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The food–service industry, dietary guidelines and change

The food–service industry, dietary guidelines and change Abstract: The influence of the food-service industry on compliance with the Australian dietary guidelines was investigated through three separate methods of data collection and analysis: a telephone survey of 1683 randomly selected Brisbane residents; telephone interviews with 69 food-service-industryoperators and 10 face-to-face interviews with key stakeholders in industry and government. Nearly 40 per cent of respondents had consumed foods prepared by the food-service industry at least once on the day before the interview, mainly from restaurants, cafes and takeaway shops, in the form of fast-food or snacks. Consumption of these foods declined with age. Those consuming foods prepared by the food-service industry ate significantly less fruit, vegetables and dairy food and were therefore less likely to comply with the dietary guidelines. Outcomes from interviews with operators in the food-service industry show that food choices offered to consumers were the result of a dynamic interaction between consumer demand and operators' own tastes and perceptions of food quality. Key informant interviews show that public health nutrition programs will have limited effect without s u p portive environmental changes in the food-service industry supply. An effective means of increasing the likelihood of compliance with the Australian dietary guidelines will be to encourage food suppliers in ways that address their core business concerns simultaneously with the goals of health professionals. (Aust N 2JPublic Health 1997; 21: 53944) ple sugars and low in fibre and complex carbohyELATIONSHIPS between diet and chronic drates. Fat as a proportion of energy is over 50 per disease are now well established, as is recogcent in many meals and snacks.8-12 Studies in the .nition that the Australian diet tends towards United States have found that the greater the conoverconsumption of fat and refined carbohydrates tribution of restaurant foods or fast foods is to a perand underconsumption of complex carbohydrates son's total intake, the less likely will be compliance and dietary fibre.' As a response, dietary guidelines, with dietary g ~ i d e 1 i n e s . l ~ ' ~ which recognise the need to change from the traditional emphasis on deficiency prevention to the avoidance of overconsumption, were f o r m ~ l a t e d . ~ ~ ~Methods The contribution the food-service industry is makThe objectives of the study were: ing to the Australian diet has been recognised to determine the role the food-service industry nati~nally.~.~ Additionally, the size and structure of plays in the acquisition of food by individuals and the food-service industry in Australia has been docthe related likelihood of compliance with the umented.6 However, little is known about the influAustralian dietary guidelines ence of the industry on the food choice of to identify the factors influencing decisions by consumers and the corresponding implications for food-service industry operators about the prodpolicy and program formulation to achieve dietary ucts they offer. change. This paper presents findings from a study The study involved three separate methods of data undertaken in Brisbane to determine the influence collection and analysis: a consumer survey; a survey of the food-service industry on compliance with the of food-service industry operators; and face-to-face Australian dietary guidelines.' interviews with key informants. Results were The food-service industry can be described as analysed and compared (triangulated) . I 6 Foods those commercial and institutional establishments included all foods prepared in food-service industry that prepare and offer foods for consumption by the establishments, and excluded prepackaged or offpublic. It has been estimated that in 1991 there were the-shelf foods, including confectionery, soft drinks, 58 076 food-service industry outlets operating in biscuits, ice cream and potato crisps. Australia; the majority were cafes, restaurants and takeaway outlets. On average, 25 per cent of all the Objectiue 1 meals and snacks consumed in Australia were preThe telephone survey was conducted by using a ranpared at food-service establishments.6 domdigit dialling technique. The sampling frame In general, takeaway foods have been found to be was all households in Brisbane city with a telephone. high in fat (particularly saturated fat), salt and simA pool of 9042 randomly generated telephone numbers was screened for contact with 1683 households. Details of the screening procedure are shown in Correspondence to Dr P.W.J. Harvey, Nutrition Program, Figure 1. Australian Centre for International and Tropical Health and The respondent was the first person to answer the Nutrition, Edith Cave11 Building, Royal Brisbane Hospital, Herston 4029. Fax (07) 3257 1253. telephone. He or she was asked to recall all the AUSTRALIAN AND NEW ZEAIAND JOURNAL O PUBLIC HEALTH 1997 F VOL. 21 NO. 5 HUGHES ET AL. 51 78 nonexistent 21 12 nonhouseholds 69 unanswered after 10 attempts to contact 455 mresponses mat and interview guide