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Self-Perceived Eating Habits and Food Skills of Canadians
Research Article Self-Perceived Eating Habits and Food Skills of Canadians Joyce J. Slater, PhD; Adriana N. Mudryj, MSc ABSTRACT Objective: This study identified and described Canadians’ self-perceived eating habits and food skills through the use of population-based data. Design: Data from the Canadian Community Health Survey 2013 Rapid Response on Food Skills was used to examine the eating quality and patterns of Canadians. Data were collected from all provinces in January and February 2013. Main Outcome Measures: Respondent variables (sex, age, Aboriginal/immigrant status) were examined to assess differentiations between socio-demographic groupings (family structure, marital status, education, and income). Analysis: Logistic regression was used to determine whether demographic variables increased the likelihood of certain responses. Results: Forty-six percent of Canadians believe they have excellent/very good eating habits, with 51% categorizing their habits as good or fair. Similarly, the majority report having good food skills. Sex and age were significantly associated with food skills, with women rating their cooking skill proficiency higher than men (72% vs 55%), and older Canadians reporting higher food skill knowledge than their younger counterparts. Conclusions and Implications: Results indicate that while portions of the Canadian population have adequate food skills, others are lacking, which may negatively impact their diet. Findings from this study have implications for education and health promotion programs focusing on foods skills, particularly among vulnerable target groups. Key Words: health surveys, food skills, eating habits, Canadian Community Health Survey (J Nutr Educ Behav. 2016;48:486-495.) Accepted April 24, 2016.
INTRODUCTION The rapidly growing rates of obesity and related chronic disease in global populations1,2 have prompted many public health and education experts to examine dietary and food behavior patterns3,4 and the role of food skills in protecting nutritional health.5-9 Eating patterns in industrialized countries, and increasingly around the globe, have been shifting in recent decades to include disproportionate amounts of highly processed convenience foods,4,10 the majority of which have
low nutritional profiles.11 The increased intake of ultra-processed foods is linked with rising obesity rates.12,13 The high use of ultraprocessed foods has also been implicated in reduced domestic food preparation time, creating a cycle of dependence on convenience food products and a decline in basic food skills.14,15 Possessing adequate food skills, or having the capabilities to plan, select, prepare, and consume food, has been proposed as a protective quality against obesity and nutrition-related
Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada Conflict of Interest Disclosure: The authors’ conflict of interest disclosures can be found online with this article on www.jneb.org. Address for correspondence: Joyce J. Slater, PhD, 409 Human Ecology Building, Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada; Phone: (204) 474-7322; Fax: (204) 474-7593; E-mail: joyce.slater@ umanitoba.ca Ó2016 Society for Nutrition Education and Behavior. Published by Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.jneb.2016.04.397
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chronic disease. While still an emerging concept, some studies have shown that having better food skills is associated with better diet quality16,17 and may help some food-insecure individuals.18 Having sufficient food skills may allow individuals to have more control over their diet by preferentially selecting and preparing basic foods with favorable nutrition profiles.19 More research, however, is needed to empirically demonstrate the linkages between food skills and diet quality. The steady and steep increase in the consumption of highly processed foods in recent decades, coinciding with increased rates of obesity and chronic disease, suggests that this is an important area that warrants examination.10,11,20 The purpose of this study was to identify and describe Canadians' selfperceived eating habits and food skills through the use of population-based data from the Canadian Community Health Survey Rapid Response on Food Skills (CCHS).
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016
METHODS Setting and Participants The CCHS is a federal cross-sectional survey aimed at providing health information at the national and provincial levels. Beginning in 2007, major changes were made to the survey design and as a result, data collection now occurs every year (although a ‘‘cycle’’ is now considered to be a 2-year period).21 The rapid response component is offered to organizations interested in national estimates on an emerging or specific issue related to the population's health.22 This research is based on results from Parts 1 and 2 of the CCHS 2013 Rapid Response on Food Skills, which collected data from a nationally representative sample of Canadians $ 12 years of age in all 10 provinces. Data collection took place across the country in January and February of 2013. Interviewers from Statistics Canada, a government agency that produces statistics to better understand the population, administered questions related to meal preparation, the amount of basic versus processed ingredients used, cooking and kitchen skills levels, time spent on food preparation, frequency of family meals, and children's participation in household food activities. The addition of these questions to the Canadian Community Health Survey Annual Component was sponsored by the Office of Nutrition Policy and Promotion, Health Canada. In total, 10,098 respondents completed Part 1 (which assessed knowledge, planning, and transference of skills) and 10,701 completed Part 2 (which focused on mechanical skills and food conceptualization). The overall response rate was 67.3%.22 Further details as well as the questionnaire can be viewed on the Statistics Canada website.21 Research for this study was conducted at the Manitoba Research Data Centre and is consistent with Research Ethics Board Requirements. Data were accessed in a secure environment and all output was first reviewed by Statistics Canada to ensure disclosure avoidance before release.
Measures This study focused on the self-rated behaviors of Canadians regarding their
eating habits, meal preparation practices, ingredients used in cooking, and kitchen skills as well as grocery shopping routines and meal adjustments. Self-reported eating habits were ranked as ‘‘excellent or very good,’’ ‘‘good or fair,’’ or ‘‘poor.’’ Similarly, self-assessment of the respondent's mechanical skills (ie, cutting, peeling, baking from a recipe or from scratch) were ranked by the respondent on a scale ranging from ‘‘very limited’’ to ‘‘very good.’’ Respondents were also asked to classify their cooking skills and meal preparation habits on the basis of categories chosen by Statistics Canada. This took into account the types of foods most often used in the meal of the day that required the most preparation (ie, whole/basic foods, easy-to-prepare items, or take out/delivery) as well as their ability to cook from basic ingredients, and the proportions of respondents falling into these categories were calculated. The food skills component asked respondents about grocery shopping habits, inquired about grocery budgeting and use of grocery lists, and whether or not respondents made choices by using Canada's Food Guide to Healthy Eating (CFGHE) when choosing and purchasing ingredients. Additionally, respondents were also asked if they had ever adjusted a recipe to make it healthier, and, if so, were asked how this was done (ie, reducing salt, sugar, or fat content, etc).22 Demographic variables such as sex, age, and education status were used to assess the variability of these practices across Canada, and key variables were examined to assess differentiations between various socio-demographic groups. Descriptive statistics were used to describe differences between sexes, in addition to Aboriginal status (being of First Nations, Metis, or Inuit as well as those with Registered or Treaty Indian status), immigrant status, and comparisons between family structure, and other characteristics were observed by looking at marital status and respondent and household education. Income was also examined as a factor, splitting respondents into 4 groups on the basis of their household income. Individuals with invalid responses, such as ‘‘refusal to answer,’’ ‘‘don't know,’’ or ‘‘not applicable,’’ were excluded from the study.
Slater and Mudryj 487
Statistical Analysis Cross-tabulations and chi-square testing were performed to compare proportions among demographic groups. Logistic regression was used to determine whether any of the aforementioned demographic variables increased the likelihood of certain practices such as recipe adjustment and grocery planning. Odds ratios were calculated and the significance level was set at P < .05 for differences and .05 < P < .10 for trends. Reference groups were chosen on the basis of hypotheses that certain characteristics (such as higher income or education) may be linked with enhanced food skills. All analyses were performed with the use of PASW SPSS Statistics (version 13, IBM Corp, Armonk, New York) and STATA Statistical Software (version 22, StataCorp LP, College Station, Texas). Because the CCHS uses a multi-stage, stratified, complex survey design and requires a complex formula to calculate variance estimates, Statistics Canada recommends using bootstrapping to estimate distribution from a sample's statistics. Bootstrapping is an approach used to estimate distribution from a sample's statistics. It can also be defined as ‘‘sampling within a sample’’ and involves the selection of random samples known as replicates and the calculation of the variation in the estimates from replicate to replicate.21 The bootstrapping method was used in all the data analyses for the present study via STATA software. As well, the sampling error of the estimates from the CCHS (quantified by the coefficient of variation, or CV) must be taken into consideration when using CCHS data. When the CV is between 16.6 and 33.3, the estimate should be interpreted with caution because of high variability.
