Public Health Nutrition: 12(10), 1767–1774 doi:10.

1017/S1368980008004394

Socio-environmental, personal and behavioural predictors of

fast-food intake among adolescents
Katherine W Bauer*, Nicole I Larson, Melissa C Nelson, Mary Story and Dianne
Neumark-Sztainer
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, West Bank
Office Building, 1300 South 2nd Street – Suite 300, Minneapolis, MN 55454, USA

Submitted 1 July 2008: Accepted 4 November 2008: First published online 24 December 2008

Abstract
Objective: To identify the socio-environmental, personal and behavioural factors
that are longitudinally predictive of changes in adolescents’ fast-food intake.
Design: Population-based longitudinal cohort study.
Setting: Participants from Minnesota schools completed in-class assessments in
1999 (Time 1) while in middle school and mailed surveys in 2004 (Time 2) while
in high school.
Subjects: A racially, ethnically and socio-economically diverse sample of adoles-
cents (n 806).
Results: Availability of unhealthy food at home, being born in the USA and pre-
ferring the taste of unhealthy foods were predictive of higher fast-food intake after
5 years among both males and females. Among females, personal and beha-
vioural factors, including concern about weight and use of healthy weight-control
techniques, were protective against increased fast-food intake. Among males,
socio-environmental factors, including maternal and friends’ concern for eating
healthy food and maternal encouragement to eat healthy food, were predictive of
lower fast-food intake. Sports team participation was a strong risk factor for
increased fast-food intake among males.
Conclusions: Our findings suggest that addressing socio-environmental factors
such as acculturation and home food availability may help reduce fast-food intake
among adolescents. Additionally, gender-specific intervention strategies, includ-
ing working with boys’ sports teams, family members and the peer group, and for Keywords
girls, emphasizing the importance of healthy weight-maintenance strategies and Fast food
the addition of flavourful and healthy food options to their diet, may help reduce Adolescents
fast-food intake. Dietary intake

Eating at fast-food restaurants is common among ado- fast-food restaurants, including hamburgers, pizza,
lescents. National data indicate that on any given day French fries and sugar-sweetened beverages(9), which are
nearly 40 % of high-school-aged adolescents report con- frequently served in large portions(10), can contribute to
suming food from a fast-food restaurant(1). In the late poor nutritional intake. Among children, adolescents
1970s, fast food comprised only 2 % of children and and adults, fast-food consumption has been associated
adolescents’ total energy intake, while in the mid-1990s it with higher BMI(11), weight gain(12,13) and decreased
rose to 10 % of their total energy intake(2). This trend of insulin sensitivity(12). Additionally, those with high fast-
increased intake from fast-food restaurants shows little food intake report higher intakes of total energy, total
evidence of slowing down, with these restaurants com- fat, saturated fat, carbohydrates, Na, added sugar and
monly located within walking distance of schools(3,4), sugar-sweetened beverages, and lower intakes of milk,
fast-food meals being served in school cafeterias(5), open fruits and vegetables(1,11,13–16).
school campus policies that allow students to leave and In order to better understand and ultimately curb the
purchase fast food for lunch(6), and excessive marketing consumption of fast food among adolescents, it is
of fast food to children and adolescents(7,8). important to understand what factors contribute to fast-
Frequently eating at fast-food restaurants may have food intake. In particular, understanding the factors that
adverse consequences for nutritional intake and weight- predict fast-food intake during the transition from middle
related health. Common adolescent food choices from to high school, when adolescents become increasingly