were standardised. The questions were based on the respondent’s concerns about how food-service industry operators purchase, prepare and sell food in Brisbane and how improvements could be made. This was done to determine the stakeholder’s own priorities and hence the influence of the person interviewed on the food-service industry’s consumers, operators and government. All interviews were recorded on audiotape and written notes were also taken. Responses were categorised manually into issues emerging from the data. F‘ ure 1: Screening the survey sample fm randomly generated r tetphone numbers in Brisbane. foods eaten (not quantities) during the day before the interview, where they were prepared and by whom. Alpha-numeric NUTTAB food codes were assigned to each food recorded.” Demographic details about the respondent and other persons in the household were also gathered. Chi-squared tests were used to determine statistical significance of differences in proportions. A logistic regression model was developed to determine the independent, adjusted effects of age, sex, employment and education for those who had consumed foods prepared by the food-service industry (at least once during the day before the telephone call) compared with others. The variables in the logistic regression model were then tested for effect modification (interactions). Objective 2 Information was collected in two stages. First was a telephone survey of food-service industry operators consisting entirely of open-ended questions. The sampling frame was all businesses listed in the 1994 Brisbane yellow pages telephone directory under the headings ‘restaurants’, ‘cafes’ and ‘takeaways’. Businesses were then randomly selected and cony tacted b telephone and the operators were asked if they would participate in the survey. From the 81 telephone numbers dialled, 69 operators were contacted and 57 agreed to participate in the survey. A scripted introduction was used for each proposed interview, and was followed by an interview, which was semistructured to promote consistency in the questioning procedure. The questions focused on factors influencing purchasing, preparing and selling food. The same person (R.H.) conducted all interviews. Responses were recorded manually and categorised into issues relating to the ways food-service industry operators purchased, prepared and sold foods. Second, in-depth, face-to-faceinterviews were conducted with 10 purposefully selected key informants representing stakeholders with interests in the foodservice industry. Those interviewed held executive positions within the food-service industry, government or consumer organisations and were involved in policy, planning and/or promotion. Again the for540 Results Consumer suruq results There were 1228 respondents (64 per cent female). Of those interviewed, 40 per cent (47 per cent male, 36 per cent female) had consumed food prepared by the food-service industry at least once on the day before the survey. Most of these foods (89 per cent) were prepared in restaurants or cafes (50.2 per cent) and takeaway shops (38.8 per cent) and were in the form of fast food and snacks. A large proportion of the food eaten away from home (74 per cent) was eaten during the day time. Males consistently consumed a statistically greater proportion of foodservice industry meals or snacks than females across all meal times, with the exception of breakfast ( P < 0.05). Over 33 per cent of all males interviewed consumed foods prepared by the food-service industry for lunch. Univariate analysis of demographic variables revealed that the most frequent consumers of prepared foods were tertiary-educated, student males and the 18- to 24years age group. When other variables were controlled for in a logistic regression model, the 18- to 24years age group was approximately twice as likely as the 25- to 64years age group, and nearly three times more likely than the 65-andover age group, to consume food-service-industryprepared foods. Females were nearly 30 per cent less likely to consume food-service industry-prepared-foods than males (odds ratio (OR) 0.71). When the effects of sex, age and education were controlled for, employment status and use of prepared foods were not associated. There were no statistically significant interactions between any of the variables ( P = 0.8). Therefore, the cumulative odds ratios were ranked. The consumption of food-service-industry-prepared foods declined with age (Table 1).The smallest proportion of any population group consuming foodservice-industry-prepared foods occurred in those aged 65 years and over. The proportions of users of food prepared by the food-service industry consuming fruit, vegetables and dairy products were significantly lower than the corresponding proportions of those using only home-prepared foods (Table 2). Of the total survey sample, significantly less fruit and more meat was consumed by males than females ( P < 0.05) and the proportion of those consuming fruit, vegetables and test for dairy foods increased with increasing age linear trend, P < 0.05). (x‘ AUSTRALIAN AND NEW ZEALAND JOURNAL O PUBLIC HEALTH 1997 voc. 21 F NO. FOOD-SERVICE INDUSTRY AND CHANGE Table 1 : Consumption of foods prepared by the foodservice industry, by age, sex and education, in Brisbane: ranked odds ratios Age group (years) Sex Education’ Odds ratio 1 .oo 0.72 18-24 18-24 25-64 25-64 265 265 Note: (a) Highest level of M F M F T S T S T S T S T S T S Most factors influencing the operators’ offerings were locally and/or personally influenced, including knowledge of the business and food purchasing and preparation techniques. Customer preferences, position of the outlet, advertising and the number of competing businesses were identified as the strongest influences on an operator’s choice of foods, but poor knowledge of business management, food preparation and presentation were also barriers identified as shaping food choices. Only one operator saw government regulation as a barrier. Nutrition and health were not identified by any respondent as being an important determinant of the types of food they offered. education attained: T = tertiary; S = completed secondary school. Table 2: Numbers of persons consuming major food groups, in Brisbane: comparison of those consuming food prepared by the food-service industry with those consuming food prepared at home Source Fadservice industry n Yo Home Food group Cereals Fruit Vegetables Dairy foods Meat Total ‘ P < 0.05, P < 0.01 t 98.0 56.8t 84.9’ 75.6’ 88.4 100.0 Operator survey results The 69 responding operators represented 8 restaurants, 24 takeaway shops, 2 hotel restaurants and 23 combined restaurants and takeaway outlets. Takeaway food was available for purchase in 47 (82 per cent) of these. Single independent outlets accounted for 77 per cent (44) of all outlets, with the remainder (23 per cent) being either franchised or part of a chain of outlets owned by companies or individuals. Most businesses (65 per cent) operated seven days per week. There were differences among operators in hours of operation, busy periods and popular foods, which indicated that each operation tended to the needs of the locality or to a specific clientele. Some food preparation methods used by operators were consumer driven. Many outlets had responded to the customer’s desire to see and purchase freshly prepared foods and therefore displayed as much as possible. Key informant interviews Key informants unanimously agreed that operator training, licensing, outlet registration and accreditation were the best ways of improving the performance (in terms of management, nutrition and food safety) of food-service-industry operations. However, they differed in their ideas on training, licensing and registration methods. Professional and trade qualifications (including nutrition), foodsafety requirements and business management experience were suggested as bases for industry or trade accreditation for food-service-industry operators. Upgrading registrations and accreditation of outlets were also suggested to improve food-service operations. Some informants observed that changes in consumer behaviour might have initiated corresponding changes in the way some operators presented their foods. However, most felt that consumer perceptions were also fashioned by operators presenting services other than food, and that some choices of consumers depend more on the service and less on the types of food offered. These services included the provision of easy access and parking, fast and courteous service, home delivery, cleanliness, special offers, entertainment and gambling. Most informants felt that the major factors influencing operators’ decisions were economic, not nutritional. They saw finance as the only barrier to entry into the food-service industry; no skills in business management or food service were required. As a consequence, some informants were concerned about the risk to health posed by inexperience in food handling. Respondents also felt that consumption patterns had changed with economic conditions, but the general trend had been towards more informal eating habits. Food service was seen as a little-understood and often overlooked link in the food chain. Some informants felt that not only more knowledge. but more control, would be required if government were to ensure a safe, sustainable and nutritious food supply. Discussion A large proportion (40 per cent) of the Brisbane population consumed food-service-industry-prepared foods on the day before being interviewed, and males, the young and tertiary-educated persons were the most frequent consumers. The proportion VOL. AUSTRALIAN AND NEW ZEAIAND JOURNAL O PUBLIC HEALTH 1997 F 21 NO. 5 HUGHES ET AL of food-service industry consumers is larger than previously reported but may still be an underestimation. Other studies have reported between 25 and 33 per cent of the population consuming foods prepared by the food-service i n d ~ s t r y . ~ , ~ ~ ’ * ~ ’ ~ Previous studies may have underestimated proportions of consumers of food-service-industry-prepared food because most have been concerned with the consumption of food eaten away from home rather than the consumption of food prepared away from home. Additionally, previous studies have not used random-digit dialling telephone techniques. Telephone interviews allowed probing that revealed respondents’ difficulties