RESULTS The majority of respondents reported having good eating habits, with almost half reporting ‘‘excellent’’ or ‘‘very good’’ and more than half reporting ‘‘good’’ or ‘‘fair.’’ Older respondents (65 years and over) were more likely (P < .05) to report ‘‘excellent’’ or ‘‘very good’’ eating habits than those 12–29 years of age. Female respondents
Meal Preparation Habits
Eating Habits
Demographic Characteristics Overall
Cooking Skills
Mostly I Can Prepare Easy-to-Prepare, Mix of I Can Prepare Simple Meals, Boil Ready-to-Eat, Easy-to-Prepare an Egg, or Cook Most Dishes, Especially Takeout, or Foods and Whole/ Mostly Excellent/ If I Have a Recipe a Grilled Cheese Delivery Basic Very Good/Fair Poor (%) Whole/Basic to Follow (%) n Sandwich (%) n Foods (%) n Foods (%) n Foods (%) n Good (%) n (%) n n 46 (4,765) 51 (5,165) 3 (295) 75 (7,690) 20 (2,000) 5 (535) 21 (2,040) 63 (6,815)
Sex Malea Female
44 (2,065) 48* (2,700)
53 (2,455) 48* (2,710)
3 (140) 4 (155)
72 (3,390) 78* (4,300)
Age 12–29 ya 30–44 y 45–64 y 65þ y
41 (955) 45* (800) 46* (1,540) 56* (1,475)
55 (1,255) 52 (1,035) 50 (1,710) 42* (1,165)
4 (80) 3 (65) 4 (130) 2 (15)
68 (1,590) 75* (1,350) 77* (2,615) 81** (2,135)
51 (2,240) 44* (360) 44* (905)
48 (2,045) 54* (460) 51 (1,040)
1 (25) 2 (15) 5 (45)
– – –
– – –
– – –
– – –
– – –
23 (555) 21 (455) 18* (600) 15* (385)
7 (325) 3E* (210) 9E (145) 4E (95) 5E (165) 3E (135)
32 (1,415) 11** (625) 31 (695) 15** (250) 17** (505) 25* (590)
55 (2,680) 72** (4,135) 58 (1,380) 68* (1,350) 65* (2,305) 64* (1,780)
41* (1,245)
54* (1,620)
5 (145)
–
–
–
–
–
Respondent education < Post-secondarya > Post-secondary
43 (1,905) 48* (2,790)
53 (2,300) 49 (2,790)
4 (170) 3 (165)
74 (2,870) 77 (n ¼ 4,250)
20 (710) 19 (n ¼ 1,095)
6E (160) 4E (130)
31 (1,030) 19* (935)
59 (2,415) 65* (3,840)
Household education < Post-secondarya > Post-secondary
40 (1,080) 48* (3,530)
55 (1,420) 49* (3,560)
5 (125) 3 (210)
70 (1,575) 77* (5,230)
20 (385) 20 (1,330)
10 (115) 3* (155)
25 (495) 23 (1,355)
62 (2,415) 63 (3,840)
Household income < $30,000a $30,000–59,999 $60,000–89,999 > $90,000
40 (900) 43 (1,360) 48* (975) 51 (1,530)
54 (1,235) 54 (1,510) 49* (1,000) 47* (1,420)
6 (130) 3 (85) 3 (60) 2 (60)
77 (1,615) 75 (2,250) 76 (1,525) 77 (2,030)
16 (380) 21 (535) 20 (390) 20 (555)
7 (100) 4 (95) 4 (55) 3* (55)
22 (495) 26 (660) 23 (405) 22 (495)
61 (1,430) 61 (1,925) 62 (1,305) 64 (1,810) (continued)
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016
Marital status Marrieda Common law Widowed, separated, or divorced Single
21 (945) 19 (1,055)
488 Slater and Mudryj
Table 1. Self-Reported Eating Habits, Meal Preparation, and Cooking Skills of Canadians
*P < .05, **P < .01. tis; EUse with caution (> 16.6% coefficient of variation < 33.3%). Reference group; bRespondent identified self as First Nations, Inuit, or Me Note: Numbers reflect proportions of Canadians who categorize themselves as having responses in each outcome category. Cross-tabulations and chi-square testing were performed to compare proportions among demographic groups. a
– – – – – – – – – – 2 (30) 4 (330) 49 (680) 51 (4,375) 49 (745) 45* (3,905) Immigration status Yesa No
Yesa,b No
Aboriginal status
37 (175) 46* (3,780)
56 (250) 51 (4,160)
7 (30) 3 (240)
– –
– –
– –
– –
– –
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016 were more likely than male respondents (P < .05) to have ‘‘excellent or very good’’ or ‘‘good/fair’’ eating habits. As well, married Canadians were more likely than single, common-law, or widowed/divorced/separated Canadians (P < .05) to have ‘‘excellent’’ or ‘‘very good’’ eating habits. Aboriginal Canadians were significantly less likely to report having ‘‘excellent’’ or ‘‘very good’’ eating habits compared with non-Aboriginals (37% vs 46%), as were those with less education and less income. Immigrants were more likely to report better eating habits than other Canadians (P < .05). Only 3% of all respondents reported having ‘‘poor’’ eating habits. Almost two-thirds of all respondents could prepare most dishes, although those 12–29 years old were less able (P < .05). Significantly more women were able to prepare most dishes than were men (72% vs 55%). Just over one-fifth reported having basic skills such as boiling an egg or making a grilled cheese sandwich. However, almost 3 times as many men responded affirmatively to this as women (32% to 11%), and those with less than postsecondary education had significantly lower cooking skills compared with those with more than post-secondary education (Table 1). Overall, the majority of respondents reported using ‘‘mostly whole/basic foods’’ when cooking; this ranged from 68% for those 12–29 years old to 81% for the cohort 65 years and older. Female respondents were more likely than male respondents to use mostly whole/basic foods during meal preparation, as were older Canadians, in comparison to those < 30 years of age (P < .05), although there were no major differences in meal preparation habits between socio-demographic groups. Only 5% used mostly easy-to-prepare, ready-to-eat, or takeout/delivery foods; however, more than twice as many men used mainly convenience/takeout food, as did those in the lowest income quartile compared with the highest (7% vs 3%). Three times the number of those 12–29 years old (9%) responded affirmatively compared with those 65 years and older (3%) (Table 1). Slightly fewer than half of respondents had a budget when grocery shopping, and three-quarters used a written list when grocery shopping (Table 2). Male respondents were less likely than
Slater and Mudryj 489 female respondents to have a budget or use a grocery list when shopping, and half as likely to use CFGHE recommendations or select foods on the basis of labels (P < .001). Younger Canadians were significantly more likely than older Canadians to have a budget but less likely to use a grocery list (P < .001). Whereas almost two-thirds selected foods on the basis of nutrition labels, less than one-third used recommendations from CFGHE. Canadians over 45 years of age were more likely to use Food Guide recommendations than were younger Canadians. Respondents reported high rates of competency with mechanical food skills such as using a knife, peeling/ chopping, and cooking raw meat/ poultry/fish and soup/stew/casseroles (Table 3). Women were significantly more likely to report having good/ very good food preparation skills than men, particularly when it came to cooking raw meat, making a soup/stew or casserole from scratch, and baking muffins or cake (regardless of baking method), and younger Canadians were less likely to report these competencies. Younger respondents (57%) and men (64%) were less likely to report ‘‘good/very good’’ skills with cooking soup/stew/casserole from scratch (57%) than were older respondents. Just over two-thirds of all respondents (72%) reported high proficiency in baking muffins/cakes from a mix, whereas just under one-third (66%) could bake muffins/cakes from scratch. Two-thirds (67%) of respondents stated they were ‘‘good/very good’’ at freezing vegetables, whereas over onethird (37%) reported having similar skills with canning from raw fruits and vegetables (Table 3). Sixty-two percent of Canadians reported having adjusted a recipe to make it healthier (Table 4). The main adjustment was reducing fat content (50%), followed by adding vegetables or fruit (47%), reducing sugar (46%), reducing salt (41%), and choosing whole-grain options (33%). Canadians 30–64 years of age were more likely to adjust recipes. Although women were more likely than men to modify recipes for health and choose whole-grain options (P < .001), men were more likely to reduce a recipe's salt content (P < .001). Forty-two percent of respondents grew vegetables, herbs, or fruits at home or in a community garden.
490 Slater and Mudryj There was no difference between men and women, although younger respondents (12–29 years of age) were less likely to do so than older respondents (results not shown).
