Appetite 65 (2013) 35–42

Contents lists available at SciVerse ScienceDirect

Appetite

journal homepage: www.elsevier .com/locate /appet

Research report

Psychosocial determinants of fruit and vegetable consumption amongstudents in a New Zealand university. Results of focus group interviews q

0195-6663/$ - see front matter � 2013 Elsevier Ltd. All rights reserved.http://dx.doi.org/10.1016/j.appet.2013.02.005

q Acknowledgments: We would like to thank all focus group participants for theircontribution. We also appreciate the assistance of our colleagues Wilma Tielemansand Rachel Mason in data collection and initial manuscript compilation.⇑ Corresponding author.

E-mail address: d.p.wadsworth@massey.ac.nz (D.P. Wadsworth).

Hilde Hartman a,b, Daniel P. Wadsworth a,⇑, Suzi Penny a, Patricia van Assema b, Rachel Page a

a Health and Life Sciences Division, Institute of Food, Nutrition and Human Health, Massey University, PO Box 756, Wellington, New Zealandb Dept. of Health Promotion, Maastricht University, The Netherlands

a r t i c l e i n f o a b s t r a c t

Article history:Received 3 April 2012Received in revised form 30 January 2013Accepted 3 February 2013Available online 13 February 2013

Keywords:Focus group interviewsFruit and vegetable intakeNew ZealandPsychosocial determinantsUniversity studentsYoung adults

The ‘5+ a day’ fruit and vegetable servings recommendation was introduced in New Zealand in 1994, butconsumption has remained low in young adults ever since. This study aimed to identify psychosocialdeterminants of fruit and vegetable consumption among New Zealand university students approximatelya decade after the guidelines’ introduction. Twenty-nine students, aged 18–24 years, took part in focusgroup interviews. Important determinants included taste and health awareness/knowledge. Flatmatesand partners had the greatest social influence. Cost and availability were major barriers to consumption.To improve consumption participants suggested: cooking sessions providing quick/easy recipes; more-varied nutritional information; ‘made-to-measure’ interventions; increasing awareness of cheap sourcesof fruit/vegetables; and increasing campus availability of fruit. Determinants including a negative atti-tude, a lack of self-efficacy and an unawareness of dietary guidelines/health consequences should be con-sidered when developing interventions for this group, whilst a variety of different delivery channelsshould be used. Participants in the study were not representative of all university students, who generallyhave a different lifestyle to other young adults and specific determinants for fruit/vegetable consumption.Consequently, additional research is required among other young adults and university students withlower fruit and vegetable intake, so that promotional strategies can be specifically targeted.

� 2013 Elsevier Ltd. All rights reserved.

Introduction

Non-communicable diseases such as cardiovascular disease,cancer, and type 2 diabetes mellitus kill more people worldwideevery year than any other cause of death (Lock, Pomerleau, Causer,Altmann, & McKee, 2005). Intake of at least 400 g of fruit and veg-etables per day (or 5+ servings a day) is proposed to help preventthese non-communicable diseases and assist in weight control(Ministry of Health, 2003; World Health Organisation, 2005). Theserecommendations were introduced to New Zealand in 1994through the ‘5+ a day’ campaign. However, survey data and statis-tics from the Food and Agriculture Organisation (FAO) imply thatmost populations are not meeting the recommended intake of fruitand vegetables (Ashfield-Watt, Stewart, & Scheffer, 2004; CancerSociety New Zealand, 2004; Food & Agriculture Organization,2004; University of Otago & Ministry of Health, 2011). Moreover,consumption decreases with age in adolescents (Krolner et al.,

2011; Lien, Lytle, & Klepp, 2001), and is particularly low in youngadults aged 18–25 years old (Keim, Stewart, & Voichick, 1997;Krebs-Smith et al., 1995; Ministry of Health, 2004; Serdula et al.,2004; Song, Schuette, Huang, & Hoerr, 1996; University of Otago& Ministry of Health, 2011; Ünüsan, 2004). In 2003, the CancerSociety of New Zealand undertook a major survey among adultNew Zealanders, aged 16 and over (Cancer Society of New Zealand,2004). This postal survey received 8163 useable responses, and forthe first time in New Zealand provided detailed information notonly on eating behaviour, but also on attitudes, motivations, andperceived barriers of eating fruit and vegetables (Cancer SocietyNew Zealand, 2004). Cost and convenience were recurrent themesfor determining fruit and vegetable consumption, yet the surveygave no consideration to different age-groups within the popula-tion, instead reporting findings as adult New Zealanders. World-wide studies have shown that higher education (HE) studentsengage in numerous unhealthy lifestyle practices, with between66% and 95% eating less than the recommended ‘5+ a day’ fruitand vegetable servings (Dodd, Al-Nakeeb, Nevill, & Forshaw,2010; Keller, Maddock, Hannöver, Thyrian, & Basler, 2008; Papa-daki, Hondros, Scott, & Kapsokefalou, 2007; Ünüsan, 2004). More-over, Ministry of Health dietary surveys (Ministry of Health, 2004;University of Otago & Ministry of Health, 2011) have shown youngadults in New Zealand to exhibit similar behaviours. However,

Fig. 1. Attitudes, social influences and self-efficacy (ASE) model of determinants of behaviour Kreuger, (2000).

36 H. Hartman et al. / Appetite 65 (2013) 35–42

to-date there has been no research into what determines the foodchoices of young adults in higher education in New Zealand.