*Corresponding author: Email [email protected] r The Authors 2008

1768 KW Bauer et al.
independent and have great access to unhealthy dietary middle school at baseline (EAT-I) and in high school at
choices, may be especially important. This knowledge follow-up five years later (EAT-II). At baseline the mean
can inform public health interventions aiming to improve age of participants was 12?8 (SD 0?8) years and at follow-
adolescents’ dietary intake and help them achieve a up their mean age was 17?2 (SD 0?6) years.
healthy weight status. For Project EAT-I (1998–9), 1672 middle-school stu-
Examining the cross-sectional data from Project EAT dents completed the Project EAT-I survey and FFQ in
(Eating Among Teens), French and colleagues(17) identi- their classrooms. Five years later, Project EAT-II (2003–4)
fied several correlates of adolescents’ fast-food intake aimed to resurvey by mail all original participants for
such as dislike for the taste of healthy foods, perceived whom contact information was available. Of those in the
lack of time to eat healthy foods, sports team participa- middle-school cohort for whom contact information was
tion, high television usage, and lack of maternal or peer available, 69?5 % completed the follow-up survey. This
concern for healthy eating. Additional cross-sectional represents 50?1 % of the original cohort. All study proto-
and longitudinal studies have identified the frequency of cols were approved by the University of Minnesota’s
television viewing, and acculturation and US nativity Institutional Review Board Human Subjects Committee.
among members of racial and ethnic minority groups, as
risk factors for adolescents’ fast-food consumption(18–20). Surveys and measures
Cross-sectional studies of adults have found that similar The development of the baseline Project EAT-I survey
factors are correlated with adult’s fast-food intake, such as was guided by Social Cognitive Theory(23), focus group
television viewing(21), as well as additional factors such discussions with adolescents(24), an in-depth literature
as perceived difficulty in preparing healthy foods and review and pilot testing. The majority of these items
self-efficacy for eating fruits and vegetables(22). were retained without modification for the Project EAT-II
The current study uses data from Project EAT to build follow-up survey completed by high-school students.
upon the previous cross-sectional analysis to identify
socio-environmental, personal and behavioural factors, as Outcome measure
suggested by Social Cognitive Theory, that longitudinally Fast-food intake was assessed at baseline and follow-up
predict fast-food intake among high-school-aged adoles- using a single item on the Project EAT surveys: ‘In the past
cents. Using these data drawn from a population-based, week, how often did you eat something from a fast-food
5-year longitudinal study, we examined the relationship restaurant (like McDonald’s, Burger King, Hardee’s, etc)?’
between the socio-environmental, personal and beha- Six response categories ranged from ‘never’ to ‘more than
vioural factors which were reported by adolescents 7 times’. Several other studies examining fast-food intake
during middle school and their fast-food consumption have used a similar item to measure fast-food intake
during high school. The present study is one of the few among adolescents(14,25). We collapsed the fast-food
theory-based, longitudinal studies to examine a diverse intake response categories into 0 times in the past week
set of potential predictors of adolescents’ fast-food intake. (low intake), 1–2 times in the past week (moderate
By examining longitudinal relationships between the intake) and 3 or more times in the past week (frequent
selected factors and fast-food intake, we are not only able intake)(17,26). Increased fast-food intake assessed using
to determine whether these factors are associated with this question, and represented in these three categories,
fast-food intake among adolescents, but also whether has been positively correlated with adolescents’ intakes of
they predict long-term increases in fast-food intake total energy, fat energy, saturated fat energy, Na, French
through the adolescent years. fries and soft drinks(17).

Exposure measures
Methods Socio-environmental, personal and behavioural char-
acteristics were assessed at baseline during Project EAT-I.
Sample and study design Table 1 contains these variables along with psychometric
Data for the current study were drawn from Project EAT information when available.
(Eating Among Teens), a prospective, population-based
study designed to examine determinants of dietary intake Covariates
and weight status. Project EAT surveyed middle- and Race/ethnicity and socio-economic status (SES) were based
high-school students in 1998–9, and then resurveyed on adolescents’ self-report in Project EAT-I. Race/ethnicity
participants again five years later in 2003–4 in order to was assessed at baseline with the question: ‘Do you think of
examine how socio-environmental, personal and beha- yourself asy?’, with responses of white, black or African-
vioural factors may influence adolescents during the American, Hispanic or Latino, Asian-American, Hawaiian or
transitions from middle to high school and high school Pacific Islander, or American Indian or Native American.
into young adulthood. The sample used in the present Subjects could choose more than one category; responses
analysis consisted of the 806 adolescents who were in indicating multiple categories were coded as ‘mixed or
Predictors of fast-food intake 1769
Table 1 Description of the socio-environmental, personal and behavioural measures assessed in the present study
Measure Description of survey item(s)

