown to impact behavior
in several consumer behavior contexts such as response to fear appeals
(Witte, 1992) and charitable donations (Basil & Ridgway, 2002). Self-
efficacy has played an important role in predicting nutrition behavior among
college students as well (Garcia & Mann, 2003; Von Ah et al., 2004).
The central purpose of this study was to test the predictive ability of the
HBM on the likelihood of eating healthy in the next two-week period among
college students. As discussed earlier, since dietary behavior and motives
differ by gender, we also intend to test HBM independently for male and
female college students. The period of two weeks was chosen in an effort
to assure that subjects would be able to remember their eating habits.
Healthy eating was defined as ‘‘Eating a diet that is low in bad fat, sodium,
bad cholesterol and sugar and, high in fiber, fresh fruits and vegetables.’’
HBM as modified for an eating context was hypothesized to predict
college students’ intentions to eat a healthy diet. Based on the above
discussion, we propose the following hypotheses:

H1: The importance of eating healthy will be positively influenced by

dietary status, perceived severity, perceived susceptibility, and cues.
H2: The importance of eating healthy will show a negative relationship
with barriers.
H3: The importance of eating healthy will show a positive relationship
with eating intentions.
H4: Food features will positively influence barriers.
H5: Food features will negatively influence benefits.
H6: Food features will positively influence efficacy.
150 S. Deshpande et al.

FIGURE 1 Model predicting likelihood of eating healthy.

H7: Barriers will negatively influence efficacy.

H8: Barriers will negatively influence behavior intention.
H9: Benefits will positively influence behavior intention.
H10: Self-efficacy will positively influence behavior intention.

See Figure 1 for a depiction of the modified HBM.

METHOD

Students were recruited at a Canadian university. The study was conducted

by advertising $5 for those who were willing to participate in a 20-minute
survey. The final convenience sample consisted of 194 Canadian university
undergraduate students. The gender distribution was 45% female and 55%
male (n ¼ 88 and 106 respectively). Respondents were predominantly in
the 18–25 year old range, representing 84% of the sample (n ¼ 162), predo-
minantly Caucasian (75% of the sample, n ¼ 146) followed by Asians (20% of
the sample, n ¼ 38), and predominantly earning less than $24,000 (68% of the
sample, n ¼ 133). Responses to height and weight questions were used to
calculate each respondent’s body mass index (BMI). The average BMI was
23 (for reference, a BMI of 25 or more indicates an overweight person).
This research was part of a larger study containing an experiment that
manipulated participants’ hypothetical health conditions and asked them to
make food product choices. The effects of the experimental manipulations
 Healthy Eating Habits Among College Students 151

were controlled while calculating the effect of HBM variables for the present
analysis to assure that they did not impact the results.

Procedure
The study was first approved by the university’s Human Subjects Committee.
Respondents were invited to a computer lab where they first took part in the
manipulated health concern portion of the research. They then completed
the HBM survey which is the focus of the present analysis. After completing
the study they were given $5 as promised compensation and a feedback
sheet informing them of the purpose of the study.

Independent Measures
All items were measured with a 7-point bipolar scale (
3 to 3) unless
otherwise noted. Questions for most variables were derived from Sapp &
Jensen’s (1998) study. The ‘dietary status’ variable was measured with four
questions (In your opinion, was your diet in the previous two-week period
lower or higher in nutrition or was it just about right compared with Health
Canada’s recommended dietary guidelines? How healthy have your food
choices been in the last two weeks: Every meal=Never? In the course of
the previous two-week period, how often have you made good food
choices? In the course of the previous two-week period, how often have
you made good food choices: Never=Always?). These items produced an
alpha of 0.80.
Perceived severity was measured using seven items (I will miss more
than two months of school or work; I will have long-lasting effects; I will
be bed-ridden for a long time, I will have medical expenses; I will harm
my career; My social relationships will suffer; I will hurt my family life)
producing an alpha of .86. Perceived susceptibility was a single item measure
(Do you think some day you will get seriously ill if you do not make good
food choices?). The cues to action variable was measured with three items
(I would pay more attention to the quality of my food choices if I read infor-
mation in the mass media (news stories, ads, other programs); I would pay
more attention to my food choices if recommended by a doctor; I would
pay more attention to my food choices if friends or family members
suggested it) producing an alpha of .66. Importance of eating a healthy diet
was measured with two items (How important is it to you to eat a diet high in
nutrition? How important is nutrition to you when you shop for food?)
producing an alpha of .80 (r ¼ .67).
The food features variable was measured with four constructs: price,
taste, ease of preparation, and convenience (price; taste; ease of preparation;
convenience is important to me when I shop for food) producing an alpha of
0.61. Benefits of healthy eating was measured with five items (For me to eat a
152 S. Deshpande et al.

