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erspectives in Practice

mericans’ Awareness, Knowledge, andehaviors Regarding Fats: 2006-2007

OBERT H. ECKEL, MD; PENNY KRIS-ETHERTON, PhD, RD; ALICE H. LICHTENSTEIN, DSc; JUDITH WYLIE-ROSETT, EdD, RD;

LLISON GROOM, MA; KIMBERLY F. STITZEL, MS, RD; SHIRLEY YIN-PIAZZA, MS

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BSTRACTn recent years, epidemiologic and clinical studies, publicnd regulatory policy activity, and media coverage haveocused on issues related to trans fats. To help increasewareness and understanding of trans fats and otherats, the American Heart Association (AHA) launched theFace the Fats” national consumer education campaign inpril 2007. The AHA commissioned a quantitative track-

ng survey between 2006 and 2007 to measure changes inonsumer awareness, knowledge, and behaviors relatedats and oils and their perceived impact on heart disease.he survey was conducted by Cogent Research. Dataere collected during March 2006 and May 2007. At both

ime points, the survey included a representative samplef the American population age 18 to 65 years (n�1,000).he sampling plan for the survey was designed based onhe 2000 and 2003 US Census. The margin of error was

. H. Eckel is professor of medicine, Division of Endo-rinology, Metabolism, and Diabetes and Division ofardiology, and professor of physiology and biophysics,harles A. Boettcher II Chair in Atherosclerosis, pro-ram director, Adult General Clinical Research Center,niversity of Colorado Denver, and director of the lipid

linic at University Hospital, Aurora, CO. P. Kris-Ether-on is distinguished professor of nutrition, Departmentf Nutritional Sciences, The Pennsylvania State Univer-ity, University Park. A. H. Lichtenstein is Gershoff Pro-essor of Nutrition Science and Policy, Gerald J. andorothy R. Friedman School of Nutrition Science andolicy, and director and senior scientist, Cardiovascularutrition Laboratory, Jean Mayer US Department ofgriculture Human Nutrition Research Center on Ag-

ng, Tufts University, Boston, MA. J. Wylie-Rosett is arofessor of epidemiology and population health, Albertinstein College of Medicine, Bronx, NY. A. Groom is aarketing research consultant, K. F. Stitzel is director,utrition and Obesity, and S. Yin-Piazza is seniorroject manager, Trans Fat Initiative, all with themerican Heart Association, Dallas, TX.Address correspondence to: Allison Groom, MA, Tech-

ology and Customer Strategy, American Heart Associa-ion, 7272 Greenville Ave, Dallas, TX 75231-4596.-mail: allison.groom@heart.orgManuscript accepted: July 18, 2008.Copyright © 2009 by the American Dietetic

ssociation.0002-8223/09/10902-0009$36.00/0

sdoi: 10.1016/j.jada.2008.10.048

88 Journal of the AMERICAN DIETETIC ASSOCIATION

3.10 percentage points. Awareness of trans fats in-reased during the 1-year study period. In 2007, 92% ofespondents were aware of trans fats, an increase from4% in 2006 (P�0.05). The 2007 level was similar to thewareness of saturated fats (93%). Perceptions that cer-ain fats and oils heighten the risk of heart disease in-reased for trans fats (73% in 2007 vs 63% in 2006;�0.05), saturated fats (77% in 2007 vs 73% in 2006;�0.05), and partially hydrogenated oils (56% in 2007 vs9% in 2006; P�0.05). Knowledge about food sources ofifferent fats remained low. On an unaided basis, 21%ould name three food sources of trans fats in 2007, uprom 17% in 2006 (P�0.05). Knowledge of food sources ofaturated fat remained unchanged at 30% in 2007. Sig-ificantly more respondents in 2007 reported behavioralhanges related to trans fat information, such as buyingood products because they show “zero trans fat” on labelsr packages (37% in 2007 vs. 32% in 2006; P�0.05).etween 2006 and 2007, consumer awareness about

rans fats increased and attained awareness levels simi-ar to saturated fats. The increased awareness is associ-ted with improved self-reported behaviors in groceryhopping. Nonetheless, overall knowledge, especially re-arding food sources of saturated and trans fats, remainselatively low, underscoring the need for heightened con-umer education activities. The positive change in con-umer awareness about trans fats is likely attributable tohe wide range of messages available to them, includinghe AHA “Face the Fats” national consumer educationampaign.Am Diet Assoc. 2009;109:288-296.

n recent years, epidemiologic and clinical studies, publicand regulatory policy activity, and media coverage havefocused extensively on issues related to reducing trans fat

ntake in the American diet and potential benefits withespect to health outcomes (1-6). The American Heart As-ociation (AHA) recommends a healthful dietary patternnd lifestyle to combat heart disease, limiting trans fatonsumption to less than 1% (or approximately 2 g on a,000-calorie diet) and saturated fat consumption to lesshan 7% of total daily energy (7). The American Dieteticssociation and the Dietitians of Canada have adopted aimilar recommendation with respect to trans fats (8).