Epidemiological evidence suggests that lifestyle habits, includ-ing food intake, formed by young adults at this transitional stageof life may have long-term health implications (Jas, 1998; Papadakiet al., 2007; Spanos & Hankey, 2010). In addition, many youngadults will start having families at this time, and will model dietarybehaviour for their children (Lau, Quadrel, & Hartman, 1990). Re-cent increased understanding of the long-term health impacts ofearly developmental influences and epigenetics further highlightsthe importance of establishing healthy dietary habits early, partic-ularly in young women prior to childbearing (Hanley et al., 2010).Therefore, promoting adequate intake of fruit and vegetables inyoung adults is likely to have maximum preventive potential ofdeveloping diseases at a later stage of life (Beerman, 1991; Geor-giou & Arquitt, 1992; Raitakari, Porkka, Räsänen, & Viikari, 1994).Developing successful strategies for implementing long-termbehavioural changes requires recognition of the importance ofvariations in motivation and possible barriers between differentpopulation groups (Ammerman, Lindquist, Lohr, & Hersey, 2002;Chapman, Armitage, & Norman, 2009; Martens, van Assema, Pau-lussen, Schaalma, & Brug, 2006; Uglem, Frølich, Stea, & Wandel,2008; Washi & Ageib, 2010). Perceptions about taste have beenfound to be an important psychosocial factor of fruit and vegetableconsumption for adults (Krebs-Smith et al., 1995; Stewart &Tinsley, 1995; Ünüsan, 2004) as have satiety, digestibility, appear-ance and texture (Krebs-Smith et al., 1995; Stewart & Tinsley,1995; Uetrecht, Greenberg, Dwyer, Sutherland, & Tobin, 1999;Ünüsan, 2004). Perceived health benefits of fruit and vegetables,and/or a good nutritional knowledge, have also been shown tohave positive associations with fruit and vegetable consumption(Brug, Lechner, & De Vries, 1995; Wardle, Parmenter, & Waller,2000). However, young Americans aged 18–24 years were shownto be less likely to think that five servings of fruit and vegetablesper day were necessary for good health (Krebs-Smith et al.,1995). Furthermore, an individual’s self-efficacy, the influence ofothers, and the availability and cost of fruit and vegetables haveall been frequently identified as important determinants of an indi-vidual’s fruit and vegetable consumption (Brug, Lechner, et al.,1995; Cancer Society New Zealand, 2004; Stewart & Tinsley,1995; Uetrecht et al., 1999; Ünüsan, 2004). Of the studies investi-gating the determinants of fruit and vegetable consumption, veryfew have focussed on students in higher education, who for thefirst time in their lives have significantly greater control over their

diets, and health/well-being. Coupled with what can be an extre-mely stressful period, this group of individuals are vulnerable topoor diet and its health-related issues. In the studies conductedto-date focussing on university students, specific determinants offruit and vegetable consumption identified included on-campusavailability, level of food preparatory skills and family/peer influ-ences (Papadaki et al., 2007; Ünüsan, 2004). At present, there hasbeen no research into what determines the food choices of youngadults in higher education in New Zealand. Therefore, the currentstudy explored the psychosocial determinants associated with fruitand vegetable consumption among university students in NewZealand in order to develop more effective targeted-interventionstrategies for this group. National dietary surveys have shown thatyoung adults in New Zealand have the lowest fruit and vegetableconsumption of all age-groups (Ministry of Health, 2004; Univer-sity of Otago & Ministry of Health, 2011), so in order to developeffective targeted-interventions for this sub-group we have chosena qualitative approach, which has been shown to be a useful tool in(i) drawing out yet unknown factors and (ii) developing such tai-lored interventions (Krolner et al., 2011).

Methods

Six focus groups were conducted for this study, each consistingof 4–5 male and female volunteers. Literature suggests that, whenparticipants have knowledge/experiences to discuss, 3+ partici-pants per group allows for sufficient variation in discussion whilestill allowing all to have input and feel at ease (Carlsen & Glenton,2011; Onwuegbuzie, Dickinson, Leech, & Zoran, 2009). Conductingsix separate focus groups has been found to be adequate in reach-ing a point of saturation, i.e. a point after which no more new infor-mation is retrieved from the interviews (Carlsen & Glenton, 2011;Onwuegbuzie et al., 2009). As such, six focus groups were con-ducted, at which point no new information appeared in the discus-sions, so no further focus groups were planned. Inclusion criteriafor this study were that participants were aged 18–24 years oldand enrolled in university studies. Participants for this study wererecruited from Massey University, New Zealand, on the premise ofparticipating in ‘food-based focus groups’, with no specific linkmade to fruit and vegetable consumption. The focus groups tookplace during the New Zealand winter-time in 2005. The methodsand procedures of this study were approved by the Massey Univer-sity Human Ethics Committee Wellington (Ethics approval number05/23).

H. Hartman et al. / Appetite 65 (2013) 35–42 37

Description of the focus groups and topics

Four of the groups consisted of a combination of students fromhealth- and non-health related study programs; one further focusgroup consisted of only students enrolled in health-related studies,while another was composed solely of students studying a non-health related degree. Focus group interviews took between one-and-a-half and 2 h each. All interviews were audio taped and con-ducted with two researchers; a health/life science lecturer facili-tated and moderated the group discussion, the second individualmade notes and monitored the interview process (Kreuger,2000). Prior to the commencement of each focus group interview,participants were asked to fill in a basic demographics question-naire which also asked participants to quantify their regular phys-ical activity level and what they thought the recommended intakewas for fruit and vegetables was and to list their consumption forthe previous day. Interviewers had an interview guide/general lineof questioning, which was developed for leading the discussionsabout fruit and vegetable consumption in the focus group inter-views. This interview guide was structured as per the Attitude-So-cial influence-self-Efficacy (ASE) model (Brug, Lechner, et al., 1995;de Vries, Dijkstra, & Kuhlman, 1988). This model has used found tobe helpful in studies explaining food-related behaviours before(Brug, Lechner, et al., 1995). In this model behavioural intentionis considered to be the most proximal determinant of a person’shealth behaviour, which is determined by people’s attitude (basedon different perceived advantages and disadvantages of the behav-iour), perception of different social influences, and self-efficacy.(Perceived) barriers and lack of abilities may hinder intentions tobecome actual behaviours (Fig. 1). Additionally, the topics of habitand of misconception of risk behaviour in relation to awareness ofrecommended amounts were included in the interview guide, forexample in questions such as ‘‘do you eat fruit very often?’’ and‘‘why do you think it is good to eat vegetables?’’, as these havebeen found to be determinants of food-related behaviour (Brug,Lechner, et al., 1995; Krebs-Smith et al., 1995; Stewart & Tinsley,1995; Wardle et al., 2000). In the final part of the interview, partic-ipants were asked to provide suggestions for promotional inter-ventions, and about what their expected consumption would bein 5 years’ time. All participants were encouraged to express theiropinions. Discussion of influences in eating fruit and vegetableswas addressed separately during the interviews, because motiva-tions for consumption could vary among these two differentgroups of food products (Brug, Debie, van Assema, & Weijts, 1995).