nutritious diet most of the time in the next two-week period would be
harmful=beneficial; unpleasant=pleasant; bad=good; worthless=valuable;
unenjoyable=enjoyable) producing an alpha of .84. Barriers to healthy eating
was measured with three items (I don’t like the taste of most foods that are
high in nutrition; I think it would take too much time to change my diet most
of the time in the next two-week period to include more foods high in nutri-
tion; Over the next two weeks, I think it would be too hard to change my diet
to include more foods high in nutrition) producing an alpha of .79. Efficacy
to healthy eating was measured with two items (If I tried, I am confident that
I could maintain a diet high in nutrition most of the time in the next
two-week period; If I wanted to, I feel that I would be able to follow a diet
high in nutrition most of the time in the next two-week period) producing
an alpha of .88 (r ¼ .80).

Dependent Measure
Likelihood of eating healthy’ was measured with three items, each measured
on a seven-point scale: (a) I intend to eat a nutritious diet most of the time in
the next two-weeks, Extremely Unlikely=Extremely Likely; (b) In the course
of the next two-week period, how often will you make good food choices?
Never=Every Meal; (c) In the course of the next two-week period, how often
will you make good food choices? Never=Always] producing an alpha of .82.
Discriminant validity analysis was conducted to check for the extent to
which a construct was truly distinct from other constructs. Pearson correla-
tions between independent variables were observed. None of the correlation
scores were strong enough (maximum r ¼ .52, p < .01) to warrant a merging
or dropping of constructs. Finally, to test for common method bias arising out
of having a single source of information from students, we conducted
Harman’s (1976) single-factor test (EFA) selecting varimax rotation and
principle components method with all the items across constructs. The
results revealed several factors with eigenvalues more than 1. We thus
concluded that there are many constructs available and that the items are
measuring distinct constructs, and found no evidence of a significant
common method bias.

RESULTS AND ANALYSIS

A Pearson correlation analysis was conducted with the independent and the
dependent variables. The correlation scores ranged from
.60 to .62. Later, a
structural equation model was constructed to test the modified HBM among
all three samples (all, male, and female students) using AMOS 5.0. As
mentioned earlier, the effect of the experimental manipulations were
controlled in order to get a better understanding of the effect of the modified
HBM variables. All subjects participated in the experimental study and were
 Healthy Eating Habits Among College Students 153

assigned to one of the health concern manipulations (diabetes, heart disease,

and generally good health). The control variable was allowed to covary with
every independent variable and a regression path on every dependent
variable among all three samples. The influence of the control variable
largely lacked significance. In the all student sample, the variable had a
significant influence on the likelihood to eat healthy, and had a significant
covariance with the adequacy of current diet variable. There was no signifi-
cant relationship of the control variable in the female student sample. In the
male student sample, the control variable had significant covariance only
with adequacy of current diet and the severity construct. In order to reduce
the clutter, paths of the control variable are not shown in the figures.

Total Sample
The HBM for the all students sample was identified given the good fit indices
(N ¼ 194, CFI ¼ .99, RMSEA ¼ .05). The four independent variables, dietary
status (M ¼ 4.41, SD ¼ 1.11, B ¼ 0.44, p < .01), perceived severity (M ¼ 4.85,
SD ¼ 1.22, B ¼ 0.17, p < .01), perceived susceptibility (M ¼ 5.18, SD ¼ 1.56,
B ¼ 0.16, p < .01), and cues (M ¼ 5.22, SD ¼ 1.12, B ¼ 0.22, p < .01)
significantly predicted the importance of eating a healthy diet. In turn, the
importance variable (M ¼ 5.42, SD ¼ 1.16) predicted barriers to eating healthy
(B ¼
0.39, p < .01) and likelihood to eat healthy with the regression weight
of 0.57 (p < .01). Food features (M ¼ 5.53, SD ¼ 0.90) had a significant influ-
ence on barriers (B ¼ 0.15, p < .05) and benefits (B ¼
0.14, p < .05) but no
influence on efficacy (B ¼ 0.09, n. s.). In turn, barriers (M ¼ 3.35, SD ¼ 1.50)
had a significant influence on likelihood to eating healthy (B ¼
0.14,
p < .05), while benefits (M ¼ 5.98, SD ¼ 0.91) did not (B ¼ 0.05, n. s.). Barriers
had a strong influence on efficacy (B ¼
0.74, p < .01). In turn, efficacy
(M ¼ 5.58, SD ¼ 1.30) had a significant influence on the likelihood variable
(M ¼ 5.28, SD ¼ 1.10, B ¼ 0.25, p < .01). Based on these results, we conclude
that the data supported all hypotheses except for H6 and H9. See Figure 2.