In January 2006 the US Food and Drug AdministrationFDA) instituted a requirement to list trans fat content asseparate item on the Nutrition Facts label on packaged

oods (9). This change in labeling requirements has

erved as a catalyst to accelerate food product reformu-

© 2009 by the American Dietetic Association

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ation. On a voluntary basis, many food manufacturersnd restaurants have reformulated their products andodified their operations to reduce trans fats in their

fferings. With respect to public policy, approximately 20tates and local jurisdictions currently have proposals toeduce trans fats in restaurants or schools. As of April008, 11 cities and counties have adopted regulations toestrict the use of industrially produced trans fats in res-aurants (10).

In addition, consumer education is needed to increasewareness and help consumers make better choices whenrocery shopping, cooking at home, and eating out. Toelp increase awareness and understanding of trans fatsnd other fats, the AHA launched the “Face the Fats”ational consumer education campaign in April 2007.News coverage of trans fats doubled between 2006 and

007, from 516 print articles in May 2006 to 1,138 in May007 (11). Given this increase in information, the expec-ation was that Americans’ awareness of specific types ofats would have increased during those 2 years, and thatnowledge of the effects of specific fats on heart healthnd the consumption pattern would be positively corre-ated with the increased level of information available.ndeed, two other recent studies have found that thewareness and perceived unhealthfulness of trans fatsave increased (12,13).The objectives of this survey were to track Americans’

urrent awareness of fats and oils and their perceivedelationships to heart health over a 1-year period, and toxplore changes in knowledge and behaviors regardingats and oils during that period of time. Although theurvey covered a wide range of fats and oils, this articleocuses on a subset of the data, particularly data relatedo saturated fats, trans fats, and partially hydrogenatedils.

ETHODShis survey included two data-collection phases: baselinend 1-year follow up. The baseline phase was conductedarch 27 to April 7, 2006, and the follow-up phase was

onducted May 10 to 25, 2007, after the April 2007 launchf the “Face the Fats” campaign. The survey was con-ucted by Cogent Research (Cambridge, MA), a full-ser-ice marketing research firm, and funded by the AHA.Both phases were conducted via Internet survey amongrepresentative sample of Americans age 18 to 65 years,ith 1,000 respondents completing the survey in eachhase. Sampling was handled by Cogent Research andne of its third-party vendors, Survey Sampling Interna-ional (Shelton, CT), a global provider of sampling solu-ions for survey research. Survey respondents were mem-ers of Survey Sampling International’s multisourcednline panels, which consist of approximately 1.2 millionanelists. These panelists are enrolled via banner adsnd permission-based online recruitment. In the 2007hase, the survey invitation was e-mailed to approximately7,000 panelists. A total of 9,836 panelists started the sur-ey, of whom 1,000 respondents completed the survey, 494ropped out, 1,484 were terminated, and 6,858 were notsked to complete the survey because quotas for theirarticular demographic profiles were full.The profile of the respondents in each phase was sim-

lar in that both samples were based on the latest US p

ensus figures (2000-2003). The samples in each phaseid not consist of the same individuals, although it isossible that some individuals participated in bothhases. Cogent Research used US Census data to deter-ine the number of completed surveys needed for each

ey demographic variable to have a representative sam-le. Cogent then provided Survey Sampling Internationalith nested quotas on sex, age, education, and ethnicity

eg, target number completes by men age 18 to 24 withess than high school education). See Table 1 for profilesf the 2006 and 2007 samples in terms of sex, age, race,thnicity, income, education, and geographic region. Ofhe 1,000 subjects completing the survey, the percentagef invitations sent to respondents corresponded with the

Table 1. Demographic composition of American adults who par-ticipated in a survey to gauge consumers’ awareness about fats