DISCUSSION Most Canadians thought they had fair to excellent eating habits, which is consistent with other survey reports, such as ‘‘Tracking Nutrition Trends 2013,’’ in which 77% of respondents felt they had ‘‘good’’ to ‘‘excellent’’ eating habits.23 These findings, however, contradict other empirical evidence on Canadians' diets. According to the latest population-based dietary survey, the 2004 CCHS, 22% of total calories were obtained from foods ‘‘other’’ than the 4 basic food groups, typically having excess amounts of fat, sugar, and salt (fats, oils, added sugars, candy and snack foods, condiments).24 In addition, over 25% of Canadians 31–50 years of age exceed the upper limit for fat intake, and 24.9% and 26.8% of Canadians 4–18 years and 19 years of age and older have the majority of total fat coming from fast foods, baked goods, and other snacks.25 Canadians also consume more calories from snacks than breakfast. Furthermore, fewer than half of adults consume 5 or more servings of fruits and vegetables per day (CCHS), and only 15% are consuming the current recommendation of 7 or more servings per day.24 These trends are corroborated in industry reports, which state that snack foods are the fastest-growing sector in the food economy, increasing more than 50% from 2000 to 2009, when snacks made up 24% of all meals.26 Surveys also consistently show that Canadians seek convenience over nutrition.23,27 Notably, few Aboriginal Canadians reported very good eating habits. This may be reflective of high rates of food insecurity, which are up to 3 times that of the rest of Canadians.28-30 The vast majority of Canadians report that they are using mainly whole/ basic ingredients for their main meal. As with eating habits, these data seem somewhat contradictory to other empirical data. Monteiro et al4 reported that ultra-processed food drinks (frozen foods such as prepared potatoes, poultry, fish, and pizza, ready
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016 meals, and desserts; snacks including salty snacks, candies, and ice cream); and soft drinks have increased from 37% of Canadians' calories in 1955 to 55% in 2009. Furthermore, in 2013, 52% of Canadians' food expenditures were on restaurant foods and non-‘‘whole/ basic’’ food items such as cookies, breakfast cereals and bars, soft drinks, candies, salty snacks, processed meat, and frozen/ready-to-serve foods.31 It is possible that these ultra-processed foods were only being consumed at times other than the ‘‘main meal.’’ However, other reports indicate that the majority of Canadians value convenience because of busy schedules27,32 and are spending less time than ever in the kitchen. This would be consistent with other surveys, which show that self-reported desired dietary behaviors are over-reported, whereas less-desired behaviors are reported less frequently because of social desirability.33,34 This was suggested in M&M Meat Shops' 2014 survey and campaign ‘‘Family Dinner is on the Decline: M&M Meat Shops Encourages Canadians to Bring Back the Lost Art of Dinner.’’ The results of their survey showed that only 30% of Canadian families eat together every night, a 30% decrease from the year before.35 This prompted the company to encourage Canadians to use their prepared, frozen products as a convenient way to ‘‘re-connect over dinner and honor the tradition of the family dinner.’’ This messaging indicates that there may be confusion in people's minds about what constitutes ‘‘whole/basic’’ food, and therefore respondents may have misunderstood the survey question. Younger Canadians were more likely to use convenience foods. This may be because they are single and less likely to have food preparation responsibilities for other family members. This may also be reflective of lower levels of food skills; fewer younger Canadians were adept at making more complex dishes such as soups and stews. This was consistent with reports of younger generations having fewer food skills because of lack of in-home learning and fewer formal educational opportunities to learn about food and nutrition.14,36,37 Almost one-third (32%) of men reported only having basic cooking skills, which suggests that a significant
gender gap in food skills persists. This could be because of division of labor within households, where women are still taking on more household food responsibilities, but also because these roles continue to be represented in media and other social narratives.38 The food delivery service named ‘‘Mom's Night Off’’ is just one example of the normative discourse around domestic food work.39 More information on household division of labor is required, in particular with respect to food shopping and preparation. The low number of respondents using CFGHE as a resource for choosing foods brings into question the Food Guide's value as an educational resource. Respondents were more inclined to consult the nutrition label of food products rather than use the food guide; however, men were much less likely than women to refer to either the Food Guide or nutrition labels. This could be due to women consistently reporting higher engagement in health-promoting behaviors than men and having greater understanding of the relationship between diet and health,40-42 whereas men view eating as ‘‘fuel’’ and part of a routine.43 The high rates of proficiency at canning and freezing vegetables are surprising, given the previously cited reports of people's desire for convenience and less time in the kitchen.26,27 However, it is to be noted that even though the respondents may possess a skill, it does not mean that they utilize it. These results clearly warrant further investigation, although 1 explanation may be a misunderstanding of the question on respondents' part. Respondents were asked about their proficiency in ‘‘in freezing vegetables or fruit, from raw to bagged in your home freezer.’’ Freezing fruits or vegetables in plastic bags may seem straightforward if one does not know the requisite steps such as blanching. The contradictions between some of these results and other empirical data can lead to several interpretations, including: some of the survey questions were not valid (ie, respondents misunderstood the meaning of the questions); respondents did not answer the questions accurately due to social desirability (ie, they wanted to portray themselves as having the ‘‘morally superior’’ behaviors such as cooking
0.75* (0.61–0.92) 0.93 (0.76–1.13) 1.09 (0.91–1.31) 1.00 59 (710) 64 (1,165) 67 (2,150) 66 (1,640) 0.41** (0.32–0.52) 0.66** (0.53–0.82) 1.02 (0.86–1.23) 1.00 19 (300) 28 (565) 38 (1,255) 37 (990)
CONCLUSIONS *P < .01, **P < .001. a Canada’s Food Guide to Healthy Eating. Note: Using multivariate logistic regression.
68 (835) 75 (1,380) 73 (2,430) 81 (2,085) 2.86** (2.33–3.51) 1.84** (1.52–2.25) 1.50** (1.26–1.80) 1.00 61 (700) 50 (885) 45 (1,355) 35 (840) Age 12–29 y 30–44 y 45–64 y 65þ y
Slater and Mudryj 491 from scratch and having ‘‘good’’ dietary habits44,45; respondents believed they were engaging in better dietary habits and food skill practices; or, finally, that their responses are valid and the other sources of empirical data are to be questioned. To gain clarity into these issues, it is first essential that better data be generated on what foods Canadians are in fact eating. The upcoming 2015 Canadian Community Health Survey (Nutrition), the first national dietary survey since 2004, will provide new empirical data to support or refute the selfreported assertion that Canadians' eating habits are good. Second, the constructs used to determine people food habits should be better conceptualized and defined. Terms such as ‘‘whole foods,’’ ‘‘convenience,’’ and ‘‘ready-to-eat’’ are ambiguous and open to much interpretation, as are ‘‘cooking’’ and ‘‘from scratch.’’ There are several limitations to this study. The data were self-reported, and it is well-accepted that desirable health behaviors are over-reported and undesirable ones are under-reported.33,34 The survey was cross-sectional, and this is the first time these data have been collected through any cycle of the CCHS, so there are no comparative data. Finally, no dietary data were collected from respondents; therefore their self-reported dietary and meal preparation habits and food skills cannot be cross-checked with actual foods eaten. Nonetheless, this initial, nationally representative survey provides important insights into Canadians' selfperceived dietary habits and food skills.
0.49** (0.39–0.62) 0.68** (0.55–0.85) 0.63** (0.51–0.79) 1.00
0.59** (0.50–0.70) 1.00 58 (2,185) 70 (3,475) 0.50** (0.43–0.59) 1.00 24 (960) 38 (2,150) 70 (2,680) 78 (4,050) 43 (1,445) 52 (2,335) Sex Male Female
0.70** (0.61–0.82) 1.00
0.65** (0.55–0.77) 1.00
Odds Ratio (CI) % Yes (n) 64 (5,665) Odds Ratio (CI) % Yes (n) 31 (3,110) Odds Ratio (CI) % Yes (n) 74 (6,725) Odds Ratio (CI) % Yes (n) 48 (3,780) Demographic Characteristics Overall
Do You Have a Budget When You Grocery Shop?
Table 2. Self-Reported Grocery Planning Skills of Canadians
Do You Use a Written Grocery List?
Do You Use Recommendations From CFGHEa?
Do You Select Foods Based on Nutrition Labels?
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016
Overall, the data in this study suggested that Canadians believe they have good eating habits and food skills, with women having somewhat better food skills than men. As shown, this is supported by other self-reported Canadian survey data yet contradicted by other empirical data including food disappearance data, population-based nutrition survey data, and data from the food industry. Nonetheless, this research suggests that there are still gender gaps with respect to food skills, and some younger Canadians appear more disadvantaged than their older counterparts with respect to food skills.
*P < .05, **P < .01. a Reference group; EUse with caution (> 16.6% coefficient of variation < 33.3%). Note: Using multivariate logistic regression. Numbers reflect proportions of Canadians who categorize themselves as having ‘‘good or very good’’ habits by food preparation activity.