Socio-environmental factors
Adult supervision ‘On how many of the past 7 days was at least one of your parents in the room with you when you
ate dinner?’ (responses options: ‘never’ to ‘every day’) and ‘Is there an adult at home at the
following time? (1) Before you go to school in the mornings; (2) When you arrive home from
school in the afternoon; (3) In the early evening – about 6 pm; (4) When you go to bed at night’
(response options: ‘almost never’ to ‘almost always’). Cronbach’s a 5 0?62
Healthy food available ‘How often are the following true? (1) Fruits and vegetables are available in my home; (2) Milk is
served at meals in my home; (3) We have fruit juice in my home; (4) Vegetables are served at
dinner in my home’ (response options: ‘never’ to ‘always’). Cronbach’s a 5 0?63
Unhealthy food available ‘How often are the following true? (1) We have ‘junk food’ in my home; (2) Potato chips or other salty
snack foods are available in my home; (3) Chocolate or other candy is available in my home;
(4) Soda pop is available at home’ (response options: ‘never’ to ‘always’). Cronbach’s a 5 0?80
Family meals ‘During the past 7 days, how many times did all, or most, of your family living in your house eat a
meal together?’ (response options: ‘never’ to ‘more than 7 times’)
Mom working ‘Does your mothery?’ (response options: ‘not work for pay’, ‘work part-time for pay’, ‘work
full-time for pay’)
Dad working ‘Does your fathery?’ (response options: ‘not work for pay’, ‘work part-time for pay’, ‘work
full-time for pay’)
Maternal concern with healthy eating ‘My mother cares about eating healthy food’ (response options: ‘not at all’ to ‘very much’)
Maternal encouragement for my ‘My mother encourages me to eat healthy food’ (response options: ‘not at all’ to ‘very much’)
healthy eating
Paternal concern with healthy eating ‘My father cares about eating healthy food’ (response options: ‘not at all’ to ‘very much’)
Paternal encouragement for my ‘My father encourages me to eat healthy food’ (response options: ‘not at all’ to ‘very much’)
healthy eating
Friends’ concern for healthy eating ‘Many of my friends care about eating healthy food’ (response options: ‘not at all’ to ‘very much’)
Friends dieting ‘Many of my friends diet to lose weight or keep from gaining weight’ (response options: ‘not at all’ to
‘very much’)
Personal factors
Born outside the USA ‘Were you born in the United States?’
Self-report BMI ‘How tall are you?’ and ‘How much do you weigh?’ BMI 5 (weight in kg)/[(height in metres)2]
Nutrition knowledge ‘For each question below, please select the food you think is better for your health’; seven pairs of
food items. Cronbach’s a 5 0?63
Benefits of healthy eating ‘The types of food I eat affecty (1) My health; (2) How I look; (3) My weight; (4) How well I do in
sports; (5) How well I do in school’ (response options: ‘strongly disagree’ to ‘strongly agree’).
Cronbach’s a 5 0?83
Barriers to healthy eating – ‘How strongly do you agree with the following statements? (1) I am too busy to eat healthy foods;
convenience (2) I am too rushed in the morning to eat a healthy breakfast; (3) Eating healthy meals just takes
too much time; (4) I don’t have time to think about healthy eating’ (response options: ‘strongly
disagree’ to ‘strongly agree’). Cronbach’s a 5 0?71
Preference for unhealthy food ‘How strongly do you agree with the following statements? (1) I like the taste of potato chips and
other salty snack foods; (2) Milk tastes good to me (reverse scored); (3) Most unhealthy foods
taste better than healthy foods; (4) I like the taste of most fruits (reverse scored); (5) Most
vegetables taste bad; (6) Most healthy foods just don’t taste that great’ (response options:
‘strongly disagree’ to ‘strongly agree’). Cronbach’s a 5 0?53
Self-efficacy for healthy eating ‘If you wanted to, how sure are you that you could eat healthy food when you arey (1) At the mall;
(2) Hungry after school; (3) With your friends; (4) Stressed out; (5) Feeling down; (6) Bored; (7)
At a fast-food restaurant; (8) Alone; (9) Eating dinner with your family?’ (response options: ‘not at