Data analysis

Transcripts of the focus group discussions were made, and re-sults were analysed with QSR NVivo�1.3 (QSR International PtyLtd., 2001), with fruit and vegetables coded separately. Deductivecoding (Hennink, Hutter, & Bailey, 2011) was completed by theprinciple investigator (HH), and verified by three different academ-ics (SP, PvA, RP) in accordance with previous research methodology(Brug, Lechner, et al., 1995). There were minimal disagreementsamong the researchers, all of which were resolved through discus-sion and agreement about the best code. Interview fragments werearranged in categories and subcategories (nodes and subnodes)based on the components of the ASE-model (attitude, social influ-ence, self-efficacy, barriers, and abilities), which has been used infood-behaviour studies previously (Brug, Lechner, et al., 1995),and the additional concepts of awareness and habit (Fig. 1). Fur-thermore, there was a separate code for interview fragments inwhich participants made suggestions for interventions and afurther code for fragments in which participants discussed theirexpected future intake.

Results

The results are described according to important issues thatwere derived from the analysis. Results are based on participants’pronouncements and should not be viewed as factually defined.

Participant characteristics

Participant characteristics are summarised in Table 1; a total of29 participants were recruited, consisting of 12 men and 17 wo-men aged 18–24 years old (mean = 22 years). The majority of par-ticipants were European New Zealanders (79%), whilst othersconsidered themselves as being of Asian or both European andMaori descent. Participants included students from both health-and non-health related study programs (59% and 41%, respec-tively). Most participants were flatting and responsible for theirown meals (72%). All participants thought that physical activityand nutrition were both important for their health; all reportedbeing physically active for at least 20 min a day (walking). The pro-portion of participants meeting the recommended consumptionlevels of fruit and vegetables on the day before the interview daywere similar, with slightly more meeting the recommended levelsof vegetable consumption (76% compared to 72% for fruit).

Attitude

With regard to attitude, the aspects most frequently identifiedas a motivation for eating fruit and vegetables were taste, healthconsequences, and satiety. Perceptions about taste were men-tioned most often by participants for both fruit and vegetables asbeing an essential prerequisite to decide whether or not to eatthem. An illustrative claim was: ‘‘Taste is a huge thing for that, be-cause if I don’t like the taste, then I won’t eat it.’’ Factors identifiedas promoting increased consumption were variety in taste be-tween different fruit and vegetables, and a preference for thesweeter taste of fruit. Past experiences of being forced to eat over-cooked vegetables led to reduced consumption, as did unripe ortoo ripe fruit.

Participants in all six interviews stated that they felt physicallyand psychologically better when they were eating fruit and vegeta-bles. ‘‘I eat fruit and vegetables because it’s healthy’’ was a remarkthat was made in all six interviews; not everybody knew exactlywhy it was good to eat them, but a number of participants men-tioned the benefits of eating fruit and vegetables in relation to pre-vention of or recovering from diseases. Students enrolled in non-health related studies thought they might be eating more fruitand vegetables if they were enrolled in a health-related course, be-cause they would have more detailed information about why it isgood to eat fruit and vegetables. Whilst concerns about weightwere never mentioned as a main factor in determining the con-sumption of fruit and vegetables, it was acknowledged in oneinterview that losing weight might be a big issue for people of theirage. Some participants mentioned pesticides and herbicides as aninfluence on health, but this did not restrain them from eating fruitand vegetables.

Satiety was mentioned in a positive and negative sense for bothfruit and vegetable consumption. Vegetables were considered asfilling, and were recognised as an inexpensive way to make a mealmore filling, while for fruit opinions were mixed - some thoughtfruit was satisfying enough for a snack, while others disagreed.

Social influences

Social influences were acknowledged by participants, with flat-mates, parents, partners, sports coaches, and friends all influencing

Table 1Participant characteristics (n = 29).

Characteristics Number of participants

EthnicityEuropean New Zealand 23European-Maori 2Asian 4

Course detailsHealth-related studies 17� Nursing 5� Sport and exercise 5� Health science 3� Midwifery 2� Environmental health 1� Psychology 1Non-health-related studies (e.g. Design and Business) 12

Living circumstancesFlatting 21Boarding 3Living with parents 2Own household 2Living in a hostel 1

Fruit and vegetable intakeMet recommended fruit intake (2+ a day) 21Met recommended vegetable intake (3+ a day) 22

38 H. Hartman et al. / Appetite 65 (2013) 35–42

the intention of participants to consume fruit and vegetables. Flat-mates had the greatest influence, by giving social support and act-ing as models, although sharing groceries and cooking had bothpositive and negative influences. An illustrative claim of the influ-ence of flatmates was ‘‘My flatmates are all Design students and theyare all the same. They all eat like fish-n’chips and just easy fast food.I’m influenced by them. Fruit and vegetables are not really common.’’Partners were also mentioned as being a model for participants, forexample stating ‘‘My partner and I just started living together and it’schanged the eating habits. . .he is a good cook’’. For some students,daily fruit and vegetable consumption was part of the normalbehaviour passed on from their parents.

Self-efficacy

Some participants had higher self-efficacy in eating fruit thanvegetables while for others the opposite was true. Participants per-ceived themselves as much more capable of eating readily conve-nient fruit and vegetables, whereas the personal effort requiredfor preparation of vegetables, and also of fruit salads and fruitjuices, led to lower self-efficacy. Students who said it was easierto eat fruit remarked that it was something they just could graband eat, and viewed it as ‘‘an easy snack to take to school’’. Con-versely, for some students there was lower self-efficacy for fruitconsumption due to their perception of fruit as a snack and notwanting to eat between the three main meals, or that they forgotto take fruit to university/eat it when there. A frequent commentwas that ‘‘taking fruit to the university was messy, because it gotsquashed [in their bags]’’. The perception that vegetables belongedin a meal was likely to lead to higher self-efficacy for eating vegeta-bles for some students, but lower self-efficacy for other partici-pants, with illustrative statements of this including ‘‘I think it’seasier to eat vegetables, because when you come home from schoolyou want a hot meal and there are not really hot fruit meals’’ and ‘‘Idon’t eat vegetables during the day, it’s only for my dinner, I can’teat it as a snack’’. If participants had less time to prepare a meal orwere tired after a day of study they tended to make a quick mealwithout vegetables, while frozen vegetables were stated to be easyto prepare and less time consuming. Lack of knowledge about somekinds of fruit and vegetables and a lack of practice in preparing (cer-tain) vegetables were also likely to lead to a lower self-efficacy of

participants. Additionally, when students shared their cooking intheir flat and it was their turn to cook, they were more considerateand put more effort in what they cooked; on the other hand, sharedcooking meant that participants had less control over what wasserved for dinner on other nights, which led to lower self-efficacywith respect to eating the right amount of vegetables.