2006 Sample(n�1,000) %

2007 Sample(n�1,000) %

SexMale 49 45Female 51 55

Age (y)18-24 10 1525-34 19 2235-44 24 2245-54 27 2555-64 21 16

Race/EthnicityWhite 78 81Black or African American 12 9American Indian or Alaskan

Native 2 2Asian or Pacific Islander 3 4Other 5 5

Hispanic/LatinoYes 13 11No 87 89

Annual income ($)�35,000 29 3135,000 to �50,000 20 1850,000 to �75,000 21 2175,000 to �100,000 10 10100,000 to �150,000 7 6�$150,000 3 3Don’t know 1 1Prefer not to answer 8 9

EducationLess than high school 11 9Graduated high school 27 26Some college/technical/

vocational 33 33Graduated college 19 21Graduate/professional 10 11

RegionNortheast 18 18Midwest 24 27South 37 34West 20 21

ercentages of those groups in the general population.

February 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION 289

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With any data-collection method, even when the outgo-ng sample is targeted and balanced to the US Census,ome populations are more likely than others to respond.equiring a minimum number of completes by each keyemographic variable allows for more precise dataeighting. As such, in the 2006 baseline phase, generalopulation data were weighted to the 2000 US Census byge and education. In 2007, general population data wereeighted to the 2003 US Census by education. Weighting

s used to ensure that the distribution of the sampleeflects that of the population on key demographics.

Differences in proportions or means that are noted astatistically significant were tested at a 95% confidenceevel using a t test. The margin of error was �3.10 per-entage points. It is unlikely that observed differences areue to sampling given this nested quota design and thathe universe for both waves was the same (Survey Sam-ling International respondents).Cogent Research developed the questions in conjunc-

ion with the AHA. Question text and answer categoriesere written at a junior-high level to ensure maximum

omprehension by all respondents. As part of the valida-ion process, a soft launch of 100 completes was con-ucted. Frequencies and cross-tabulations of the 100 softaunch completes were analyzed to determine whetherhere were egregious misunderstandings of the questionsased on respondents’ answers and compared with indus-ry data of consumer knowledge about trans fats. The softaunch did not require changes to the questions or answerategories.

The 99-question survey covered the following topics:oncern with the amount and type of fat consumed;wareness of specific fats and oils; awareness of the FDArans-fat labeling requirement; knowledge of sources ofaturated and trans fats; knowledge of the effects of spe-ific fats and oils on heart disease; behaviors related toats for grocery store purchases and cooking; and behav-ors at restaurants. To measure knowledge of the sources

igure 1. Concern with amount and type of fat among American adats.

f saturated and trans fats, the AHA compiled a list of h

90 February 2009 Volume 109 Number 2

ommonly consumed foods, most of which were generallyegarded as high in saturated fats and/or trans fats. Withegard to the term trans fats, survey respondents wereold to consider manmade or artificial trans fats for theurpose of this survey.

ESULTSoncernhe majority of respondents (62%) reported they wereoncerned with both the amount and types of fat theyonsume, and this concern was significantly higher in007 than in 2006 (Figure 1). In 2007, more than 6 in 10espondents (62%) were concerned about the amount ofat consumed, an increase from 55% in 2006 (P�0.05).ikewise, in 2007 62% of respondents reported concernbout the types of fat consumed, up from 52% in 2006P�0.05).

ommunications about Fatso gauge whether Americans have seen or heard infor-ation about trans fats that might influence their knowl-

dge, consumers were asked directly whether they hadeard or seen information about trans fats from a varietyf different sources, including television, magazines,ewspapers, the Internet, radio, food packages, the Nu-rition Facts panel, advertisements, physicians or otherealth care professionals, family or friends, or cookbooks.lthough the majority of respondents had heard some-

hing about trans fats in both years, they were moreikely to have heard of trans fats in 2007 (74% in 2007 vs4% in 2006; P�0.05).In 2007, significantly more respondents were aware of

he FDA requirement to list trans fat on food labels thann 2006 (43% in 2007 vs 37% in 2006; P�0.05). In addi-ion, more than half of respondents (54%) in 2007 had

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rans fats in their foods and about half (51%) had heard ofegulations to phase out trans fats in restaurants.