all sure’ to ‘very sure’). Cronbach’s a 5 0?83
Weight concerns ‘How strongly do you agree with the following statements? (1) I think a lot about being thinner; (2) I
am worried about gaining weight; (3) I weigh myself often; (4) I sometimes skip meals since I am
concerned about my weight’ (response options: ‘strongly disagree’ to ‘strongly agree’).
Cronbach’s a 5 0?82
Weight perception ‘At this time, do you feel that you arey?’ (response options: ‘very underweight’ to ‘very overweight’)
Behavioural factors
Healthy weight-control behaviours ‘Have you done any of the following things in order to lose weight or keep from gaining weight
during the past year? (1) Exercise; (2) Ate more fruits and vegetables; (3) Ate less high-fat
foods; (4) Ate less sweets’ (response options: yes/no). Cronbach’s a 5 0?81
Unhealthy weight-control behaviours ‘Have you done any of the following things in order to lose weight or keep from gaining weight during the
past year? (1) Fasted; (2) Ate very little food; (3) Used food substitute (e.g. Slim-Fast); (4) Skipped
meals; or (5) Smoked more cigarettes’ (response options: yes/no). Cronbach’s a 5 0?70
Substance use ‘How often have you used the following during the past year (12 months)? (1) Cigarettes; (2) Beer,
wine, hard liquors; (3) Marijuana; (4) Drugs other than marijuana (acid, cocaine, crack, etc.)
(response options: ‘never’ to ‘daily’). Cronbach’s a 5 0?79
Sports team participation ‘During the past 12 months, on how many sports teams did you play?’ (four response categories
ranging from ‘0 teams’ to ‘3 or more teams’; responses were dichotomized into 0 or 1 or more)
Work for pay ‘How many hours do you work for pay in a typical week during the school year?’ (response options:
‘none’ to ‘over 20 hours a week’)
Vegetarian ‘Are you a vegetarian?’ (response options: yes/no)
Television viewing ‘In your free time on an average weekday, how many hours do you spend watching TV & videos?’
and ‘In your free time on an average weekend day (Saturday or Sunday) how many hours do you
spend watching TV & videos?’ (response options: ‘0 hours’ to ‘51 hours’)
1770 KW Bauer et al.
other’. Due to the small number of respondents in some of significance was used to direct attention to statistically
the racial/ethnic categories, Hawaiian or Pacific Islander, significant results. Analyses were conducted using the
American Indian or Native American and mixed heritage Statistical Analysis System (SAS) statistical software
were combined to form an ‘other’ category in the analysis. package version 8?2 (SAS Institute, Cary, NC, USA).
The primary determinant of SES was parental educational
level, defined by the highest level of educational attainment
of either parent. In addition, an algorithm was developed Results
to take into account family eligibility for public assistance,
eligibility for free or reduced-cost school meals and At follow-up, approximately one-third of both males
employment status of the mother and the father(27). (31?2 %) and females (30?9 %) reported frequent con-
sumption of fast food (3 or more times in the past week).
Statistical analyses One-fifth of males (21?2 %) and females (21?8 %) reported
Of the 806 high-school-aged adolescents who provided low consumption of fast food (0 times in the past week).
follow-up survey data, exclusions were made for those Among females, fast-food intake differed by race/ethni-
missing data on fast-food intake (n 14). Data were city, SES and age (Table 2). A higher percentage of white
weighted to adjust for differential response rates to Pro- and Asian girls were low fast-food consumers (26?2 % and
jects EAT-I and EAT-II using the response propensity 26?7 %, respectively) compared with girls of the other
method(28). The weighted ethnic/racial and SES propor- racial/ethnic backgrounds. Compared with girls from
tions of the study sample were as follows: 33?3 % white, higher SES families, low-SES girls were more likely to
22?9 % Asian-American, 24?2 % African-American, 6?5 % report frequent fast-food consumption. Females in the