Barriers and abilities

Key factors identified as barriers to fruit and vegetable con-sumption were cost, availability and seasonal influences. Financialcost was raised as an important barrier for both fruit and vegeta-bles; on tight budgets participants preferred to buy only the essen-tial groceries and considered fruit an optional extra. Cost alsolimited students in buying a variety of fruit and vegetables, whichmade it monotonous and thus limited consumption; converselythough, students who shopped at the market did not judge fruitand vegetables as that expensive. Although judged as containingfewer vegetables, it was mentioned several times that ‘‘it is mucheasier and less expensive to get a cheap take-away instead of prepar-ing a whole dinner.’’

Availability was mentioned as a barrier for both fruit and vege-table consumption. Flatting was frequently recognised as affectingavailability because (i) a fruit/vegetable is not as readily availableas it used to be when living with parents and (ii) when flatting,fruit and vegetables were purchased in a weekly shopping tripand by the end of the week the shopping was almost gone, there-fore less was available. Additionally, because students often did notknow what their plans were for the week, there were difficultiesestimating the amounts of fruit and vegetables they had to buydue to their perishable nature. Some participants commented thatthey would eat more fruit if individual pieces were available atmore places, like the campus, dairies, cafes, and other take-awayplaces. In all interviews remarks were made on the very limitedavailability, cost, and quality of fruit and vegetables on the univer-sity campus; an example comment being ‘‘If they sold fruit at theuniversity for supermarket prices...if they cost 20 cents I would buyit.’’ Others said they would not be influenced by the price, butdid not perceive fruit as a treat and were willing to pay more forother snacks, stating for example ‘‘when I buy an ice-cream that’snot what I do all the time. It’s a treat and I expect to pay more for

H. Hartman et al. / Appetite 65 (2013) 35–42 39

it, whereas fruit like an apple or orange, it’s just what you eat.’’ Sea-sonal influences were recognised as limiting availability, and werestrongly associated with the issues of taste, variety and price. Theinterviews were conducted in the winter and this season seemedto have a negative influence on the fruit and vegetableconsumption.

In conjunction with the barriers, participants also brought updifferent aspects that stimulated fruit and vegetable consumption.Those who lived with their parents said they had the ability to eatenough fruit and vegetables, since it was always available at home.Some participants said that having a good recipe-book made it eas-ier for them to include and prepare vegetables, and identified dif-ferent cultural influences as providing opportunities to makemeals more interesting, for example:

It’s good that it’s all coming in, because like my mum wasbrought up with potatoes, a piece of meat and maybe carrotsand another green vegetable or something. But now havingthe stuff available and doing a Thai stir-fry you can do six orseven different vegetables in there. So now I find it easier toeat vegetables, because I can vary with it.

Habits

Participants identified eating habits as being a key factor,repeatedly stating during the interviews that it was normal forthem to eat fruit and vegetables because in their childhood fruitwas always available, they got it if they wanted a snack, vegetableswere always part of the meal, and they were told that fruit andvegetables were good for them. Because of their upbringing, eatingfruit and vegetables has become a habit, for example ‘‘I live on myown now and I can buy anything I want, but I still do feel like vegeta-bles are better for me.’’

Misconception of risk behaviour

When asked, using 24-h recall, to quantify their fruit and vege-table intake, most students met the recommendations (Table 1).Although some participants honestly said they did not (always)eat enough fruit and vegetables, others incorrectly thought thatthey were eating sufficient amounts. During the interviews the(un)awareness of the risk behaviour was also discussed. In theinterviews participants thought everybody of their age was awareof the recommended intake of 5+ servings of vegetables and fruit aday, most (79%) were aware of these recommendations but only26% of participants correctly identified that it was two servingsof fruit and three of vegetables. There appeared to be a correlationbetween knowledge of the recommended intake and actual fruitand vegetable consumption.

Suggestions for promotional interventions

In providing suggestions about how to promote fruit and vege-table consumption among their age group, participants suggested atargeted campaign using a variety of media-channels, includingbillboards and the internet. They also suggested that providing suf-ficient reasons why it is good to eat fruit and vegetables, especiallyin regard to short-term health implications, information aboutplaces where to get cheap fruit and vegetables, and cheap/quick/easy recipes would help in increasing fruit and vegetable intake.Example comments on promoting fruit and vegetable consumptionin their peers included ‘‘Accessibility to recipes that are quick andeasy, basic and simple, not to add to many things. . .a cook book foruniversity students. . .for me it’s difficult to make something that ischeap and easy and has a good taste’’ and ‘‘when you want the

attention of our age group it needs to be specific to our age group.The visuals have to be relevant for us, not that there is a kid on theposter.’’

Expected future consumption

Most participants had the intention to start eating more fruitand vegetables when they were older; believing they would beable to spend more money on a variety of fruit and vegetables,have more control over what they would buy and eat, and be moreconcerned about their health, stating for example ‘‘once I have a joband I’m not a student, I definitely would eat more fruit and nicer fruit,like strawberries and grapes, but now I don’t have the money.’’ Partic-ipants also thought there was a difference between being a studentand having a job since they would have more routine in their lifeinto which they could incorporate eating fruit and vegetables, stat-ing ‘‘you have a bit more routine, I hope, when you’re older. It’s like mydad, he always eats an apple after dinner.’’ Having a family and try-ing to be a good role model was another reason stated for increas-ing their fruit and vegetable intake, since this meant that they hadto take responsibility not only for their own health, but also for thehealth of their children.

Discussion

The current study utilised focus groups to garner informationabout fruit and vegetable consumption in students at a New Zea-land university, and revealed a number of different issues to beimportant dictators. Based on the ASE model, we could only haveexpectations about what type of factors would be influential to stu-dents’ fruit and vegetable consumption. In the focus group inter-views, students displayed a wide range of opinions about factorsinfluential to their fruit and vegetable consumption; in particularinfluences from their peers, perception of taste, and preparatoryskills prioritising the consumption of fruit were identified asimportant determinants with relation to the ASE-model. Conse-quently interventions focused on increasing these factors are pro-posed as potentially effective tools for improving fruit andvegetable consumption in university students.