wareness of Fatswareness about trans fats increased among Americansver the 1-year study period. Specifically, unaided aware-ess of trans fats increased to 38% in 2007 from 31% in006 (P�0.05; Table 2). When prompted with a list of fatsnd oils, consumer awareness of trans fats increased sig-ificantly to 92% in 2007 from 84% in 2006 (P�0.05), andecame on par with awareness of saturated fats (93% in007).Even though partially hydrogenated oils and trans fats

re closely related, consumer awareness of partially hy-rogenated oils was less than for trans fats in 2007. Only

Table 2. Unaided and aided awareness of selected fats and oilsamong American adults who participated in a survey to gaugeconsumers’ awareness about fats (n�1,000)

Unaided: Pleaselist out all thetypes of fatsand oils youcan think of a %

Aided: ROTATE. Pleasecheck all of the typesof fats and oils thatyou have ever heardof b %

Vegetable oils2007 52 952006 55 95

Saturated fats2007 29 932006 30 92

Trans fats2007 38* 92*2006 31 84

Animal fats2007 25 842006 35* 84

n-3 fatty acids2007 8 81*2006 8 74

Polyunsaturated fats2007 12 732006 14 76

Monounsaturated fats2007 9 662006 9 70*

Partially hydrogenatedoils

2007 1 662006 2 68

Tropical oils2007 7 432006 7 45

aSurvey respondents were not prompted with a list of fats and oils in the unaidedquestion.bSurvey respondents were exposed to a list of fats and oils in the aided question. Thelist was rotated to avoid order bias.*P�0.05.

pproximately two thirds of respondents heard of par- c

ially hydrogenated oils in 2007, even when shown a listf fats and oils, and that percentage was virtually un-hanged from 2006.

nowledge of the Relationship between Dietary Fat Type andeart Diseaseonsumers were asked to determine, to the best of theirnowledge, what effects specific fats and oils have on theisk of heart disease. In 2007, among respondents alreadyware of specific fats, more reported that saturated fats,rans fats, and partially hydrogenated oils increase theisk of heart disease (Table 3), with 77% in 2007 respond-ng that saturated fats increase heart disease risk, anncrease from 73% in 2006 (P�0.05); 73% in 2007 re-ponded that trans fats increase this risk, up from 63%P�0.05), and 56% in 2007 responded that partially hy-rogenated oils increase this risk, up from 49% (P�0.05).The improvement in knowledge generally held true for

he entire population regardless of the awareness level.ore respondents in 2007 correctly associated saturated

ats with an increased risk of heart disease (72% in 2007s 67% in 2006; P�0.05). Similarly, more respondents in007 correctly associated trans fats with an increasedisk of heart disease (68% in 2007 vs 52% in 2006;�0.05).

nowledge of Sources of Saturated and Trans Fatsonsumers were asked to list, unaided, sources of satu-ated and trans fats, and were also asked to identifyources from a list of foods (aided). Unaided and aidedwareness of specific sources of saturated fats remainedimilar in 2006 and 2007. Slightly fewer than one third ofespondents could name three food sources of saturatedats in both years. Another one third could not name anyources of saturated fats without seeing a list. Knowledgef sources of saturated fats was significantly higher whenonsumers were aided with a list of foods. More than twohirds of respondents identified french fries, lard, butter,atty beef, and doughnuts as foods that typically containaturated fats (Table 4). However, the fact that frenchries and doughnuts are not typically high in saturatedat indicates that a certain level of consumer confusionxists.Unaided and aided awareness of sources of trans fats

ncreased from 2006 to 2007. In 2007, 21% of respondentsould identify three food sources of trans fats on an un-ided basis, an increase from 17% on 2006 (P�0.05).lose to half (46%) could not name any sources of trans

ats on their own. When given a list of foods from which toelect, significantly more respondents identified frenchries (53% in 2007 vs 41% in 2006; P�0.05) and dough-uts (51% in 2007 vs 44% in 2006; P�0.05) as the top foodxamples that typically contain trans fats. Interestingly,erhaps again indicating consumer confusion, more alsoncorrectly identified lard (40% in 2007 vs 35% in 2006;�0.05) as a food that typically contains trans fats. Also,onsumers continued to be more aware of foods that typ-cally contain saturated fats than foods that typically

ontain trans fats.

February 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION 291

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ehaviorsonsumers were prompted with a list of elements andsked which they looked for on a food label. The elementsncluded: total fats, trans fats, saturated fats, partiallyydrogenated oils, hydrogenated oils, tropical oils, cho-

esterol, sodium, statements about heart health benefitseg, reduces risk of heart disease, good source of fiber),erving size, and total calories. In 2007, at least halfeported looking for sodium, total fats, total calories, cho-esterol, trans fats, and saturated fats (Table 5). Signifi-antly more reported looking for trans fats in 2007 (53%)ompared to 2006 (44%; P�0.05).