57 (1,805) 80* (1,500) 82* (2,315) 82* (1,495) 85 (1,975) 94* (1,800) 95* (3,220) 92* (2,495) Age 12–29 ya 30–44 y 45–64 y 65þ y
90 (2,090) 95E* (1,830) 96* (3,245) 95* (2,565)
59 (1,410) 72* (1,350) 73* (2,410) 70* (1,880)
31 (720) 34 (645) 39* (1,425) 45* (1,205)
75 (1,755) 93* (1,805) 94** (3,210) 89* (2,435)
75 (1,575) 75 (1,390) 74 (2,345) 59* (1,655)
49 (2,190) 83** (4,590) 64 (2,585) 86** (4,530) 89 (4,225) 94* (5,260) 94 (4,435) 95 (5,295) Sex Malea Female
Rating (%) Overall
Knife Skills Good/Very Good (n) 94 (9,730)
64 (2,915) 73* (4,135)
31 (1,410) 42* (2,585)
85 (4,050) 91* (5,155)
58 (2,210) 86** (4,755)
Baking Muffins/Cake From Scratch Good/Very Good (n) 66 (7,005) Baking Muffins/ Cake From a Pre-Packaged Mix Good/Very Good (n) 72 (6,965) Cooking a Soup, Stew, Casserole From Scratch Good/Very Good (n) 75 (7,110) Cooking a Piece of Raw Meat/ Chicken/Fish Good/Very Good (n) 88 (9,210) Canning From Raw Ingredients Good/Very Good (n) 37 (3,995) Freezing Vegetables Good/Very Good (n) 68 (7,050) Peeling or Chopping Good/Very Good (n) 92 (9,485)
Table 3. Self-Rated Mechanical Skills of Canadians
65 (1,540) 69 (1,365) 68 (2,305) 61 (1,670)
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492 Slater and Mudryj
Although the study was conducted on Canadian data, it is likely that similar results could be found in other countries, in particular industrialized countries that have undergone the nutrition transition12 and exhibit high consumption rates of ultra-processed foods.11 These findings have implications for formal and non-formal food skills training programs in schools and community settings. Policymakers should re-think policies leading to the removal of school-based home economics food and nutrition courses.46,47 Furthermore, all children should have access to life-skill courses that include budgeting, planning, cooking, and shopping. In addition, policies and programs should be implemented to improve the food security status of Aboriginal Canadians.48,49 More research is needed to ascertain the dietary and food habits of Canadians and the drivers of these habits, as well as to clarify food skill competencies and associated measurement methods.
IMPLICATIONS FOR RESEARCH AND PRACTICE Although results suggested that the vast majority of Canadians believe that they have ‘‘good’’ eating habits, this study also found that certain groups, such as Aboriginal Canadians, reported lower rates of ‘‘good’’ eating habits. Additionally, this study also observed gender and age gaps when it came to self-rated food skills, which suggests that there are several opportunities for dietitians and other health professionals to engage with Canadians around these issues. The results of this study contribute to the emerging literature involving food skills. Findings from this study have implications for education and health promotion programs focusing on foods skills in Canada as well as encouraging ideas to create specific programs to appeal to and reach target groups who may be particularly vulnerable.
ACKNOWLEDGMENTS Financial support was provided University of Manitoba/Social Sciences and Humanities Research Council. The authors would like to extend thanks to Dr Ian Clara and Kelly Cranswick at the Manitoba Research
29 (415)
35 (720)
1.44** (1.16–1.79) 49 (650) 1.27 (1.05–1.54) 45 (1,010) 1.07 (0.89–1.30) 43 (585) 1.00 52 (580)
0.70* (0.56–0.88) 46 (560) 0.96 (0.77–1.20) 50 (1,075) 1.10 (0.91–1.35) 47 (630) 1.00 39 (425)
65þ y
45–64 y
52 (1,180) Age 12–29 y
30–44 y
50 (2,185)
*P < .01, **P < .001, ***.1 < P < .05. Note: Using multivariate logistic regression.
43 (545)
45 (870)
38 (450)
0.71* (0.55–0.92) 0.80*** (0.63–1.02) 1.08 (0.88–1.33) 1.00 35 (335)
0.92 (0.74–1.15) 53 (685) 1.32* 73 (1,370) 2.48** (0.85–1.17) (1.07–1.64) 68 (2,310) 1.99** 53 (1,140) 1.35* (1.68–2.30) (1.10–1.65) 52 (1,425) 1.00 45 (615) 1.00 43 (460)
62 (6,285)
Sex Male
Female
34 (445)
1.16 (0.92–1.47) 1.35 (1.02–1.55) 1.16 (1.05–1.61) 1.00 32 (335)
REFERENCES
0.99
36 (1375)
29 (545)
0.73** (0.61–0.88) 1.00 47 (2,825) 46 (2,685) 41 (2,200) 50 (2,900)
Slater and Mudryj 493 Data Centre for their statistical help and support. The authors also thank the staff from the Office of Nutrition Policy and Promotion at Health Canada for their assistance.
Overall
0.34** 47 (895) 0.73 45 (870) 1.32** 38 (750) 0.61** 48 (975) 1.07 (0.30–0.39) (0.69–0.96) (1.11–15.6) (0.52–0.71) (0.90–1.26) 74 (4,100) 1.00 52 (2,005) 1.00 38 (1,330) 1.00 51 (1,935) 1.00 47 (1,850) 1.00
33 (1920)
Odds Ratio (CI) % Yes (n) Odds Ratio (CI) % Yes (n) Odds Ratio (CI) % Yes (n) Odds Ratio (CI) % Yes (n) Odds Ratio (CI) % Yes (n) Odds Ratio (CI) Demographic Characteristics % Yes (n)
Did You Reduce Its Fat Content? Have You Ever Adjusted a Recipe to Make It Healthier?
Table 4. Self-Reported Recipe Adjustments by Canadians
Did You Reduce Its Salt Content?
Did You Reduce Its Sugar Content?
Did You Add More Vegetables or Fruit?
Did You Choose Whole Grain Options?
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016
1. World Health Organization. Obesity and overweight. http://www.who.int/ mediacentre/factsheets/fs311/en/. Updated 2015. Accessed March 3, 2016. 2. Twells LK, Gregory DM, Reddigan J, Midodzi WK. Current and predicted prevalence of obesity in Canada: a trend analysis. Can Med Assoc Open Access J. 2014;2:E18-E26. 3. Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378:804-814. 4. Monteiro CA, Moubarac JC, Cannon G, Ng SW, Popkin B. Ultraprocessed products are becoming dominant in the global food system. Obes Rev. 2013;14(Suppl 2):21-28. 5. Smith LP, Ng SW, Popkin BM. Trends in US home food preparation and consumption: analysis of national nutrition surveys and time use studies from 1965-1966 to 2007-2008. Nutr J. 2013;12. 6. Chu YL, Storey KE, Veugelers PJ. Involvement in meal preparation at home is associated with better diet quality among Canadian children. J Nutr Educ Behav. 2014;46:304-308. 7. Chenhall C. Improving cooking and food preparation skills: a synthesis of the evidence to inform program and policy development. Ottawa, Ontario, Canada: Public Health Agency of Canada; 2010. 8. Hartmann C, Dohle S, Siegrist M. Importance of cooking skills for balanced food choices. Appetite. 2013; 65C:125-131. 9. Laska MN, Larson NI, NeumarkSztainer D, Story M. Does involvement in food preparation track from adolescence to young adulthood and is it associated with better dietary quality? Findings from a 10-year longitudinal study. Public Health Nutr. 2011;15:1-9. 10. Moubarac JC, Batal M, Martins AP, et al. Processed and ultra-processed food products: consumption trends in Canada from 1938 to 2011. Can J Diet Pract Res. 2014;75:15-21. 11. Luiten CM, Steenhuis IH, Eyles H, Mhurchu CN, Waterlander WE. Ultra-processed foods have the worst
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nutrient profile, yet they are the most available packaged products in a sample of New Zealand supermarkets. Public Health Nutr. 2015;19:1-9. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70:3-21. Pan American Health Organization. Ultra-processed foods are driving the obesity epidemic in Latin America, says new PAHO/WHO Report. http:// www.paho.org/hq/index.php?option¼ com_content&view¼article&id¼11180 %3Aultra-processed-foods&Itemid¼1926 &lang¼en. Accessed January 5, 2016. Jaffe J, Gertler M. Victual vicissitudes, consumer deskilling and the transformation of food systems. Agric Hum Values. 2006;23:143-162. Caraher M, Lang T. Can’t cook, won’t cook: a review of cooking skills and their relevance to health promotion. Int J Health Promot Educ. 1999;37: 89-100. Laska MN, Larson NI, NeumarkSztainer D, Story M. Does involvement in food preparation track from adolescence to young adulthood and is it associated with better dietary quality? Findings from a 10-year longitudinal study. Public Health Nutr. 2012;15: 1150-1158. Archuleta M, VanLeeuwen D, Halderson K, et al. Cooking schools improve nutrient intake patterns of people with type 2 diabetes. J Nutr Educ Behav. 2012;44:319-325. Engler-Stringer R, Stringer B, Haines T. Complexity of food preparation and food security status in lowincome young women. Can J Diet Pract Res. 2011;72:133-136. Vidgen HA, Gallegos D. Defining food literacy and its components. Appetite. 2014;76:50-59. Moubarac J, Martins APB, Claro RM, Levy RB, Cannon G, Monteiro CA. Consumption of ultra-processed foods and likely impact on human health: evidence from Canada. Public Health Nutr. 2013;16:2240-2248. Statistics Canada. Canadian Community Health Survey - Nutrition (CCHS): detailed information for cycle 2.2(2004). http://www23.statcan.gc.ca/imdb/p2SV .pl?Function¼getSurvey&Id¼7498. Updated 2007. Accessed January 11, 2016. Statistics Canada. Canadian Community Health Survey (CCHS) Food Skills Mechanical skills and food conceptualiza-
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tion. http://www23.statcan.gc.ca/imdb/ pIX.pl?Function¼showStaticArchive HTML&a¼1&fl¼http://www23.statcan. gc.ca/imdb-bmdi/document/3226_D78_ T9_V1-eng.htm&Item_Id¼144173. Updated 2013. Accessed January 10, 2016. Canadian Foundation for Dietetic Research. Tracking nutrition trends 2013. https://www.cfdr.ca/Downloads/ CCFN-docs/TNT-2013-Summary-Re port.aspx. Updated 2013. Accessed February 1, 2016. Garriguet D. Canadians’ eating habits. Health Rep. 2007;18:17. Heart and Stroke Foundation. 2013 Report on the health of Canadians. http://www.heartandstroke.com/atf/cf/ %7B99452D8B-E7F1-4BD6-A57D-B 136CE6C95BF%7D/Report-on-CndHealth–D17.pdf. Updated 2013. Accessed January 4, 2016. Government of Alberta. Consumer corner: Snacking in Canada. 2012. http:// www1.agric.gov.ab.ca/$department/dept docs.nsf/all/sis13895. Accessed January 10, 2016. Serecon Management Consulting. Canadian food trends to 2020: a long range consumer outlook. 2005. http://stayactive eathealthy.ca/sites/default/files/resources/ Canadian_Food_Trends_2020.pdf. Accessed February 4, 2016. Health Canada. Household food insecurity in Canada in 2007–2008: Key statistics and graphics. 2012. http://www.hc-sc.gc. ca/fn-an/surveill/nutrition/commun/inse curit/key-stats-cles-2007-2008-eng.php. Accessed February 1, 2016. Kirkpatrick SI, Tarasuk V. Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents. J Nutr. 2008;138: 604-612. McLaughlin C, Tarasuk V, Kreiger N. An examination of at-home food preparation activity among low-income, food-insecure women. J Am Diet Assoc. 2003;103:1506-1512. Statistics Canada. Average household food expenditure, by province. http:// www.statcan.gc.ca/tables-tableaux/sumsom/l01/cst01/famil132a-eng.htm. Accessed February 3, 2016. Agriculture and Agri-Food Canada. Market analysis report: consumer trend report: convenience. https://www.gov. mb.ca/agriculture/market-prices-andstatistics/trade-statistics/pubs/canada_ convenience_trend_report_en.pdf. Accessed February 3, 2016.