Female Sample
The HBM model was later tested for each gender. The HBM for the female
students sample was identified given the good fit indices (N ¼ 88, CFI ¼ .98,
RMSEA ¼ .07). As expected, the model was supported by the data. The three
independent variables, dietary status (M ¼ 4.55, SD ¼ 1.15, B ¼ 0.52, p < .01),
perceived severity (M ¼ 4.77, SD ¼ 1.25, B ¼ 0.27, p < .01), and cues (M ¼ 5.41,
SD ¼ 1.14, B ¼ 0.17, p < .05) significantly predicted the importance of eating a
healthy diet. But the influence of perceived susceptibility (M ¼ 5.27,
SD ¼ 1.54) on importance of eating a healthy diet was not significant
(B ¼ 0.10, n. s.). In turn, the importance variable (M ¼ 5.64, SD ¼ 1.15)
predicted barriers to eating healthy (B ¼
0.73, p < .01) and the likelihood
154 S. Deshpande et al.

FIGURE 2 Model predicting likelihood of eating healthy (all students).

to eat healthy with the regression weight of 0.82 (p < .01). Food features
(M ¼ 5.59, SD ¼ 1.01) did not have a significant influence on barriers
(B ¼ 0.15, n. s.), nor on efficacy (B ¼ 0.02, n. s.) but a significant influence
on benefits (B ¼
0.25, p < .01). In turn, barriers (M ¼ 3.28, SD ¼ 1.62) had
a significant influence on likelihood to eating healthy (B ¼
0.46, p < 0.1),
while benefits (M ¼ 6.15, SD ¼ 0.84) did not (B ¼
0.31, n. s.). Barriers had
a strong influence on efficacy (B ¼
0.55, p < .01). In turn, efficacy
(M ¼ 5.73, SD ¼ 1.19) had a significant influence on the likelihood variable
(B ¼ 0.33, p < .05). See Figure 3.

Male Sample
The HBM for the male students sample was identified with good fit indices
(N ¼ 106, CFI ¼ .97, RMSEA ¼ .06). As expected, the model was supported
by the data. The three independent variables, dietary status (M ¼ 4.30,
SD ¼ 1.07, B ¼ 0.37, p < .01), perceived susceptibility (M ¼ 5.09, SD ¼ 1.57,
B ¼ 0.23, p < .01), and cues (M ¼ 5.06, SD ¼ 1.10, B ¼ 0.16, p < .05) signifi-
cantly predicted the importance of eating a healthy diet. But perceived
 Healthy Eating Habits Among College Students 155

FIGURE 3 Model predicting likelihood of eating healthy (female students).