Consumers were also prompted with a list of dietaryehaviors related to fats and asked if any of these wereheir regular behaviors. In 2007, more than half (54%)eported using vegetable oils (eg, canola oil, olive oil) forood preparation instead of animal fats (eg, butter) andpproximately half reported using cooking sprays andiquid vegetable oils instead of butter. These behaviors

Table 3. Knowledge of relationship between dietary fats and risk of hconsumers’ awareness about fats

Response to question: “To the best of your knowledge, what efdisease?” (Asked among respondents aware of the fat/oil.)

Increases

Animal fats (eg, lard, tallow, butter)2007 (n�836) 812006 (n�843) 78

Saturated fats2007 (n�934) 77*2006 (n�920) 73

Trans fats2007 (n�919) 73*2006 (n�838) 63

Partially hydrogenated oils2007 (n�664) 56*2006 (n�680) 49

Tropical oils (eg, palm oil, coconut oil)2007 (n�425) 442006 (n�447) 45

n-3 fatty acids (eg, fish, fish oil)2007 (n�805) 62006 (n�736) 6

Polyunsaturated fats (eg, nuts, salmon)2007 (n�729) 112006 (n�758) 9

Monounsaturated fats (eg, olive oil, avocado)2007 (n�658) 92006 (n�702) 8

Vegetable oils (eg, canola oil, corn oil)2007 (n�948) 272006 (n�946) 27

a✓�correct response.*P�0.05.

id not change significantly from 2006 (Table 6). u

92 February 2009 Volume 109 Number 2

Significantly more consumers reported behavioralhanges related to trans fats in 2007 compared to 2006.pecifically, more respondents in 2007 bought food prod-cts because they show “zero trans fat” on labels or pack-ges (37% in 2007 vs 32% in 2006; P�0.05). More respon-ents reviewed information on trans fat before makingurchasing decisions (29% in 2007 vs 23% in 2006;�0.05). Finally, more indicated using a “zero/low trans

at” version of solid fat products in 2007 compared to 200626% in 2007 vs 21% in 2006; P�0.05).

Consumers were also asked about their dietary be-aviors at restaurants. Although most did not ask forutrition information or healthful food options whenining at a restaurant, a small but increasing numberf consumers (21% in 2007 vs 15% in 2006; P�0.05)equested, at least some of the time, ingredient orutrition information for menu items. In addition, ap-roximately half (51%) indicated that they ordered thehealthier” menu items at least some of the time (Fig-

isease among American adults who participated in a survey to gauge

if any, do each of the following have on your risk of heart

Responses (%)

Decreases No effect Don’t know

2 3 142 3 17

2 3 183 2 22*

5 3 187 2 28*

4 4 366 6 38

19 8 2920 5 30

74 ✓ 5 1572 4 19*

60 ✓ 8 2162 6 23

63 ✓ 10 1861 7 23*

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ifferences by Demographic Variablesome demographic differences were observed in the sampleegarding awareness, knowledge, and behaviors related torans fats. Significant differences in responses were driveny sex, age, education, and income. Respondents who exhib-ted higher levels of awareness, knowledge, and/or health-elated behaviors were more apt to be female, age 45 yearsr older, report at least some college education, report

Table 4. Knowledge of food sources of saturated and trans fats amawareness about fats (n�1,000)

Year

R“isa%

French fries 2007 72006 7

Lard 2007 72006 7

Butter 2007 62006 6

Fatty beef 2007 62006 7

Doughnuts 2007 62006 6

Pastries 2007 52006 5

Hard margarine 2007 52006 5

Vegetable shortening 2007 52006 5

Cookies 2007 52006 5

Dairy products 2007 42006 4

Soft tub margarine 2007 42006 4

Whole milk 2007 42006 4

Crackers 2007 22006 3

Chicken 2007 22006 2

None of the above 2007 12006 1

aSurvey respondents were exposed to a list of fats and oils (aided). Checkmarks are gireformulation and changes in frying oils have taken place to produce “zero trans fat” verto cookies and pastries for saturated fats, it is recognized that the amount of saturatedchips) used.bIn the questionnaire, respondents were asked to consider artificial trans fats for the puc✓�correct response.*P�0.05.

ousehold incomes of $75,000 or more, and live in the a

ortheast or South. The geographical variation may haveeen influenced by regional regulatory and media activityTable 7). No pattern of significant differences was foundith regard to race or ethnicity.