33. Elgar FJ, Stewart JM. Validity of selfreport screening for overweight and obesity: evidence from the Canadian Community Health Survey. Can J Public Health. 2008;99:423-427. 34. Elgar FJ, Roberts C, Tudor-Smith C, Moore L. Validity of self-reported height and weight and predictors of bias in adolescents. J Adoles Health. 2005;37:371-375. 35. Family dinner is on the decline: M&M meat shops encourages Canadians to bring back the lost art of dinner. 2014. http://www1.mmmeatshops.com/en/ aboutmm/mediaroom/pdf/NFDN_2014 .pdf. Accessed February 1, 2016. 36. Slater J. Is cooking dead? The state of home economics food and nutrition education in a Canadian province. Int J Consum Studies. 2013;37: 617-624. 37. Lang T, Caraher M. Is there a culinary skills transition? Data and debate from the UK about changes in cooking culture. J Home Econ Inst Aust. 2001;8:2-14. 38. Statistics Canada. General Social Survey: 2010: overview of the time use of Canadians; 2011. http://www.statcan.gc.ca/ pub/89-647-x/89-647-x2011001-eng.htm. Accessed January 11, 2016. 39. Metro News. Ottawa women deliver so mom doesn’t have to. Metro News. 2013. http://www.metronews.ca/news/ ottawa/2013/12/09/ottawa-women-deliver -so-mom-doesnt-have-to.html. Accessed January 11, 2016. 40. Lake AA, Hyland RM, Mathers JC, Rugg AJ, Wood CE, Adamson AJ. Food shopping and preparation among the 30-somethings: whose job is it? (the ASH30 study). Br Food J. 2006;108: 475-486. 41. Gough B. ‘Real men don’t diet’: an analysis of contemporary newspaper representations of men, food and health. Soc Sci Med. 2007;64:326-337. 42. Hess R, Visschers VHM, Siegrist M. The role of health-related, motivational and sociodemographic aspects in predicting food label use: a comprehensive study. Public Health Nutr. 2012;15: 407-414. 43. Arganini C, Turrini A, Saba A, Virgili F, Comitato R. Gender differences in food choice and dietary intake in modern western societies. INTECH Open Access Publisher; 2012. 44. Coveney J, Begley A, Gallegos D. ‘Savoir fare’: are cooking skills a new morality? Aust J Adult Learn. 2012;52: 617-642.
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016 45. Bowen S, Elliott S, Brenton J. The joy of cooking? Contexts. 2014;13:20-25. 46. Lichtenstein AH, Ludwig DS. Bring back home economics education. J Am Med Assoc. 2010;303:1857-1858. 47. Murphy G. The fall and rise of home economics education: newly available home
economics archives at the women’s library. Int J Consum Studies. 2011;35:595-600. 48. Power EM. Conceptualizing food security for aboriginal people in Canada. Can J Public Health. 2008;99:95-97. 49. Council of Canadian Academies. Aboriginal food security in northern
Slater and Mudryj 495 Canada: an assessment of the state of knowledge. 2014. http://www.sciencea dvice.ca/uploads/eng/assessments%20and %20publications%20and%20news%20 releases/food%20security/foodsecurity_ fullreporten.pdf. Accessed January 11, 2016.
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CONFLICT OF INTEREST The authors have not stated any conflicts of interest.
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016
INTRODUCTION The rapidly growing rates of obesity and related chronic disease in global populations1,2 have prompted many public health and education experts to examine dietary and food behavior patterns3,4 and the role of food skills in protecting nutritional health.5-9 Eating patterns in industrialized countries, and increasingly around the globe, have been shifting in recent decades to include disproportionate amounts of highly processed convenience foods,4,10 the majority of which have
low nutritional profiles.11 The increased intake of ultra-processed foods is linked with rising obesity rates.12,13 The high use of ultraprocessed foods has also been implicated in reduced domestic food preparation time, creating a cycle of dependence on convenience food products and a decline in basic food skills.14,15 Possessing adequate food skills, or having the capabilities to plan, select, prepare, and consume food, has been proposed as a protective quality against obesity and nutrition-related
Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada Conflict of Interest Disclosure: The authors’ conflict of interest disclosures can be found online with this article on www.jneb.org. Address for correspondence: Joyce J. Slater, PhD, 409 Human Ecology Building, Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, R3T 2N2, Canada; Phone: (204) 474-7322; Fax: (204) 474-7593; E-mail: joyce.slater@ umanitoba.ca Ó2016 Society for Nutrition Education and Behavior. Published by Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.jneb.2016.04.397
486
chronic disease. While still an emerging concept, some studies have shown that having better food skills is associated with better diet quality16,17 and may help some food-insecure individuals.18 Having sufficient food skills may allow individuals to have more control over their diet by preferentially selecting and preparing basic foods with favorable nutrition profiles.19 More research, however, is needed to empirically demonstrate the linkages between food skills and diet quality. The steady and steep increase in the consumption of highly processed foods in recent decades, coinciding with increased rates of obesity and chronic disease, suggests that this is an important area that warrants examination.10,11,20 The purpose of this study was to identify and describe Canadians' selfperceived eating habits and food skills through the use of population-based data from the Canadian Community Health Survey Rapid Response on Food Skills (CCHS).
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016
METHODS Setting and Participants The CCHS is a federal cross-sectional survey aimed at providing health information at the national and provincial levels. Beginning in 2007, major changes were made to the survey design and as a result, data collection now occurs every year (although a ‘‘cycle’’ is now considered to be a 2-year period).21 The rapid response component is offered to organizations interested in national estimates on an emerging or specific issue related to the population's health.22 This research is based on results from Parts 1 and 2 of the CCHS 2013 Rapid Response on Food Skills, which collected data from a nationally representative sample of Canadians $ 12 years of age in all 10 provinces. Data collection took place across the country in January and February of 2013. Interviewers from Statistics Canada, a government agency that produces statistics to better understand the population, administered questions related to meal preparation, the amount of basic versus processed ingredients used, cooking and kitchen skills levels, time spent on food preparation, frequency of family meals, and children's participation in household food activities. The addition of these questions to the Canadian Community Health Survey Annual Component was sponsored by the Office of Nutrition Policy and Promotion, Health Canada. In total, 10,098 respondents completed Part 1 (which assessed knowledge, planning, and transference of skills) and 10,701 completed Part 2 (which focused on mechanical skills and food conceptualization). The overall response rate was 67.3%.22 Further details as well as the questionnaire can be viewed on the Statistics Canada website.21 Research for this study was conducted at the Manitoba Research Data Centre and is consistent with Research Ethics Board Requirements. Data were accessed in a secure environment and all output was first reviewed by Statistics Canada to ensure disclosure avoidance before release.