severity (M ¼ 4.93, SD ¼ 1.20) failed to significantly influence the importance

variable (B ¼ 0.12, n. s.). In turn, the importance variable (M ¼ 5.25,
SD ¼ 1.14) significantly predicted barriers (B ¼
0.30, p < .01) and the likeli-
hood to eating healthy with the regression weight of 0.45 (p < .05). Food
features (M ¼ 5.47, SD ¼ 0.79) did not statistically influence barriers
(B ¼ 0.07, n. s.), efficacy (B ¼ 0.14, n. s.), and benefits (B ¼ 9.71, n. s.). Simi-
larly, barriers (M ¼ 3.41, SD ¼ 1.39, B ¼
0.04, n. s.) and benefits (M ¼ 5.85,
SD ¼ 0.94, B ¼
0.01, n. s.) did not statistically influence likelihood to eating
healthy. However, barriers had a strong influence on efficacy (B ¼
1.31,
p < .01). In turn, efficacy (M ¼ 5.45, SD ¼ 1.38) had a significant influence
on the likelihood variable (B ¼ 0.39, p < .01) (See Figure 4). Comparing the
chi-square value and support for the hypotheses for the male and female
samples, it seems the model fits the female group data slightly better
(Chi-Sq. for females ¼ 18.89, Chi-Sq. for males ¼ 23.94) despite a smaller
sample size (Females ¼ 88, Males ¼ 106).
In addition, one-way ANOVA was conducted to compare the means of
the HBM variables by gender. Females had a higher intention (M ¼ 5.52,
SD ¼ 1.06) to intake a nutritious diet than males (M ¼ 5.08, SD ¼ 1.09,
F ¼ 7.80, p < .01). Among independent variables, females similarly reported
higher means than males among all variables except for severity and barriers.
However, there was a statistical difference only among three variables.
156 S. Deshpande et al.

FIGURE 4 Model predicting likelihood of eating healthy (male students).

Females reported statistically higher means for cues to action (M diff. ¼ 0.34,
F ¼ 4.54, p < .05), importance of eating a healthy diet (M diff. ¼ 0.39, F ¼ 5.50,
p < .05) and benefits from a healthy diet (M diff. ¼ 0.30, F ¼ 5.43, p < .05).
To summarize, for females, the intention to consume a healthy diet is
indirectly influenced by dietary status, severity, and cues through their effect
on importance of a healthy diet. The importance of a healthy diet also influ-
ences behavior intention through its influence on barriers. Food features
influences benefits, but benefits failed to influence behavior, while barriers
influence behavior directly as well as via its effect on efficacy. For males,
the intention to consume a healthy diet is indirectly influenced by dietary
status, susceptibility, and cues through their effect on importance of a healthy
diet, by importance through its effect on barriers, and by barriers through its
effect on efficacy.
In general, the relationship of dietary status and cues on behavior
intention via importance of a healthy diet, the relationship of importance
with behavior intention through its relationship with barriers, and the
relationship of barriers with behavior intention via the influence of efficacy
seem to hold true among both males and females. Similarly, food features
failed to predict barriers and benefits failed to predict behavior intention
 Healthy Eating Habits Among College Students 157

among both the samples. But males and females differed on other variables.
The severity construct among males and susceptibility among females failed
to influence importance of eating a healthy diet. Food features of price, taste,
ease of preparation, and convenience while shopping for healthy food
negatively influenced benefits among females, but not among males.
Finally, barriers significantly and negatively influenced behavior
intention among females but not among males. The barriers construct
included two important items of taste and time sufficiency. As Marquis
(2005) suggested, these issues matter to females.

DISCUSSION

Summary of Findings
These results make an important contribution to our understanding of
student health behavior. Previous research is extended by incorporating
important additional variables into the HBM. This research focused on an
important population which is at a key crossroads in nutritional health. The
HBM was helpful in predicting the variance in likelihood of healthy eating.
Since eating behaviors and reasons for eating vary by gender (Dutta-Bergman,
2005), we also investigated how these factors varied by gender. The results of
this study demonstrate potential mechanisms by which these gender
differences occur. In a study conducted among the general population,
Kristal, Hedderson, Patterson, & Neuhauser (2001) argue that efforts need
to target men. Since male students reported a lower intention to consume a
healthy diet than did females, our research supports this contention.
Our findings were similar to other college studies in terms of influence
of variables such as perceived severity (Mooney & Walbourn, 2001), and effi-
cacy to eat healthy (Garcia & Mann, 1003; Von Ah et al., 2004). Some find-
ings bear a close resemblance with the Sapp & Jensen (1998) study
conducted with the general population. The influence of gender, dietary
status, importance of a healthy diet, food features, and cues to action on
the intention to eat healthy in our study was similar to their study. Despite
similarities with earlier research this study found no significant effects of
the food features such as price, taste, ease of preparation, and convenience
on barriers, efficacy, and thus the likelihood to eat a healthy diet. Although
the mean was strongly positive (M ¼ 5.53 among all student sample), the
food features variable did not have a significant influence. Given the student
lifestyle (Belaski, 2001), preference, and findings reported by Horacek &
Betts (1998) & Marquis (2005), food features were expected to have a strong
influence on healthy eating. But surprisingly, that was not the case. It is
likely that other factors may after all play a more important role in influen-
cing healthy diet. HBM has allowed us to understand the comparative
influence of various factors.
158 S. Deshpande et al.