ISCUSSIONubstantially more information related to fats became

American adults who participated in a survey to gauge consumers’

nse to question:h of these foods,, typically containted fats? Checkt apply.” (aided)a

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Response to question:“Which of these foods, ifany, typically containtrans fats? Check all thatapply.” (aided)b % whochecked food

53* ✓c

41

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✓ 3533

✓ 36*30

51* ✓44

✓ 46 ✓43

41 ✓40

39 ✓38

✓ 44 ✓40

✓ 2223

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✓ 1919

29 ✓28

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food products traditionally high in saturated and/or trans fats. It is acknowledged thatf some of these products in recent years. In addition, even though a checkmark is givenbaked items can vary greatly depending on the main ingredients (eg, butter, chocolate

of this survey.

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February 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION 293

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ine information was collected, mid 2006, and approxi-ately 1 year later. Consumers indicated that they hadeard more about trans fats in 2007 from a variety ofources. We hypothesized that the awareness of fatshifted between 2006 and 2007, and that knowledge ofhe effects of specific fats on heart health and the overallonsumption pattern would be positively correlated withhe increased level of information available.

The hypothesis seems to hold true for awareness and tocertain extent, knowledge. Awareness of specific fats

nd oils shifted from 2006 to 2007, and was positivelyorrelated with the increased level of information aboutrans fats. Further, respondents’ knowledge about theffect of saturated fats and trans fats on the risk of heartisease increased. In many print articles and on the In-ernet (such as the www.AmericanHeart.org/FaceTheats Web site), saturated fats and trans fats are men-ioned as the “bad” fats for heart health. This may haveontributed to the increased knowledge.

The increased awareness has also had some impact onehaviors, although more so in food choices at grocery

Table 5. Heart health nutrition information American consumerslook for on a food label based on responses to a survey about fats(n�1,000)

Year

Response to question: “Whichof the following specific typesof information that relate toheart health do you look foron food or beverage labels orpackages? Please check allthat apply.” % who checkeditem

Sodium 2007 602006 57

Total fats 2007 582006 58

Total calories 2007 562006 56

Cholesterol 2007 542006 52

Trans fats 2007 53*2006 44

Saturated fats 2007 502006 47

Serving size 2007 422006 43

Statement about hearthealth benefits

2007 412006 42

Partially hydrogenatedoils

2007 262006 26

Hydrogenated oils 2007 262006 25

Tropical oils 2007 142006 16

None of the above 2007 172006 19

*P�0.05.

tores and food preparation at home than in food behavior a

94 February 2009 Volume 109 Number 2

t restaurants. Americans reported taking more actionso make more healthful food choices, particularly relatedo trans fats.

However, knowledge levels about the major foodources of saturated fats and trans fats remain insuffi-ient. The lack of knowledge about tropical oils is of note,oo, especially because tropical oils, high in saturatedats, are being used in some foods as substitutes for transats. Consequently, consumers need some key informa-ion to improve their food choices.

It seems that the media’s extensive coverage of transat–related issues as well as consumer education effortsave had a substantial impact on consumer awarenessnd knowledge of trans fats. It is not yet clear whetheronsumers are focusing on trans fats and overlookingther fats or switching to trans fat–free products withouthecking the saturated fat content. Efforts should beade to continue to monitor consumer behaviors in this

Table 6. Specific dietary behaviors related to fats when selectingand preparing food among American adults who participated in asurvey to gauge consumers’ awareness about fats (n�1,000)

Year

Response to question:“Which of thefollowing, if any, areyou doing on aregular basis? Checkall that apply.” %who checkedbehavior

Using vegetable oils (eg, canolaoil, olive oil) instead of animalfats (eg, butter)

20072006

5454

Using cooking spray or liquidvegetable oils instead ofbutter

20072006

4850

Using more healthful fats insteadof trans fats

20072006

3736

Buying food products becausethey show “zero trans fat” onlabels or packages

20072006

37*32

Using more healthful fats insteadof saturated fats

20072006

3234

Using more liquid vegetable oilsinstead of solid fats

20072006

3134

Reviewing information on transfats specifically before makingdecisions on purchases

20072006

29*23

Reviewing information on transfats and saturated fatstogether before makingdecisions on purchases

20072006

2724

Using a “zero/low trans fat”version of products instead ofa solid fat version

20072006

26*21

None of the above 20072006

2425

*P�0.05.

rea and educate consumers about different types of fats.