Hispanic and 13?9 % mixed or other race; whereas SES frequent fast-food category were more likely to be older
percentages were 17?2 % low, 18?6 % low–middle, 31?0 % than those females in the moderate and low intake cate-
middle, 18?3 % upper–middle and 14?9 % high. gories. Fast-food intake was not associated with any of
Several analyses were conducted to examine the rela- these sociodemographic variables among males.
tionships between sociodemographic characteristics and
fast-food intake. The x2 test was used to examine asso- Associations of socio-environmental, personal
ciations of the three-level fast-food intake variable with and behavioural variables with fast-food intake
race/ethnicity in five categories and SES in five categories. at follow-up
ANOVA was used to compare the mean ages of partici- Among males, many of the Time 1 variables that predicted
pants in each of the three levels of fast-food intake. fast-food intake at Time 2 were from the domain of the
To separately examine associations between each of the social environment (Table 3). After controlling for socio-
potential socio-environmental, personal and behavioural demographic characteristics, socio-environmental factors
predictors assessed at baseline with follow-up fast-food that were protective against higher fast-food intake inclu-
intake, ordinal logistic regression analyses were conducted ded maternal concern with her own healthy eating (Model
on the three-level dependent fast-food intake variable using 1: OR 5 0?70, P 5 0?002), maternal encouragement of
two models. Model 1 controlled for baseline race/ethnicity the adolescent to eat healthy food (Model 1: OR 5 0?80,
in two categories (white/non-white) and SES in five cate- P 5 0?04) and friends’ concern for eating healthy food
gories. Model 2 controlled for baseline race/ethnicity, (Model 1: OR 5 0?76, P 5 0?03). For each standard devia-
SES and fast-food intake during EAT-I. Model 1 was used to tion increase in the adolescents’ report at Time 1 that their
examine the total association of potential correlates with friends cared about eating healthy food, there was a 26 %
fast-food intake at follow-up, while Model 2 was used to decreased odds of adolescents being in a higher fast-food
examine associations between potential correlates and intake category at Time 2, e.g. being a frequent v. moderate
change in fast-food intake over the 5-year study period. All fast-food consumer. Availability of unhealthy food in the
analyses were stratified by gender. home was also a socio-environmental risk factor for higher
For Models 1 and 2, non-dichotomous personal, fast-food intake (Model 1: OR 5 1?29, P 5 0?02). After
behavioural and socio-environmental variables were adjustment for Time 1 fast-food intake (Model 2), the
standardized to allow for relative comparisons of strength inverse relationship between maternal concern with her
between the observed associations. Models for every own healthy eating and adolescents’ fast-food intake
potential correlate satisfied the proportionality of odds remained, therefore maternal concern for healthy food was
assumption for ordinal logistic regression, indicating that associated with a 27 % lower odds of increasing to the next
the odds ratios for being in either of the two higher intake higher fast-food intake category at Time 2 (OR 5 0?73,
categories (frequent or moderate) v. the lowest intake P 5 0?005). In addition to these socio-environmental fac-
category (low) were not statistically different from the tors, being born outside the USA was protective against
odds ratios for being in the highest intake category (fre- increased fast-food intake among males (Model 2: OR 5
quent) v. either of the two lower intake categories 0?45, P 5 0?006), while Time 1 television viewing (Model 2:
(moderate or low). P , 0?05 from a two-sided test of OR 5 1?24, P 5 0?04) and participating on a sports team
Predictors of fast-food intake 1771
Table 2 Time 2 fast-food Intake among male and female participants in Project EAT according to sociodemographic characteristics*-