Perceptions about taste, including past experiences, were foundto be the most important attitudinal determinant; a not unex-pected outcome that is consistent with other reported research(Brug, Lechner, et al., 1995; Neumark-Sztainer, Story, Perry, &Casey, 1999; Spanos & Hankey, 2010; Ünüsan, 2004). Exposurecan help people to appreciate taste (Guidetti & Cavazza, 2008),and therefore offering tasting and cooking sessions at the univer-sity could provide students with the opportunity to see, feel, andtaste different kinds of fruit and vegetables. Important factorswhich were likely to lead to lower self-efficacy were convenience,lack of time, not being the person that prepares the meals, and lackof the skills needed to prepare vegetables – all of which are alsosupported by other studies (Brug, Lechner, et al., 1995; Hagdrup,Simoes, & Brownson, 1998; Uetrecht et al., 1999; Ünüsan, 2004).Due to lack of practice in preparing vegetables, students statedthere was a need for cheap, quick and easy recipes, provided in acheap cookbook or in student magazines or diaries. The recipesmust contain easily-available ingredients which are useful formore than one occasion.

Perceived health consequences were important outcome beliefsfound in both the current and previous studies (Brug, Debie, et al.,1995; Ünüsan, 2004). In the current study, students mentionedtheir general well-being and eating healthily because of theirsport-participation, however a possible association between fruitand vegetable consumption and prevention of chronic diseaseswas never mentioned spontaneously. Indeed, it is doubtful

40 H. Hartman et al. / Appetite 65 (2013) 35–42

whether potential future health benefits are motivating enough foryoung people to include fruit and vegetables in their diet (Neu-mark-Sztainer et al., 1999; Uglem et al., 2008). This might indicatethat direct health benefits are more important for young adultsthan long-term health implications, although some students didthink that providing information about the cancer-protective ef-fects of fruit and vegetables also might have an impact, becauseof an increased awareness of cancer. In particular, students ofhealth-related studies knew about the beneficial effects of fruitand vegetables, whereas some non-health related students couldonly mention the general healthiness of fruit and vegetables. Thisseemed to indicate that ‘study’ is an important source for informa-tion and may influence fruit and vegetable consumption, some-thing also acknowledged by students enrolled in non-healthstudies. Providing new and more varied nutritional informationabout fruit and vegetables, especially about their short-term healthimplications, might be a useful promotional strategy in encourag-ing a positive attitude towards eating fruit and vegetables (Witte,1995). Although having the right knowledge has been shown tohave a positive impact on the selection of healthier foods by ado-lescents (Pirouznia, 2001), the individual also needs to possess areadiness for change in order to result in healthier life-style choices(Keller et al., 2008).

The results of the present study indicate a gap in the under-standing of the current campaign regarding the recommendationsfor fruit and vegetable intake. Ashfield-Watt et al. (2004) demon-strated that in New Zealand the ‘5+ a day’ logo was widely recog-nised and understood in terms of the message to increase the fruitand vegetable intake and eat five or more servings of fruit and veg-etables per day. Most participants in the present study were alsoaware of the recommended intakes because of the 5+ a day-cam-paign, but there was confusion about the exact recommended serv-ings of fruit and vegetables. This misconception has also beenfurther reported in previous research (Brug, Debie, et al., 1995;Uglem et al., 2008; Ünüsan, 2004). A quantitative standard isimportant for people to evaluate their own fruit and vegetables in-take, indeed nutritional knowledge and awareness of recom-mended intake have been shown to influence fruit and vegetableconsumption in young adolescents (Hill, Casswell, Maskill, Jones,& Wyllie, 1998; Krolner et al., 2011).

Cost, lack of variety, seasonal influences, and availability werefound to be the most important barriers for eating the rightamount of fruit and vegetables in this study, in line with the find-ings of earlier studies (Betts et al., 1995; Brug, Debie, et al., 1995;Neumark-Sztainer et al., 1999; Ünüsan, 2004). Although Stewartand Tinsley (1995) showed that cost was not as important for em-ployed young adults in making their food choices, the currentstudy suggests that cost is unsurprisingly an important consider-ation/barrier for young adults studying at university. In the presentstudy, since the fruits apples, oranges and bananas are commonlyavailable on campus and at supermarkets, they were seen to be rel-atively expensive and the students preferred to treat themselvespurchasing other foods. Students who bought their fruit and vege-tables at the market did not judge them as being expensive, andtherefore suggested that making their peers more aware of inex-pensive fruit and vegetable sources may enhance consumption.In line with previous research on Turkish students, the poor avail-ability and quality, coupled with high prices, of fruit and vegetablesat campus were also reasons given for low consumption (Ünüsan,2004). Alongside attitudinal interventions, it seems to be impor-tant to make university students more aware of places wherecheaper fruit and vegetables are available. To address the barriersof poor availability/quality and high prices of individual fruit andvegetables, it is suggested that increased availability of attractive,inexpensive, special kinds of (single) fruits, such as peaches orstrawberries, may help in increasing consumption. The attractive-

ness and freshness of fruit could be enhanced by changes in distri-bution and packaging. Finally, because students spend a lot of theirtime at the university, it has the potential to be an importantsource for providing fruit and vegetables, and colleges/universitieshave previously been recognised as important settings for dietaryintervention in adolescents (Huang et al., 2004).

Influences of others were also strongly associated in this studywith the intention to eat fruit and vegetables. People of a similarage, particularly flatmates and partners, seemed to have the big-gest influence on students, exerting both positive and negativeinfluences by acting as models and providing both social supportand social pressure. This finding is consistent with the influenceof house-hold members on fruit and vegetable consumption re-ported by Brug, Debie, et al. (1995) and the differences highlightedbetween Greek students living at or away from home demon-strated by Papadaki et al. (2007). Living circumstances are alsoimportant influences on students’ eating patterns, because formany participants the availability of fruit and vegetables in the flatdepended on their flatmates (also reported by Brunt and Rhee(2008), Uglem et al. (2008)), while students still living with theirparents did not complain about availability. Students’ recognitionof parents as important influences on fruit and vegetable consump-tion reflects the findings of other populations, where parents havepassed on their norms and given social support – both directlythrough parental role-modelling and indirectly through the trans-mission of attitudes or values (Boutelle, Birkeland, Hannan, Story,& Neumark-Sztainer, 2007; Uglem, Frølich, Stea, & Wandel,2007). Arcan et al. (2007) suggest that adolescents may revert backto their parents’ norms as young adults, and the findings of thisstudy would seem to support this. The finding that participantshad developed a habit of eating fruit and vegetables as a result oftheir upbringing emphasises the importance of developing gooddietary behaviour among children. A focus on child self-efficacy,as well as parent support and modelling, is seemingly important– it is assumed that repeated behaviour over a long period of timewill result in performing that behaviour habitually. However,Guidetti and Cavazza (2008) state that repeated exposure to newfoods and social influence, as is the case with flatmates and peers,can transform an initial neophobic response toward a new foodinto a preference. Food choice is also linked to the constructionand expression of identity both at a personal and social level,and so is part of establishing autonomy. Because people of thesame age were stated as being important others, using peer modelsin mass media promotion is suggested (Steckler et al., 1994).