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igure 2. Frequency of requesting nutrition information or ordering healthful menu items at restaurants among American adults who participated

n a survey to gauge consumers’ awareness about fats.

Table 7. Differences in specific awareness, knowledge, and behavior by demographic variables among American adults who participated in asurvey to gauge consumers’ awareness about fats (n�1,000)

Concerna %Unaidedawarenessb %

Aidedawarenessc %

Increasesriskd %

Name threesourcese % Consume lessf %

SexMalew 55 40 89 73 25 66Femalex 68w 37 95w 74 21 75w

Age (y)25-34w 54 43y 95 69 24 6935-44x 56 37 91 72 21 6045-54y 65wx 31 92 73 26 75x

55-65z 70wx 38 90 79w 23 78wx

EducationHigh school or lessw 58 32 88 63 21 60Some collegex 63 41w 92 76w 23 76w

College graduatey 64 45w 96w 83w 27 78w

Income�$35,000w 64 36 90 69 18 66$35,000-49,999x 58 39 97w 75 26 72$50,000-74,999y 57 44 93 74 26 74�$75,000z 66 43 94 81w 27w 75

RegionNortheastw 63 42 94 83xyz 23 74x

Midwestx 57 40 92 74 25 64Southy 65x 38 90 72 22 73x

Westz 59 35 94 68 23 68

a“How concerned, if at all, are you with the amount of fat that you consume in foods?” (Top-2 box rating on 5-point scale).b“Please list out all the types of fats and oils that you can think of.”c“Please check all of the types of fats and oils that you have ever heard of.”d“To the best of your knowledge, what effect, if any, do trans fats have on your risk of heart disease?”e“(If aware of trans fats) Can you name up to three types of foods that typically contain trans fats?” (unaided).f“Please indicate whether you are trying to consume less trans fats.”

wxyzSignificant differences between different demographic variable values are indicated (P�0.05).

February 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION 295

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Specific communications should be developed to targetroups with different demographic profiles, specificallyased on sex, age, education, and income.

ONCLUSIONetween 2006 and 2007, consumer awareness about

rans fats increased and attained levels similar to satu-ated fats. The increased awareness is associated withmproved self-reported behaviors in grocery shopping.onetheless, overall knowledge, especially regarding food

ources of saturated and trans fats, remains relativelyow, underscoring the need for heightened consumer ed-cation activities. The positive change in consumerwareness about trans fats is likely attributable to theide range of messages available to them, including theHA “Face the Fats” national consumer education cam-aign.

ractical Application for Dietitians and Otherealth Professionalshe Nutrition Facts panel on food labels can be very

nformative, and registered dietitians and other healthrofessionals should teach consumers to examine itlosely. Regarding trans fats, registered dietitians andther health professionals should stress to consumers toook not only at the Nutrition Facts panel for trans-fatontent, but to also check the ingredient list for partiallyydrogenated oils, which indicate the existence of trans

ats. In addition, it is important to teach consumers toeview both saturated fat and trans fat content on theutrition Facts panel to avoid substituting one unhealth-

ul fat for another.Consumers also need help identifying foods high in

aturated and/or trans fats so they can learn to limithese foods. With the recent food reformulation and theublicity surrounding policies to restrict trans fats inoods served in restaurants, consumers may not appreci-te that “trans fat–free” foods are not necessarily health-ul. Many fried foods and baked goods are high in satu-ated fats and calories even if trans fat–free oils and fatsre used. Registered dietitians and other health profes-ionals also should stress to consumers that many foodsaturally contain saturated fats (regardless of the prep-ration method) and should provide examples of theseoods.

Registered dietitians and other health professionalshould help consumers identify ways to cook heart-ealthy foods at home and choose more heart-healthyptions in restaurants. To facilitate behavior change, reg-stered dietitians and other health professionals shouldrovide specific tips such as using liquid vegetable oils

nstead of animal fats; choosing foods that are steamed,

96 February 2009 Volume 109 Number 2

roiled, baked, grilled, or roasted; and asking restaurantervers about the oil used in food preparation and thevailability of nutrition information.

he American Heart Association funded the marketingesearch related to this manuscript.Institutional Review Board approval does not pertain

o this survey.

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