Fast-food intake (past week)

Males Females

Moderate Frequent Moderate Frequent

Low (0 times) (1–2 times) ($3 times) Low (0 times) (1–2 times) ($3 times)

% n % n % n % n % n % n

Total sample 21?2 76 47?5 169 31?2 111 21?8 95 47?3 206 30?9 134
Race/ethnicity
White 21?1 28 48?1 63 30?8 40 26?2 34 48?4 63 25?4 33
African-American 24?0 18 41?4 32 34?6 27 18?3 20 47?9 53 33?8 37
Asian 23?9 20 52?1 43 24?0 20 26?7 25 51?6 49 21?7 21
Hispanic 21?2 4 37?5 7 41?3 8 16?0 5 54?4 17 29?5 9
Other 13?9 6 48?2 21 37?9 16 13?0 8 37?3 23 49?7 31
2 2
x(df 5 8)5 5?9; P 5 0?66 x(df 5 8)5 18?8; P 5 0?02

SES
Low 11?1 4 44?4 15 44?5 15 19?9 18 37?8 35 42?3 39
Low–middle 14?5 9 47?6 30 37?9 24 16?9 12 45?5 34 37?7 28
Middle 27?5 35 41?0 51 31?6 39 17?1 17 55?1 56 27?8 28
Upper–middle 19?8 12 54?4 33 25?8 16 22?4 16 49?4 36 28?2 20
High 29?2 13 43?6 19 27?2 12 37?8 24 45?0 29 17?1 11
2 2
x(df 5 8) 5 11?2; P 5 0?19 x(df 5 8)5 22?1; P 5 0?005

Mean Mean Mean Mean Mean Mean

a a
Age (years) 17?2 17?3 17?3 17?2 17?2 17?4b
F 5 1?3; P 5 0?26 F 5 3?9; P 5 0?02

SES, socio-economic status.

a,b
Mean values with unlike superscript letters were significantly different.
*Adjusted frequencies, means and percentages were determined using response propensity weights. Race/ethnicity and SES status were assessed at
baseline. Age was assessed at follow-up.
-The sample size for different variables may vary from the total sample size because of missing responses.

(Model 2: OR 5 2?17, P 5 0?001) were risk factors for longitudinally predict fast-food intake among high-
increased fast-food intake at Time 2. school-aged adolescents. Frequent fast-food intake was
Among females, several of the personal and behavioural common among our follow-up sample of high-school
factors reported at Time 1 were significantly associated with students; almost one-third of adolescents reported eating
both higher fast-food consumption (Model 1) and increased fast food at least three times in the previous week. Several
fast-food consumption (Model 2) at Time 2 (Table 3). socio-environmental, personal and behavioural factors, as
Weight concerns (Model 2: OR 5 0?79, P 5 0?02) and using assessed during middle school, were identified as long-
healthy weight-control strategies such as exercising and itudinal predictors of fast-food intake five years later
eating fruits and vegetables in order to lose weight (Model during high school.
2: OR 5 0?78, P 5 0?008) were protective against increased Many of the predictors of fast-food intake among males
fast-food intake at Time 2. Meanwhile, preferring the taste of were socio-environmental factors, including friends’ con-
unhealthy foods was a risk factor for increased fast-food cern for healthy eating and the home food environment.
consumption at Time 2 (Model 2: OR 5 1?28, P 5 0?01). Of specific interest is the strong protective relationship
Having been born outside the USA was a strong protective between maternal concern for healthy eating and males’
factor against increased fast-food intake at Time 2, with fast-food intake, which remained after adjustment for
those born outside the USA being approximately 50 % baseline fast-food intake. Although the other significant
less likely to increase to a higher fast-food consumption predictors of males’ fast-food intake, being born outside
category at Time 2 (Model 2: OR 5 0?45, P 5 0?004). The the USA and participating on sports teams, were categor-
sole socio-environmental predictor of increased fast-food ized as personal and behavioural based on our use of the
intake among females was having unhealthy food available Social Cognitive Theory, it may be that the socio-cultural
in the home (Model 2: OR 5 1?34, P 5 0?004). aspects of these factors play a role in males’ fast-food
intake. Expanding on the cross-sectional analysis of base-
line data from Project EAT-I(17), the current study found
Discussion that males’ sports team participation in middle school
predicted increased fast-food intake during the high
The goal of the present study was to identify socio- school years. Of all the factors examined in the present
environmental, personal and behavioural factors that study, sports team participation in middle school was the
1772 KW Bauer et al.
Table 3 Socio-environmental, personal and behavioural predictors of fast-food intake at follow-up in Project EAT participants