In suggesting intervention strategies to increase fruit and vege-table consumption in their peers, participants proposed the use oftechnology and highlighted the importance of tailoring interven-tions to their age-group. In a mass-media society, choosing theappropriate channel in which to deliver nutritional interventionscan greatly enhance the effectiveness and efficiency of the inter-vention. In a 12-month intervention study of 2540 Americans, aged21–65 years, Alexander et al. (2010) demonstrated online nutri-tional interventions to be well received, convenient, easy to dis-seminate, and associated with sustained dietary change; onaverage, participants increased average servings of fruit and vege-tables by two servings/day, and reported a high program satisfac-tion. What is more, a recent study of 2949 ethnically diverseadolescents (mean age: 17.3 ± 1.7 years) in Austria (Freisling, Haas,& Elmadfa, 2009) concluded that adolescents exposed to nutri-tional information provided by booklets, the Internet or newspaperarticles were more likely to eat fruit and vegetables daily thanwhen radio, television and magazines were the source of informa-tion. Although the participants in the comprehensive studies ofFreisling et al. (2009) and Alexander et al. (2010) were not solelyof university age, the findings highlight not only the potential ofmedia in enhancing fruit and vegetable consumption but also the

H. Hartman et al. / Appetite 65 (2013) 35–42 41

importance of selecting the appropriate media tool. Between indi-vidual people, however, the importance of the different determi-nants might vary, as shown in the present study; in order tomake dietary changes nutritional messages must be seen as per-sonally relevant (Uglem et al., 2008). Therefore as well as massmedia promotion, developing ‘made-to-measure’ interventionsthat are tailored to the individual is suggested. Several Dutch stud-ies reported the use and effectiveness of online computer-tailoredinterventions in increasing fruit and vegetable intake (Brug, Stee-nhuis, van Assema, & de Vries, 1996; Brug, Steenhuis, van Assema,Glanz, & De Vries, 1999; Oenema, Brug, & Lechner, 2001). Thesestudies established fruit and vegetable consumption using an on-line questionnaire, before a range of personal and behaviour deter-minant-focused feedback is delivered in a letter or via the web.This tailored feedback can in turn make individuals more awareof their possible risk behaviour, also identified as an important is-sue in this study.

Prior to this study, there had been no research into the determi-nants of fruit and vegetable consumption in New Zealand univer-sity students. However targeting such a specific group doespresent a limitation of the study. In solely researching the determi-nants of university students, we are unable to generalise our find-ings to young adults of a similar age who are in employment, andthus may have different determinants of their fruit and vegetableconsumption. Whilst it is likely that they will share many of thesame determinants, factors such as cost may be of less importanceto employed young adults (Stewart & Tinsley, 1995), who may alsobe exposed to different social influences. In order to encourage asmany different participants/dietary needs as possible to participatein the focus groups, no dietary exclusion-criteria were specified.However, in the focus group discussions there were no mentionsof special dietary needs, and as such the present study populationmay not be a true representation of the total population of univer-sity students. The proportion of study participants consuming therecommended amounts of fruit or vegetables was substantiallyhigher than has been previously reported in students across theworld (Dodd et al., 2010; Keller et al., 2008; Papadaki et al.,2007; Ünüsan, 2004) or in young adults in New Zealand (Universityof Otago & Ministry of Health, 2011). Studies with significantly lar-ger sample numbers at German (Keller et al., 2008) and British(Dodd et al., 2010) universities reported between 66% and 95% ofparticipants not meeting fruit and vegetable consumption recom-mendations, coupled with the presence of at least one additionalrisk factor (low physical activity, binge drinking, and smoking).In the current study, two-thirds of participants were studyinghealth-related topics and perhaps this provides an explanation be-hind the enhanced consumption reported in this study comparedto universities in other countries (Dodd et al., 2010; Keller et al.,2008; Papadaki et al., 2007; Ünüsan, 2004). Of these studies, thework of Keller et al. (2008) on German university students sug-gested the importance of students’ health knowledge on their life-style choices, with medicine students more likely to have fewerrisk behaviours (as measured by low fruit and vegetable consump-tion, binge drinking, smoking, and low physical activity levels)than those studying law or education. Ünüsan (2004) indirectlyacknowledge the importance of health-related study on fruit andvegetable consumption by purposely excluding any student study-ing in this topic area from their research on the relationship be-tween stress and fruit and vegetable consumption in Turkishstudents.

Conclusions

Results from this preliminary study begin to fill a gap in the cur-rent knowledge of fruit and vegetable consumption by youngadults in New Zealand. Determinants including attitude, a lack of

self-efficacy and an (un)awareness of dietary guidelines and healthconsequences should be considered when developing future inter-ventions students as those participating in the present study,whilst a variety of different media should be used to deliver these.University students have a different lifestyle compared to manyother young adults, and students studying health-related topicsmight have a different lifestyle compared to other university stu-dents, and thus have factors and individuals influencing their fruitand vegetable intake which are specific to their population. There-fore, additional research is suggested among other groups of youngadults and students with low fruit and vegetable intakes, so thatfuture promotional strategies can be more specifically targeted –a campaign focused towards a target population may have moresuccess than promotional strategies conducted among the generalpopulation (Green & Kreuter, 1999). New Zealand is an ever-grow-ing multicultural society, and consequently cultural considerationsshould be included in any nutrition promotion project based here.

References

Alexander, G. L., McClure, J. B., Calvi, J. H., Divine, G. W., Stopponi, M. A., Rolnick, S. J.,et al. (2010). A randomized clinical trial evaluating online interventions toimprove fruit and vegetable consumption. American Journal of Public Health,100(2), 319–326.