Measures This study focused on the self-rated behaviors of Canadians regarding their
eating habits, meal preparation practices, ingredients used in cooking, and kitchen skills as well as grocery shopping routines and meal adjustments. Self-reported eating habits were ranked as ‘‘excellent or very good,’’ ‘‘good or fair,’’ or ‘‘poor.’’ Similarly, self-assessment of the respondent's mechanical skills (ie, cutting, peeling, baking from a recipe or from scratch) were ranked by the respondent on a scale ranging from ‘‘very limited’’ to ‘‘very good.’’ Respondents were also asked to classify their cooking skills and meal preparation habits on the basis of categories chosen by Statistics Canada. This took into account the types of foods most often used in the meal of the day that required the most preparation (ie, whole/basic foods, easy-to-prepare items, or take out/delivery) as well as their ability to cook from basic ingredients, and the proportions of respondents falling into these categories were calculated. The food skills component asked respondents about grocery shopping habits, inquired about grocery budgeting and use of grocery lists, and whether or not respondents made choices by using Canada's Food Guide to Healthy Eating (CFGHE) when choosing and purchasing ingredients. Additionally, respondents were also asked if they had ever adjusted a recipe to make it healthier, and, if so, were asked how this was done (ie, reducing salt, sugar, or fat content, etc).22 Demographic variables such as sex, age, and education status were used to assess the variability of these practices across Canada, and key variables were examined to assess differentiations between various socio-demographic groups. Descriptive statistics were used to describe differences between sexes, in addition to Aboriginal status (being of First Nations, Metis, or Inuit as well as those with Registered or Treaty Indian status), immigrant status, and comparisons between family structure, and other characteristics were observed by looking at marital status and respondent and household education. Income was also examined as a factor, splitting respondents into 4 groups on the basis of their household income. Individuals with invalid responses, such as ‘‘refusal to answer,’’ ‘‘don't know,’’ or ‘‘not applicable,’’ were excluded from the study.
Slater and Mudryj 487
Statistical Analysis Cross-tabulations and chi-square testing were performed to compare proportions among demographic groups. Logistic regression was used to determine whether any of the aforementioned demographic variables increased the likelihood of certain practices such as recipe adjustment and grocery planning. Odds ratios were calculated and the significance level was set at P < .05 for differences and .05 < P < .10 for trends. Reference groups were chosen on the basis of hypotheses that certain characteristics (such as higher income or education) may be linked with enhanced food skills. All analyses were performed with the use of PASW SPSS Statistics (version 13, IBM Corp, Armonk, New York) and STATA Statistical Software (version 22, StataCorp LP, College Station, Texas). Because the CCHS uses a multi-stage, stratified, complex survey design and requires a complex formula to calculate variance estimates, Statistics Canada recommends using bootstrapping to estimate distribution from a sample's statistics. Bootstrapping is an approach used to estimate distribution from a sample's statistics. It can also be defined as ‘‘sampling within a sample’’ and involves the selection of random samples known as replicates and the calculation of the variation in the estimates from replicate to replicate.21 The bootstrapping method was used in all the data analyses for the present study via STATA software. As well, the sampling error of the estimates from the CCHS (quantified by the coefficient of variation, or CV) must be taken into consideration when using CCHS data. When the CV is between 16.6 and 33.3, the estimate should be interpreted with caution because of high variability.
RESULTS The majority of respondents reported having good eating habits, with almost half reporting ‘‘excellent’’ or ‘‘very good’’ and more than half reporting ‘‘good’’ or ‘‘fair.’’ Older respondents (65 years and over) were more likely (P < .05) to report ‘‘excellent’’ or ‘‘very good’’ eating habits than those 12–29 years of age. Female respondents
Meal Preparation Habits
Eating Habits
Demographic Characteristics Overall
Cooking Skills
Mostly I Can Prepare Easy-to-Prepare, Mix of I Can Prepare Simple Meals, Boil Ready-to-Eat, Easy-to-Prepare an Egg, or Cook Most Dishes, Especially Takeout, or Foods and Whole/ Mostly Excellent/ If I Have a Recipe a Grilled Cheese Delivery Basic Very Good/Fair Poor (%) Whole/Basic to Follow (%) n Sandwich (%) n Foods (%) n Foods (%) n Foods (%) n Good (%) n (%) n n 46 (4,765) 51 (5,165) 3 (295) 75 (7,690) 20 (2,000) 5 (535) 21 (2,040) 63 (6,815)
Sex Malea Female
44 (2,065) 48* (2,700)
53 (2,455) 48* (2,710)
3 (140) 4 (155)
72 (3,390) 78* (4,300)
Age 12–29 ya 30–44 y 45–64 y 65þ y
41 (955) 45* (800) 46* (1,540) 56* (1,475)
55 (1,255) 52 (1,035) 50 (1,710) 42* (1,165)
4 (80) 3 (65) 4 (130) 2 (15)
68 (1,590) 75* (1,350) 77* (2,615) 81** (2,135)
51 (2,240) 44* (360) 44* (905)
48 (2,045) 54* (460) 51 (1,040)
1 (25) 2 (15) 5 (45)
– – –
– – –
– – –
– – –
– – –
23 (555) 21 (455) 18* (600) 15* (385)
7 (325) 3E* (210) 9E (145) 4E (95) 5E (165) 3E (135)
32 (1,415) 11** (625) 31 (695) 15** (250) 17** (505) 25* (590)
55 (2,680) 72** (4,135) 58 (1,380) 68* (1,350) 65* (2,305) 64* (1,780)
41* (1,245)
54* (1,620)
5 (145)
–
–
–
–
–
Respondent education < Post-secondarya > Post-secondary
43 (1,905) 48* (2,790)
53 (2,300) 49 (2,790)
4 (170) 3 (165)
74 (2,870) 77 (n ¼ 4,250)
20 (710) 19 (n ¼ 1,095)
6E (160) 4E (130)
31 (1,030) 19* (935)
59 (2,415) 65* (3,840)
Household education < Post-secondarya > Post-secondary
40 (1,080) 48* (3,530)
55 (1,420) 49* (3,560)
5 (125) 3 (210)
70 (1,575) 77* (5,230)
20 (385) 20 (1,330)
10 (115) 3* (155)
25 (495) 23 (1,355)
62 (2,415) 63 (3,840)
Household income < $30,000a $30,000–59,999 $60,000–89,999 > $90,000
40 (900) 43 (1,360) 48* (975) 51 (1,530)
54 (1,235) 54 (1,510) 49* (1,000) 47* (1,420)
6 (130) 3 (85) 3 (60) 2 (60)
77 (1,615) 75 (2,250) 76 (1,525) 77 (2,030)
16 (380) 21 (535) 20 (390) 20 (555)
7 (100) 4 (95) 4 (55) 3* (55)
22 (495) 26 (660) 23 (405) 22 (495)
61 (1,430) 61 (1,925) 62 (1,305) 64 (1,810) (continued)
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016
Marital status Marrieda Common law Widowed, separated, or divorced Single
21 (945) 19 (1,055)
488 Slater and Mudryj
Table 1. Self-Reported Eating Habits, Meal Preparation, and Cooking Skills of Canadians
*P < .05, **P < .01. tis; EUse with caution (> 16.6% coefficient of variation < 33.3%). Reference group; bRespondent identified self as First Nations, Inuit, or Me Note: Numbers reflect proportions of Canadians who categorize themselves as having responses in each outcome category. Cross-tabulations and chi-square testing were performed to compare proportions among demographic groups. a
– – – – – – – – – – 2 (30) 4 (330) 49 (680) 51 (4,375) 49 (745) 45* (3,905) Immigration status Yesa No
Yesa,b No
Aboriginal status
37 (175) 46* (3,780)
56 (250) 51 (4,160)
7 (30) 3 (240)
– –
– –
– –
– –
– –
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016 were more likely than male respondents (P < .05) to have ‘‘excellent or very good’’ or ‘‘good/fair’’ eating habits. As well, married Canadians were more likely than single, common-law, or widowed/divorced/separated Canadians (P < .05) to have ‘‘excellent’’ or ‘‘very good’’ eating habits. Aboriginal Canadians were significantly less likely to report having ‘‘excellent’’ or ‘‘very good’’ eating habits compared with non-Aboriginals (37% vs 46%), as were those with less education and less income. Immigrants were more likely to report better eating habits than other Canadians (P < .05). Only 3% of all respondents reported having ‘‘poor’’ eating habits. Almost two-thirds of all respondents could prepare most dishes, although those 12–29 years old were less able (P < .05). Significantly more women were able to prepare most dishes than were men (72% vs 55%). Just over one-fifth reported having basic skills such as boiling an egg or making a grilled cheese sandwich. However, almost 3 times as many men responded affirmatively to this as women (32% to 11%), and those with less than postsecondary education had significantly lower cooking skills compared with those with more than post-secondary education (Table 1). Overall, the majority of respondents reported using ‘‘mostly whole/basic foods’’ when cooking; this ranged from 68% for those 12–29 years old to 81% for the cohort 65 years and older. Female respondents were more likely than male respondents to use mostly whole/basic foods during meal preparation, as were older Canadians, in comparison to those < 30 years of age (P < .05), although there were no major differences in meal preparation habits between socio-demographic groups. Only 5% used mostly easy-to-prepare, ready-to-eat, or takeout/delivery foods; however, more than twice as many men used mainly convenience/takeout food, as did those in the lowest income quartile compared with the highest (7% vs 3%). Three times the number of those 12–29 years old (9%) responded affirmatively compared with those 65 years and older (3%) (Table 1). Slightly fewer than half of respondents had a budget when grocery shopping, and three-quarters used a written list when grocery shopping (Table 2). Male respondents were less likely than
Slater and Mudryj 489 female respondents to have a budget or use a grocery list when shopping, and half as likely to use CFGHE recommendations or select foods on the basis of labels (P < .001). Younger Canadians were significantly more likely than older Canadians to have a budget but less likely to use a grocery list (P < .001). Whereas almost two-thirds selected foods on the basis of nutrition labels, less than one-third used recommendations from CFGHE. Canadians over 45 years of age were more likely to use Food Guide recommendations than were younger Canadians. Respondents reported high rates of competency with mechanical food skills such as using a knife, peeling/ chopping, and cooking raw meat/ poultry/fish and soup/stew/casseroles (Table 3). Women were significantly more likely to report having good/ very good food preparation skills than men, particularly when it came to cooking raw meat, making a soup/stew or casserole from scratch, and baking muffins or cake (regardless of baking method), and younger Canadians were less likely to report these competencies. Younger respondents (57%) and men (64%) were less likely to report ‘‘good/very good’’ skills with cooking soup/stew/casserole from scratch (57%) than were older respondents. Just over two-thirds of all respondents (72%) reported high proficiency in baking muffins/cakes from a mix, whereas just under one-third (66%) could bake muffins/cakes from scratch. Two-thirds (67%) of respondents stated they were ‘‘good/very good’’ at freezing vegetables, whereas over onethird (37%) reported having similar skills with canning from raw fruits and vegetables (Table 3). Sixty-two percent of Canadians reported having adjusted a recipe to make it healthier (Table 4). The main adjustment was reducing fat content (50%), followed by adding vegetables or fruit (47%), reducing sugar (46%), reducing salt (41%), and choosing whole-grain options (33%). Canadians 30–64 years of age were more likely to adjust recipes. Although women were more likely than men to modify recipes for health and choose whole-grain options (P < .001), men were more likely to reduce a recipe's salt content (P < .001). Forty-two percent of respondents grew vegetables, herbs, or fruits at home or in a community garden.