Males (n 335) Females (n 409)

Model 1* Model 2- Model 1* Model 2-

OR P OR P OR P OR P

Socio-environmental factors
Adult supervision 1?04 0?71 1?11 0?34 0?91 0?35 0?92 0?40
Healthy food available 0?84 0?14 0?81 0?09 0?90 0?28 0?91 0?33
Unhealthy food available 1?29 0?02 1?16 0?18 1?38 0?001 1?34 0?004
Family meals 0?84 0?11 0?85 0?13 0?89 0?23 0?89 0?23
Mom working 1?21 0?09 1?22 0?09 1?17 0?14 1?16 0?15
Dad working 1?20 0?13 1?22 0?09 0?95 0?68 0?94 0?61
Maternal concern with healthy eating 0?70 0?002 0?73 0?005 0?94 0?50 0?93 0?49
Maternal encouragement for my healthy eating 0?80 0?04 0?85 0?12 0?91 0?37 0?93 0?45
Paternal concern with healthy eating 0?82 0?06 0?84 0?11 0?87 0?16 0?87 0?18
Paternal encouragement for my healthy eating 0?90 0?33 0?95 0?64 0?88 0?21 0?89 0?25
Friends concern for healthy eating 0?76 0?03 0?80 0?07 0?86 0?19 0?88 0?28
Friends dieting 0?85 0?20 0?83 0?17 0?94 0?61 0?93 0?52
Personal factors
Born outside the USA 0?46 0?006 0?45 0?006 0?46 0?005 0?45 0?004
Self-report BMI 0?93 0?48 0?98 0?87 1?03 0?77 1?02 0?86
Nutrition knowledge 1?00 0?97 1?11 0?36 0?86 0?16 0?89 0?28
Benefits of healthy eating 0?92 0?43 0?95 0?63 0?94 0?54 0?97 0?74
Barriers to healthy eating – convenience 1?19 0?11 1?11 0?33 1?12 0?26 1?09 0?39
Preference for unhealthy food 1?29 0?02 1?21 0?09 1?33 0?003 1?28 0?01
Self-efficacy for healthy eating 0?83 0?08 0?84 0?10 1?04 0?69 1?08 0?44
Weight concerns 0?94 0?55 0?96 0?73 0?81 0?02 0?79 0?02
Weight perception 0?91 0?37 0?95 0?60 0?84 0?07 0?83 0?06
Behavioural factors
Healthy weight-control behaviours 0?86 0?15 0?90 0?30 0?79 0?01 0?78 0?008
Unhealthy weight-control behaviours 0?89 0?26 0?89 0?27 0?93 0?43 0?92 0?38
Substance use 1?12 0?33 1?08 0?53 1?01 0?22 0?98 0?81
Sports team participation 2?36 0?0003 2?17 0?001 1?35 0?14 1?33 0?16
Work for pay 1?12 0?28 1?11 0?34 1?16 0?15 1?15 0?18
Vegetarian 1?40 0?52 1?35 0?57 1?41 0?32 1?42 0?31
Television viewing 1?29 0?02 1?24 0?04 1?00 0?63 1?00 0?87

*Model 1 adjusted for baseline socio-economic status (SES) in five categories and race/ethnicity (white/non-white).
-Model 2 adjusted for baseline SES, race/ethnicity and fast-food intake at Time 1.