Recommendations for Social Change Strategies to Promote

Healthy Eating Among College Students
A variety of social change campaigns could be employed to promote healthy
eating among university students. Since the HBM revealed a few important
differences by gender, males and females deserve tailored campaigns.
For females, the campaign should highlight the severity of not eating a
healthy diet, while the one targeting males should focus on increasing their
perceptions of susceptibility. To achieve these objectives, an education
campaign would be an important tool to employ. In terms of appeals, a com-
bination of fear (highlighting negative consequences among women and
susceptibility among men) and efficacy could be appropriate. A combination
of fear and solution approach has been shown to be effective (Witte, 1992).
Use of food labels, another form of communication-only tool, does
influence dietary habits, but in a conditional manner. According to Kristal
et al. (2001), individuals who use labels report reductions in fat intake but
not an increase in fruits and vegetables simply because one can read
nutritional facts of processed foods but not fruits and vegetables. When used
as point-of-purchase (POP) messages, labels have shown less effectiveness
among students, especially when competing with more attractive commercial
messages in the university cafeteria (Mayer, Dubbert, & Elder, 1989). POP
interventions have been used in the past to promote a healthy diet, but with
mixed results (Buscher, Martin, & Crocker, 2001). POP interventions
increased yogurt, pretzel, and whole fruit sales but had no effect on fruit
basket and vegetable basket sales. According to the authors, effective POP
displays emphasize budget friendliness, sensory=taste, convenience, and
energizing properties of food. Placement of POPs is also critical. The
researchers found that POP messages placed at the entrance of the food-
service facility were more effective than keeping them near the healthy
food items. POPs can also be used as reminders to ensure sustainability of
interventions (Maddux, 1993).
Successful attempts have been made to influence healthy eating when
offered in the form of a nutrition course (Matvienko, Lewis, & Schafer,
2001). But in many cases, awareness creation by itself may not be an effective
technique (Brown, Dresen, & Eggett, 2005; Schnoll & Zimmerman, 2001),
especially while addressing the influence of efficacy to eat healthy. For exam-
ple, a study conducted by Schnoll & Zimmerman (2001) incorporated the
self-regulation strategies of goal-setting and self-monitoring in a nutrition
course. Goal-setting by itself and in combination with self-monitoring had
a positive impact on self-efficacy to consume and consumption of dietary
fiber. In other campaigns, when promotion (that is newsletters and e-mails)
was combined with motivational interviews, the campaign seemed to have a
positive impact on fruit and vegetable consumption among college students
(Richards, Kattelmann, & Ren, 2006). Additionally, while reaching women,
 Healthy Eating Habits Among College Students 159

studies have shown the effectiveness of a counseling approach (Leslie &

St. Pierre, 1999).
To address the influence of barriers and efficacy by promoting tasty but
healthy food with convenience on and off campus, employing the social
marketing approach could be effective. Social marketing applies marketing
principles to encourage voluntary behavior change, and a key element of
social marketing is to offer attractive alternatives in the environment. Since
barriers influenced behavior intention among females, a survey identifying
those barriers should be conducted followed by employing a social
marketing campaign that would reduce these barriers by altering the
environmental factors on the campus. These efforts will hopefully also increase
efficacy among female students. For males, a social marketing campaign would
also be desirable but the focus ought to be explicitly on increasing efficacy.
We found very few attempts that used a social marketing approach to
promote healthy diet behavior among college students. Buscher et al.
(2001) was one of them. They tested the effectiveness of product and place
intervention (ensuring easy availability of vegetables, fruits, pretzels, and
yogurt) along with promotional POP messages in the cafeteria. As discussed
earlier, the study found that sales of yogurt, pretzels, and whole fruit
increased as a result of the intervention. We commend the Buscher et al.
study because they considered promotion of products, a variety of products,
products that are desirable and those that compete with junk food options.
The intervention also ensured availability of intervention products, pro-
motional tools that emphasized positive qualities of products rather than
focusing on creating fear, and in general a strong consumer orientation. This
may have resulted in a successful intervention.
Previous studies have recommended the use of prepaid meal plan (Brown
et al., 2005) and seeking cooperation of food service administrators (Leslie &
St. Pierre, 1999) especially for on-campus food offerings. Buscher et al.
(2001) has also recommended dieticians to work with food service administra-
tors for better offering of meals on campus. Availability of healthy food will
reduce the perception of barriers of eating a healthy diet. According to Marquis
(2005), convenience has two dimensions, time and energy, in preparing
healthy food. Both these dimensions may warrant differing strategies
among college students. Strategies such as meal sharing and meal preparation
sharing as suggested by Sobal & Nelson (2003) could address these barriers.
A meal plan intervention study (Beth Brown et al., 2005) influenced
students’ intake of food groups. Participants reported more favorable intake
of vegetables, fruits, and meat. This study also revealed significant interaction
of meal plan participation with gender. Males more favorably responded to
the meal plan than females in relation to intake of meat and vegetables.
Other features such as attractive packaging and branding of healthy food
to deal with similar strategies utilized by the competitors would be critical
(Belaski, 2001).
160 S. Deshpande et al.