Ammerman, A. S., Lindquist, C. H., Lohr, K. N., & Hersey, J. (2002). The efficacy ofbehavioral interventions to modify dietary fat and fruit and vegetable intake. Areview of the evidence. Preventive Medicine, 35, 25–41.

Arcan, C., Neumark-Sztainer, D., Hannan, P., van den Berg, P., Story, M., & Larson, N.(2007). Parental eating behaviours, home food environment and adolescentintakes of fruits, vegetables and dairy foods. Longitudinal findings from ProjectEAT. Public Health Nutrition, 10(11), 1257–1265.

Ashfield-Watt, P. A., Stewart, E., & Scheffer, J. (2004). 5+ A day. Are we getting themessage across? Asia Pacific Journal of Clinical Nutrition, 13, S38.

Beerman, K. A. (1991). Variation in nutrient intake of college students. Acomparison by student’s residence. Journal of American Dietetic Association,91(3), 343–344.

Betts, N. M., Amos, R. J., Georgiou, C., Hoerr, S. L., Ivaturi, R., Keim, K. S., et al. (1995).What young adults say about factors affecting their food intake. Ecology of Foodand Nutrition, 34, 59–64.

Boutelle, K. N., Birkeland, R. W., Hannan, P. J., Story, M., & Neumark-Sztainer, D.(2007). Associations between maternal concern for healthful eating andmaternal eating behaviors, home food availability, and adolescent eatingbehaviors. Journal of Nutrition Education and Behavior, 39(5), 248–256.

Brug, J., Debie, S., van Assema, P., & Weijts, W. (1995). Psychosocial determinants offruit and vegetable consumption among adults. Results of focus groupinterviews. Food Quality and Preference, 6(2), 99–107.

Brug, J., Lechner, L., & De Vries, H. (1995). Psychosocial determinants of fruit andvegetable consumption. Appetite, 25(3), 285–296.

Brug, J., Steenhuis, I., van Assema, P., & de Vries, H. (1996). The impact of acomputer-tailored nutrition intervention. Preventive Medicine, 25(3), 236–242.

Brug, J., Steenhuis, I., van Assema, P., Glanz, K., & De Vries, H. (1999). Computer-tailored nutrition education. Differences between two interventions. HealthEducation Research, 14(2), 249–256.

Brunt, A. R., & Rhee, Y. S. (2008). Obesity and lifestyle in U.S. college students relatedto living arrangements. Appetite, 51(3), 615–621.

Cancer Society of New Zealand (2004). Pulp fiction – The facts harvested. A study ofNew Zealander’s physical activity and nutrition. Wellington, New Zealand: CancerSociety of New Zealand. <http://www.cancernz.org.nz>.

Carlsen, B., & Glenton, C. (2011). What about N? A methodological study of sample-size reporting in focus group studies. BMC Medical Research Methodology, 11, 26.

Chapman, J., Armitage, C. J., & Norman, P. (2009). Comparing implementationintention interventions in relation to young adults’ intake of fruit andvegetables. Psychology and Health, 24(3), 317–332.

de Vries, H., Dijkstra, M., & Kuhlman, P. (1988). Self-efficacy. The third factor besidesattitude and subjective norm as a predictor of behavioural intentions. HealthEducation Research, 3(3), 273–282.

Dodd, L. J., Al-Nakeeb, Y., Nevill, A., & Forshaw, M. J. (2010). Lifestyle risk factors ofstudents. A cluster analytical approach. Preventive Medicine, 51(1), 73–77.

Food and Agriculture Organization (2004). Faostat database. Rome: Food andAgriculture Organization.

Freisling, H., Haas, K., & Elmadfa, I. (2009). Mass media nutrition informationsources and associations with fruit and vegetable consumption amongadolescents. Public Health Nutrition, 13(2), 269–275.

Georgiou, C. C., & Arquitt, A. B. (1992). Different food sources of fat for youngwomen who consumed lower-fat diets and those who consumed higher-fatdiets. Journal of the American Dietetic Association, 92(3), 358–360.

Green, L. W., & Kreuter, M. W. (1999). Health promotion planning. An educational andecological approach. Mayfield.

42 H. Hartman et al. / Appetite 65 (2013) 35–42

Guidetti, M., & Cavazza, N. (2008). Structure of the relationship between parents’and children’s food preferences and avoidances. An explorative study. Appetite,50(1), 83–90.

Hagdrup, N. A., Simoes, E. J., & Brownson, R. C. (1998). Fruit and vegetableconsumption in Missouri. Knowledge, barriers and benefits. American Journal ofHealth Behavior, 22(2), 90.

Hanley, B., Dijane, J., Fewtrell, M., Grynberg, A., Hummel, S., Junien, C., et al. (2010).Metabolic imprinting, programming and epigenetics – A review of presentpriorities and future opportunities. British Journal of Nutrition, 104, S1–S25.

Hennink, M., Hutter, I., & Bailey, A. (2011). Qualitative research methods. Sage.Hill, L., Casswell, S., Maskill, C., Jones, S., & Wyllie, A. (1998). Fruit and vegetables as

adolescent food choices in New Zealand. Health Promotion International, 13(1),55–65.

Huang, T. T.-K., Kempf, A. M., Strother, M. L., Li, C., Lee, R. E., Harris, K. J., et al. (2004).Overweight and components of the metabolic syndrome in college students.Diabetes Care, 27(12), 3000–3001.

Jas, P. (1998). Aspects of food choice behaviour in adolescents. Nutrition and FoodScience, 3, 163–165.

Keim, K. S., Stewart, B., & Voichick, J. (1997). Vegetable and fruit intake andperceptions of selected young adults. Journal of Nutrition Education, 29(2),80–85.

Keller, S., Maddock, J. E., Hannöver, W., Thyrian, J. R., & Basler, H.-D. (2008). Multiplehealth risk behaviors in German first year university students. PreventiveMedicine, 46(3), 189–195.

Krebs-Smith, S. M., Heimendinger, J., Patterson, B. H., Subar, A. F., Kessler, R., &Pivonka, E. (1995). Psychosocial factors associated with fruit and vegetableconsumption. American Journal of Health Promotion, 10(2), 98–104.

Kreuger, R. A. (2000). Focus groups. A practical guide for applied research. ThousandOaks: Sage.