strongest risk factor for fast-food intake in high school. both males and females may benefit from interventions
This relationship may emerge because adolescents who that aim to decrease the availability of unhealthy foods in
are on sports teams have little time for meals at home and the home. Additionally, adolescents whose families have
therefore may rely on fast food for quick meals. recently immigrated to the USA may benefit from inter-
Among females, a pattern of personal and behavioural ventions that emphasize the maintenance of healthier,
predictors of fast-food intake emerged. These include culturally specific eating patterns from their native coun-
weight concerns, healthy weight-control behaviours and tries. Meanwhile, some gender-specific strategies may be
taste preference for unhealthy foods. All of the predictors appropriate for reducing fast-food intake. For boys, it may
of fast-food intake among females remained after con- be important to address the strong association between
trolling for baseline fast-food intake. Therefore, they were sports team participation and fast-food intake. One strategy
not only associated with higher fast-food intake in high to address this may be ensuring that team practices end
school but an increase in intake between middle and high early enough in the evening so that families are able to
school. Similar to males, being born outside the USA was prepare a family meal at home. Programmes that aim to
associated with fast-food intake in high school. These modify girls’ personal beliefs and behaviours may be
findings support those of other cross-sectional and long- successful in reducing their fast-food intake. Interventions
itudinal studies which have found that first-generation for girls may choose to focus on encouraging girls to use
immigrants and less acculturated adolescents and adults healthy weight-management strategies such as eating fruits
often have better dietary intake patterns, including lower and vegetables, choosing low-fat food options, and trying
consumption of fast food, compared with their US-native new, healthy foods in the hope of finding several that they
and acculturated peers(20,29). enjoy and can integrate into their daily intake.
These patterns of longitudinal predictors can help The results of the current study align well with the find-
guide intervention strategies to reduce adolescents’ fast- ings of previous cross-sectional studies in adolescent(17,19)
food intake. Findings from the current study suggest that and adult(21,22) populations. In a separate analysis of
Predictors of fast-food intake 1773
longitudinal predictors of fast-food intake among the healthy weight-maintenance strategies and the addition of
young adult population that participated in Project EAT, flavourful and healthy food options, may help to reduce
Larson et al.(26) similarly found that peer support for fast-food intake.
healthy eating predicted decreased consumption of fast
food among males, while personal and behavioural fac- Acknowledgements
tors such as taste preference for unhealthy foods and
perceived lack of time to eat healthfully were long- We would like to thank Mr Peter Hannan for his statistical
itudinally associated with higher fast-food intake among assistance with this paper. The study was supported by
females. This consistency of findings across the life span Grant R40 MC 00319 (D.N.-S., Principal Investigator) from
lends itself to the development of population-based the Maternal and Child Health Bureau (Title V, Social
interventions that can use similar strategies to affect both Security Act), Health Resources and Services Administra-
adults’ and adolescents’ fast-food habits. tion, US Department of Health and Human Services.
Strengths of the current study include its longitudinal K.W.B. is supported by the Adolescent Health Protection
design and use of a racially, ethnically and socio- Program (School of Nursing, University of Minnesota)
economically diverse population. The large sample size grant number T01-DP000112 (Principal Investigator:
of Project EAT allowed for the examination of gender- Bearinger) from the Centers for Disease Control and
specific relationships between socio-environmental, Prevention (CDC). The contents of this paper are solely
behavioural and personal factors and fast-food intake. the responsibility of the authors and do not necessarily
A limitation of the study was its dependence on a single represent the official views of the CDC. The authors
measure of fast-food intake. While this measure has been declare that they have no competing interests. K.W.B.,
used in several other studies(14,21,25), the item inquired N.I.L., M.C.N., M.S. and D.N.-S. contributed to the study
only about the participant’s fast-food intake in the past design; K.W.B. conducted the statistical analysis and wrote
week, assuming that this reflects usual intake. Addition- the manuscript; and all authors edited the manuscript and
ally, new types of fast-food restaurants are rapidly read and approved the final manuscript. D.N.-S. is the
becoming available, expanding the concept of what is Principal Investigator of Project EAT-II.
considered ‘fast food’ beyond hamburgers and fried
chicken and into such realms as ethnic fast foods(30). This References
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