Tailored education campaigns should use student input in order to

be effective (Cousineau, Goldstein, & Franko, 2004), use computer and Inter-
net technology (Cousineau et al., 2004; Hanauer, Dibble, Fortin, & Col, 2004)
and peer networks (Kessler, Gilham, & Vickers, 1992) to reach the intended
audience. Ohio State University, for example, has utilized the Internet to pro-
vide nutritional information about food on campus (Belaski, 2001). While
addressing students, use of appropriate media (mass as well as non-mass
media options) and the messenger should be borne in mind since external
cues played an important role in our HBM model.

LIMITATIONS AND FUTURE RESEARCH

The main limitation of this study is that the experimental manipulation may
have influenced students’ perceptions and heightened the importance of
eating healthy. However, the relationship of the control variable (experi-
mental manipulation) was significant with very few variables among all three
samples, reducing the concern of this extraneous variable. Second, this study
was conducted only on one campus, using convenience sample, and within
one culture. Testing the influence of these factors on other campuses and a
more representative sample would increase the generalizability of the study.
Nutrition habits and predictors may vary by geographical location and this
could influence the tendency to eat healthy. Third, our dependent variable
on intention to eat healthy was asked at a global level. This may have
prevented us from understanding the predictors unique to each food group.
Studies for example by Brown et al. (2005) showed how a prepaid meal plan
had a differential effect on each food group.
The moderate to high averages of many variables could be a result of
social desirability, nevertheless many of these results are consistent with
other studies. The zero-order correlation score of likelihood to eat healthy
with a few variables such as barriers and benefits are much higher than their
standard regression weights. This could be because there is a third variable
moderating the influence. Future research could be conducted to investigate
this. Finally, in relation to factor analysis, two limitations are noted. First, the
alpha level for cues to action and food features were under the .70 ceiling
typically regarded as the minimum acceptable level. Second, importance of
eating healthy, and perceived susceptibility, scales were formed on the basis
of one or two items. Future studies should investigate these constructs with
multiple items to provide higher reliability.
The Kristal et al. (2001) study conducted among an adult population
showed that stage of change was one of the strongest predictors of decreased
fat intake. Individuals in the maintenance stage were highly likely to change
their diet. Richards et al. (2006) study showed favorable influence of tailoring
messages by stages of change of students on their consumption of fruits and
 Healthy Eating Habits Among College Students 161

vegetables. It might be worthwhile to understand the predictors using HBM

at various stages. This would also enable campaign managers to better tailor
their campaigns appropriately.
As a follow up study, it would be useful to compare the influence of
each social change strategy (education only, education combined with coun-
seling, and social marketing) in influencing students’ healthy eating habits.
This will enable campaign managers to effectively appropriate funds. Two
surprising results were that food features failed to influence barriers and, sec-
ondly benefits failed to influence behavior intention. Future studies should
investigate the nature of these relationships, or lack thereof. Since efficacy
played an important role in influencing the behavior intention and showed
a significant relationship with the barrier variable, future studies should
investigate the role of two types of efficacy as discussed by Witte (1992):
self-efficacy and response-efficacy.

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