Krolner, R., Rasmussen, M., Brug, J., Klepp, K. I., Wind, M., & Due, P. (2011).Determinants of fruit and vegetable consumption among children andadolescents: a review of the literature. Part II. Qualitative studies.International Journal of Behavioural Nutrition and Physical Activity, 8(112).

Lau, R. R., Quadrel, M. J., & Hartman, K. A. (1990). Development and change of youngadults’ preventive health beliefs and behavior. Influence from parents andpeers. Journal of Health and Social Behavior, 31(3), 240–259.

Lien, N., Lytle, L. A., & Klepp, K.-I. (2001). Stability in consumption of fruit,vegetables, and sugary foods in a cohort from age 14 to age 21. PreventiveMedicine, 33(3), 217–226.

Lock, K., Pomerleau, J., Causer, L., Altmann, D. R., & McKee, M. (2005). The globalburden of disease attributable to low consumption of fruit and vegetables.Implications for the global strategy on diet. Bulletin of the World HealthOrganization, 83, 100–108.

Martens, M., van Assema, P., Paulussen, T., Schaalma, H., & Brug, J. (2006).Krachtvoer. Process evaluation of a Dutch programme for lower vocationalschools to promote healthful diet. Health Education Research, 21(5), 695–704.

Ministry of Health (2003). Food and nutrition guidelines for healthy adults. Abackground paper. Wellington, New Zealand: Ministry of Health. <http://www.moh.govt.nz/moh.nsf/0/07BC6DBE764FDABBCC256DDB006D9AB4/$File/foodandnutritionguidelines-adults.pdf>.

Ministry of Health (2004). A portrait of health. Key results of the 2002/03 New Zealandhealth survey. Wellington, New Zealand: Ministry of Health.<www.moh.govt.nz/moh.nsf/0/D15E13BFE803073CC256EEB0073CFE6/$File/aportraitofhealth.pdf>.

Neumark-Sztainer, D., Story, M., Perry, C., & Casey, M. A. (1999). Factors influencingfood choices of adolescents. Findings from focus-group discussions withadolescents. Journal of the American Dietetic Association, 99(8), 929–937.

Oenema, A., Brug, J., & Lechner, L. (2001). Web-based tailored nutrition education.Results of a randomized controlled trial. Health Education Research, 16(6),647–660.

Onwuegbuzie, A. J., Dickinson, W. B., Leech, N. L., & Zoran, A. G. (2009). A qualitativeframework for collecting and analyzing data in focus group research.International Journal of Qualitative Methods, 8(3), 1–21.

Papadaki, A., Hondros, G., Scott, J. A., & Kapsokefalou, M. (2007). Eating habits ofUniversity students living at, or away from home in Greece. Appetite, 49(1),169–176.

Pirouznia, M. (2001). The association between nutrition knowledge and eatingbehavior in male and female adolescents in the US. International Journal of FoodSciences and Nutrition, 52(2), 127–132.

QSR International Pty Ltd. (2001). Introducing NVivo. A workshop handbook. NVivo1.3. Victoria: Doncaster.

Raitakari, O. T., Porkka, K. V. K., Räsänen, L., & Viikari, J. S. A. (1994). Relations of life-style with lipids, blood pressure and insulin in adolescents and young adults.The Cardiovascular Risk in Young Finns Study. Atherosclerosis, 111(2), 237–246.

Serdula, M., Gillespie, C., Kettel-Khan, L., Farris, R., Seymour, J., & Denny, C. (2004).Trends in fruit and vegetable consumption among adults in the United States.Behavioral risk factor surveillance system, 1994–2000. [Comparative StudyResearch Support, U.S. Gov’t, P.H.S.]. American Journal of Public Health, 94(6),1014–1018.

Song, W. O., Schuette, L. K., Huang, Y.-L., & Hoerr, S. (1996). Food group intakepatterns in relation to nutritional adequacy of young adults. Nutrition Research,16(9), 1507–1519.

Spanos, D., & Hankey, C. R. (2010). The habitual meal and snacking patterns ofuniversity students in two countries and their use of vending machines. Journalof Human Nutrition and Dietetics, 23(1), 102–107.

Steckler, A., Allegrante, J. P., Altman, D., Brown, R., Burdine, J. N., Goodman, R. M.,et al. (1994). Health education intervention strategies. Recommendations forfuture research. Health Education and Behavior, 22(3), 307–328.

Stewart, B., & Tinsley, A. N. N. (1995). Importance of food choice influences forworking young adults. Journal of the American Dietetic Association, 95(2),227–230.

Uetrecht, C. L., Greenberg, M., Dwyer, J. J. M., Sutherland, S., & Tobin, S. (1999).Factors influencing vegetable and fruit use. Implications for promotion.American Journal of Health Behavior, 23(3), 172–181.

Uglem, S., Frølich, W., Stea, T. H., & Wandel, M. (2007). Correlates of vegetableconsumption among young men in the Norwegian National Guard. Appetite,48(1), 46–53.

Uglem, S., Frølich, W., Stea, T. H., & Wandel, M. (2008). Preferences and perceptionsof personal vegetable consumption. A study among young men in theNorwegian National Guard. International Journal of Food Sciences and Nutrition,59(4), 279–290.

University of Otago and Ministry of Health (2011). A focus on nutrition. Key findingsof the 2008/09 New Zealand adult nutrition survey. Wellington, New Zealand:Ministry of Health.

Ünüsan, N. (2004). Fruit and vegetable consumption among Turkish universitystudents. International Journal for Vitamin and Nutrition Research, 74(5),341–348.

Wardle, J., Parmenter, K., & Waller, J. (2000). Nutrition knowledge and food intake.Appetite, 34(3), 269–275.

Washi, S. A., & Ageib, M. B. (2010). Poor diet quality and food habits are related toimpaired nutritional status in 13- to 18-year-old adolescents in Jeddah.Nutrition Research, 30(8), 527–534.

Witte, K. (1995). Fishing for success. Using the persuasive health messageframework to generate effective campaign messages. In E. Maibach & R. L.Parrott (Eds.), Designing new health messages. Approaches from communicationtheory and public health practice (pp. 145–166). Thousand Oakes: Sage.

World Health Organisation (2005). Fruit and vegetables for health. World HealthOrganisation. <http://www.who.int/dietphysicalactivity/publications/en/fruit_vegetables_report.pdf>.