490 Slater and Mudryj There was no difference between men and women, although younger respondents (12–29 years of age) were less likely to do so than older respondents (results not shown).
DISCUSSION Most Canadians thought they had fair to excellent eating habits, which is consistent with other survey reports, such as ‘‘Tracking Nutrition Trends 2013,’’ in which 77% of respondents felt they had ‘‘good’’ to ‘‘excellent’’ eating habits.23 These findings, however, contradict other empirical evidence on Canadians' diets. According to the latest population-based dietary survey, the 2004 CCHS, 22% of total calories were obtained from foods ‘‘other’’ than the 4 basic food groups, typically having excess amounts of fat, sugar, and salt (fats, oils, added sugars, candy and snack foods, condiments).24 In addition, over 25% of Canadians 31–50 years of age exceed the upper limit for fat intake, and 24.9% and 26.8% of Canadians 4–18 years and 19 years of age and older have the majority of total fat coming from fast foods, baked goods, and other snacks.25 Canadians also consume more calories from snacks than breakfast. Furthermore, fewer than half of adults consume 5 or more servings of fruits and vegetables per day (CCHS), and only 15% are consuming the current recommendation of 7 or more servings per day.24 These trends are corroborated in industry reports, which state that snack foods are the fastest-growing sector in the food economy, increasing more than 50% from 2000 to 2009, when snacks made up 24% of all meals.26 Surveys also consistently show that Canadians seek convenience over nutrition.23,27 Notably, few Aboriginal Canadians reported very good eating habits. This may be reflective of high rates of food insecurity, which are up to 3 times that of the rest of Canadians.28-30 The vast majority of Canadians report that they are using mainly whole/ basic ingredients for their main meal. As with eating habits, these data seem somewhat contradictory to other empirical data. Monteiro et al4 reported that ultra-processed food drinks (frozen foods such as prepared potatoes, poultry, fish, and pizza, ready
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016 meals, and desserts; snacks including salty snacks, candies, and ice cream); and soft drinks have increased from 37% of Canadians' calories in 1955 to 55% in 2009. Furthermore, in 2013, 52% of Canadians' food expenditures were on restaurant foods and non-‘‘whole/ basic’’ food items such as cookies, breakfast cereals and bars, soft drinks, candies, salty snacks, processed meat, and frozen/ready-to-serve foods.31 It is possible that these ultra-processed foods were only being consumed at times other than the ‘‘main meal.’’ However, other reports indicate that the majority of Canadians value convenience because of busy schedules27,32 and are spending less time than ever in the kitchen. This would be consistent with other surveys, which show that self-reported desired dietary behaviors are over-reported, whereas less-desired behaviors are reported less frequently because of social desirability.33,34 This was suggested in M&M Meat Shops' 2014 survey and campaign ‘‘Family Dinner is on the Decline: M&M Meat Shops Encourages Canadians to Bring Back the Lost Art of Dinner.’’ The results of their survey showed that only 30% of Canadian families eat together every night, a 30% decrease from the year before.35 This prompted the company to encourage Canadians to use their prepared, frozen products as a convenient way to ‘‘re-connect over dinner and honor the tradition of the family dinner.’’ This messaging indicates that there may be confusion in people's minds about what constitutes ‘‘whole/basic’’ food, and therefore respondents may have misunderstood the survey question. Younger Canadians were more likely to use convenience foods. This may be because they are single and less likely to have food preparation responsibilities for other family members. This may also be reflective of lower levels of food skills; fewer younger Canadians were adept at making more complex dishes such as soups and stews. This was consistent with reports of younger generations having fewer food skills because of lack of in-home learning and fewer formal educational opportunities to learn about food and nutrition.14,36,37 Almost one-third (32%) of men reported only having basic cooking skills, which suggests that a significant
gender gap in food skills persists. This could be because of division of labor within households, where women are still taking on more household food responsibilities, but also because these roles continue to be represented in media and other social narratives.38 The food delivery service named ‘‘Mom's Night Off’’ is just one example of the normative discourse around domestic food work.39 More information on household division of labor is required, in particular with respect to food shopping and preparation. The low number of respondents using CFGHE as a resource for choosing foods brings into question the Food Guide's value as an educational resource. Respondents were more inclined to consult the nutrition label of food products rather than use the food guide; however, men were much less likely than women to refer to either the Food Guide or nutrition labels. This could be due to women consistently reporting higher engagement in health-promoting behaviors than men and having greater understanding of the relationship between diet and health,40-42 whereas men view eating as ‘‘fuel’’ and part of a routine.43 The high rates of proficiency at canning and freezing vegetables are surprising, given the previously cited reports of people's desire for convenience and less time in the kitchen.26,27 However, it is to be noted that even though the respondents may possess a skill, it does not mean that they utilize it. These results clearly warrant further investigation, although 1 explanation may be a misunderstanding of the question on respondents' part. Respondents were asked about their proficiency in ‘‘in freezing vegetables or fruit, from raw to bagged in your home freezer.’’ Freezing fruits or vegetables in plastic bags may seem straightforward if one does not know the requisite steps such as blanching. The contradictions between some of these results and other empirical data can lead to several interpretations, including: some of the survey questions were not valid (ie, respondents misunderstood the meaning of the questions); respondents did not answer the questions accurately due to social desirability (ie, they wanted to portray themselves as having the ‘‘morally superior’’ behaviors such as cooking
0.75* (0.61–0.92) 0.93 (0.76–1.13) 1.09 (0.91–1.31) 1.00 59 (710) 64 (1,165) 67 (2,150) 66 (1,640) 0.41** (0.32–0.52) 0.66** (0.53–0.82) 1.02 (0.86–1.23) 1.00 19 (300) 28 (565) 38 (1,255) 37 (990)
CONCLUSIONS *P < .01, **P < .001. a Canada’s Food Guide to Healthy Eating. Note: Using multivariate logistic regression.
68 (835) 75 (1,380) 73 (2,430) 81 (2,085) 2.86** (2.33–3.51) 1.84** (1.52–2.25) 1.50** (1.26–1.80) 1.00 61 (700) 50 (885) 45 (1,355) 35 (840) Age 12–29 y 30–44 y 45–64 y 65þ y
Slater and Mudryj 491 from scratch and having ‘‘good’’ dietary habits44,45; respondents believed they were engaging in better dietary habits and food skill practices; or, finally, that their responses are valid and the other sources of empirical data are to be questioned. To gain clarity into these issues, it is first essential that better data be generated on what foods Canadians are in fact eating. The upcoming 2015 Canadian Community Health Survey (Nutrition), the first national dietary survey since 2004, will provide new empirical data to support or refute the selfreported assertion that Canadians' eating habits are good. Second, the constructs used to determine people food habits should be better conceptualized and defined. Terms such as ‘‘whole foods,’’ ‘‘convenience,’’ and ‘‘ready-to-eat’’ are ambiguous and open to much interpretation, as are ‘‘cooking’’ and ‘‘from scratch.’’ There are several limitations to this study. The data were self-reported, and it is well-accepted that desirable health behaviors are over-reported and undesirable ones are under-reported.33,34 The survey was cross-sectional, and this is the first time these data have been collected through any cycle of the CCHS, so there are no comparative data. Finally, no dietary data were collected from respondents; therefore their self-reported dietary and meal preparation habits and food skills cannot be cross-checked with actual foods eaten. Nonetheless, this initial, nationally representative survey provides important insights into Canadians' selfperceived dietary habits and food skills.
0.49** (0.39–0.62) 0.68** (0.55–0.85) 0.63** (0.51–0.79) 1.00
0.59** (0.50–0.70) 1.00 58 (2,185) 70 (3,475) 0.50** (0.43–0.59) 1.00 24 (960) 38 (2,150) 70 (2,680) 78 (4,050) 43 (1,445) 52 (2,335) Sex Male Female
0.70** (0.61–0.82) 1.00
0.65** (0.55–0.77) 1.00
Odds Ratio (CI) % Yes (n) 64 (5,665) Odds Ratio (CI) % Yes (n) 31 (3,110) Odds Ratio (CI) % Yes (n) 74 (6,725) Odds Ratio (CI) % Yes (n) 48 (3,780) Demographic Characteristics Overall
Do You Have a Budget When You Grocery Shop?
Table 2. Self-Reported Grocery Planning Skills of Canadians
Do You Use a Written Grocery List?
Do You Use Recommendations From CFGHEa?
Do You Select Foods Based on Nutrition Labels?
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Overall, the data in this study suggested that Canadians believe they have good eating habits and food skills, with women having somewhat better food skills than men. As shown, this is supported by other self-reported Canadian survey data yet contradicted by other empirical data including food disappearance data, population-based nutrition survey data, and data from the food industry. Nonetheless, this research suggests that there are still gender gaps with respect to food skills, and some younger Canadians appear more disadvantaged than their older counterparts with respect to food skills.
*P < .05, **P < .01. a Reference group; EUse with caution (> 16.6% coefficient of variation < 33.3%). Note: Using multivariate logistic regression. Numbers reflect proportions of Canadians who categorize themselves as having ‘‘good or very good’’ habits by food preparation activity.
57 (1,805) 80* (1,500) 82* (2,315) 82* (1,495) 85 (1,975) 94* (1,800) 95* (3,220) 92* (2,495) Age 12–29 ya 30–44 y 45–64 y 65þ y
90 (2,090) 95E* (1,830) 96* (3,245) 95* (2,565)
59 (1,410) 72* (1,350) 73* (2,410) 70* (1,880)
31 (720) 34 (645) 39* (1,425) 45* (1,205)
75 (1,755) 93* (1,805) 94** (3,210) 89* (2,435)
75 (1,575) 75 (1,390) 74 (2,345) 59* (1,655)
49 (2,190) 83** (4,590) 64 (2,585) 86** (4,530) 89 (4,225) 94* (5,260) 94 (4,435) 95 (5,295) Sex Malea Female
Rating (%) Overall
Knife Skills Good/Very Good (n) 94 (9,730)
64 (2,915) 73* (4,135)
31 (1,410) 42* (2,585)
85 (4,050) 91* (5,155)
58 (2,210) 86** (4,755)
Baking Muffins/Cake From Scratch Good/Very Good (n) 66 (7,005) Baking Muffins/ Cake From a Pre-Packaged Mix Good/Very Good (n) 72 (6,965) Cooking a Soup, Stew, Casserole From Scratch Good/Very Good (n) 75 (7,110) Cooking a Piece of Raw Meat/ Chicken/Fish Good/Very Good (n) 88 (9,210) Canning From Raw Ingredients Good/Very Good (n) 37 (3,995) Freezing Vegetables Good/Very Good (n) 68 (7,050) Peeling or Chopping Good/Very Good (n) 92 (9,485)
Table 3. Self-Rated Mechanical Skills of Canadians
65 (1,540) 69 (1,365) 68 (2,305) 61 (1,670)
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492 Slater and Mudryj
Although the study was conducted on Canadian data, it is likely that similar results could be found in other countries, in particular industrialized countries that have undergone the nutrition transition12 and exhibit high consumption rates of ultra-processed foods.11 These findings have implications for formal and non-formal food skills training programs in schools and community settings. Policymakers should re-think policies leading to the removal of school-based home economics food and nutrition courses.46,47 Furthermore, all children should have access to life-skill courses that include budgeting, planning, cooking, and shopping. In addition, policies and programs should be implemented to improve the food security status of Aboriginal Canadians.48,49 More research is needed to ascertain the dietary and food habits of Canadians and the drivers of these habits, as well as to clarify food skill competencies and associated measurement methods.
IMPLICATIONS FOR RESEARCH AND PRACTICE Although results suggested that the vast majority of Canadians believe that they have ‘‘good’’ eating habits, this study also found that certain groups, such as Aboriginal Canadians, reported lower rates of ‘‘good’’ eating habits. Additionally, this study also observed gender and age gaps when it came to self-rated food skills, which suggests that there are several opportunities for dietitians and other health professionals to engage with Canadians around these issues. The results of this study contribute to the emerging literature involving food skills. Findings from this study have implications for education and health promotion programs focusing on foods skills in Canada as well as encouraging ideas to create specific programs to appeal to and reach target groups who may be particularly vulnerable.
ACKNOWLEDGMENTS Financial support was provided University of Manitoba/Social Sciences and Humanities Research Council. The authors would like to extend thanks to Dr Ian Clara and Kelly Cranswick at the Manitoba Research
29 (415)
35 (720)
1.44** (1.16–1.79) 49 (650) 1.27 (1.05–1.54) 45 (1,010) 1.07 (0.89–1.30) 43 (585) 1.00 52 (580)
0.70* (0.56–0.88) 46 (560) 0.96 (0.77–1.20) 50 (1,075) 1.10 (0.91–1.35) 47 (630) 1.00 39 (425)
65þ y
45–64 y
52 (1,180) Age 12–29 y
30–44 y
50 (2,185)
*P < .01, **P < .001, ***.1 < P < .05. Note: Using multivariate logistic regression.
43 (545)
45 (870)
38 (450)
0.71* (0.55–0.92) 0.80*** (0.63–1.02) 1.08 (0.88–1.33) 1.00 35 (335)
0.92 (0.74–1.15) 53 (685) 1.32* 73 (1,370) 2.48** (0.85–1.17) (1.07–1.64) 68 (2,310) 1.99** 53 (1,140) 1.35* (1.68–2.30) (1.10–1.65) 52 (1,425) 1.00 45 (615) 1.00 43 (460)
62 (6,285)
Sex Male
Female
34 (445)
1.16 (0.92–1.47) 1.35 (1.02–1.55) 1.16 (1.05–1.61) 1.00 32 (335)
REFERENCES
0.99
36 (1375)
29 (545)
0.73** (0.61–0.88) 1.00 47 (2,825) 46 (2,685) 41 (2,200) 50 (2,900)
Slater and Mudryj 493 Data Centre for their statistical help and support. The authors also thank the staff from the Office of Nutrition Policy and Promotion at Health Canada for their assistance.
Overall
0.34** 47 (895) 0.73 45 (870) 1.32** 38 (750) 0.61** 48 (975) 1.07 (0.30–0.39) (0.69–0.96) (1.11–15.6) (0.52–0.71) (0.90–1.26) 74 (4,100) 1.00 52 (2,005) 1.00 38 (1,330) 1.00 51 (1,935) 1.00 47 (1,850) 1.00
33 (1920)
Odds Ratio (CI) % Yes (n) Odds Ratio (CI) % Yes (n) Odds Ratio (CI) % Yes (n) Odds Ratio (CI) % Yes (n) Odds Ratio (CI) % Yes (n) Odds Ratio (CI) Demographic Characteristics % Yes (n)
Did You Reduce Its Fat Content? Have You Ever Adjusted a Recipe to Make It Healthier?
Table 4. Self-Reported Recipe Adjustments by Canadians
Did You Reduce Its Salt Content?
Did You Reduce Its Sugar Content?
Did You Add More Vegetables or Fruit?
Did You Choose Whole Grain Options?
Journal of Nutrition Education and Behavior Volume 48, Number 7, 2016
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CONFLICT OF INTEREST The authors have not stated any conflicts of interest.
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