in differentiating between the consumption of food eaten away and food pepared away from home. In addition, some respondents did not easily recall the contribution the food-service industry made to their dietary intake. For example, interviewers had to remind many respondents that consumption of snacks and sandwiches provided at their places of employment or home deliveries were foods prepared by the foodservice industry. Telephone interviews may be superior to mailed surveys and equal in accuracy to personal interviews in this regard.20-22 Additionally, telephone interviews are less invasive than face-toface interviews, resulting in more relaxed and frank responses. The group of respondents consuming food-service-industry-prepared foods were significantly less likely to have eaten fruit, vegetables or dairy foods on the day prior to the survey (Table 2). Therefore, this group is less likely to have complied with Australian dietary guideline 2, ‘Eat plenty of breads and cereals (preferably wholegrain), vegetables (including legumes) and fruits’.‘ As the proportion of the population eating food-service-industry-prepared foods increases, the proportion of the population likely to comply with this guideline will decrease. Similar findings have been reported in a study from the United States14and work done in a rural community in Q~eensland.’~ Elsewhere, young adults have been shown to have less interest in nutritional matters than older g r o ~ p s . ~ ~ ~ ‘ ~ Other studies found older adults to be more concerned about nutrition and health,z6~z7 and this seems to be reflected in the foods consumed by those aged 65 years and over in this study (Table 2). Additionally, the 65-years-and-over group was found to consume the least amount of food-service-industry-prepared foods (Table 1). Nevertheless, there are indications that aged persons do not modify their diets until the presence of various medical conditions force a change.**Perhaps fewer aged people consume food-service-industry-prepared foods because food service has played only a minor role in forming lifelong food habits. In previous studies women have been found to be more concerned than men about food quality and health.*5~2g~30 High-income-earning women have been shown to be leading the way in selecting healthy diets.29However, in other studies, the awayfrom-home eating patterns of this same socioeconomic group of women have been found to have significantly different nutrient intakes (higher fat and cholesterol) from their at-home eating patterns, and up to 12 per cent were consuming 66 per cent of their energy away from home.31 The effect on nutrient adequacy depends on how frequently eating away from home occurs.32 Perhaps the awareness of nutrition issues among women involves only foods eaten at home by the whole family, possibly because they have greater control themselves over home consumption. However, when eating away from home, they either have little control over the nutritional value of the foods they consume or they do not regard it as significant. Results show that most foods prepared by the food-service industry (80 per cent) were consumed during the day time as fast food and snacks, not as structured meals. This observation is consistent with what Emerson described as ‘functional eating’.33 This trend was confirmed by food-service-industry operators and key informants. The largest food component of food service is now low-priced, quickly served foods, not meals.34It is not surprising, therefore, that takeaway and fast-food outlets make up the largest sector of the industry in Queensland. The cafe-restaurant sector is next largest. However, results from a Brisbane study show most cafes and restaurants also sell takeaway food.’ Likelihood o compliance with the Australian dietary f guidelines Three issues influencing compliance with the Australian dietary guidelines emerged from this study. 1. There seems to be an inverse relationship between use of prepared foods and compliance with the dietary guidelines. 2. Choices available to the consumer are determined by a dynamic interaction between the consumers of food-service-industry-prepared foods and operators. Results from the operator’s survey and key informant interviews show that operators respond to consumer demands while also attempting to fashion consumer food choice. The choice of foods offered by food-service-industry operators is driven out of economic necessity, not concern for nutrition. Therefore, the ability of consumers to make healthy choices is limited to those that coincidentally improve business for the operator. This is reinforced by the actions of some operators who offer services other than food. The major attractions of many food-service-industry venues are entertainment, poker machines and sport, not food. 3. The success of public health nutrition education programs will be limited if supportive environmental changes are not made to the food-serviceindustry food supply. The thrust of public health nutrition policy in the past has focused on nutrition education, but the effectiveness of this in initiating dietary change in the population without corresponding structural changes has been quest i ~ n e d Continuing nutrition education pro. ~ ~ ~ ~ grams have resulted in increased consumer NO. AUSTRALIAN AND NEW ZEALAND JOURNAL O PUBLIC HEALTH 1997 vot. 21 F FOOD-SERVICE INDUSTRY AND CHANGE knowledge about associations between nutrition and chronic disease. This knowledge has resulted in some behaviour change, but these changes appear to be in the types of foods selected and the way they are prepared at home only. There has been little behaviour change in the food-service sector. The results of this study show that the motivation driving operators’ selection of menu relates to taste, palatability and increasing costs. As a consequence, operators attempt to define food quality in those terms. In addition, ‘safe, clean food’ seems to be a marketable feature, especially for the larger operators: key informants identified food safety as an issue. This is consistent with the incidence of food poisoning in Queensland having increased dramatically over recent years.36 contrast, consumer conBy cerns about food quality have focused more on nutrition, additives and contamir~ants.~’-~~ Changes to the food supply can be achieved through policy and programs directed at food-service operators and staff. The major influences on the choice of foods operators offer were a mixture of their own perceptions and the demands of their customers. Government intervention was not seen as a barrier to improvement of trade by most operators interviewed. If programs directed at food-service operators aim at improving food quality as defined by the operators (taste, appearance, palatability), then aspects of food quality as defined by those in public health nutrition (food safety, nutritional quality) and by consumers (nutrition, additives and contaminants) could also be addressed. The most desirable means of doing this is through an integrated form of training and/or business accreditation for operators in the food-service industry. Already there have been programs and projects aimed at improving the food-service industry’s compliance with dietary guidelines elsewhere in A u ~ t r a l i aMost of these programs have involved .~~ local government, media coverage and rewards and training for food-service-industry operators. The food-service industry is a rapidly expanding industry and, accordingly, deserves more attention from public health nutrition professionals than it has received in the past. To achieve dietary guideline recommendations, nutrition education programs need to be supported across sectors to encourage changes in the supply of food-service-industry-prepared foods. An effective means of modifymg the food supply is to encourage food suppliers in a way that addresses their core business concerns simultaneously with the goals of health professionals. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

The food–service industry, dietary guidelines and change

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Publisher
Wiley
Copyright
Copyright © 1997 Wiley Subscription Services, Inc., A Wiley Company
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1467-842X.1997.tb01748.x
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Abstract

Abstract: The influence of the food-service industry on compliance with the Australian dietary guidelines was investigated through three separate methods of data collection and analysis: a telephone survey of 1683 randomly selected Brisbane residents; telephone interviews with 69 food-service-industryoperators and 10 face-to-face interviews with key stakeholders in industry and government. Nearly 40 per cent of respondents had consumed foods prepared by the food-service industry at least once on the day before the interview, mainly from restaurants, cafes and takeaway shops, in the form of fast-food or snacks. Consumption of these foods declined with age. Those consuming foods prepared by the food-service industry ate significantly less fruit, vegetables and dairy food and were therefore less likely to comply with the dietary guidelines. Outcomes from interviews with operators in the food-service industry show that food choices offered to consumers were the result of a dynamic interaction between consumer demand and operators' own tastes and perceptions of food quality. Key informant interviews show that public health nutrition programs will have limited effect without s u p portive environmental changes in the food-service industry supply. An effective means of increasing the likelihood of compliance with the Australian dietary guidelines will be to encourage food suppliers in ways that address their core business concerns simultaneously with the goals of health professionals. (Aust N 2JPublic Health 1997; 21: 53944) ple sugars and low in fibre and complex carbohyELATIONSHIPS between diet and chronic drates. Fat as a proportion of energy is over 50 per disease are now well established, as is recogcent in many meals and snacks.8-12 Studies in the .nition that the Australian diet tends towards United States have found that the greater the conoverconsumption of fat and refined carbohydrates tribution of restaurant foods or fast foods is to a perand underconsumption of complex carbohydrates son's total intake, the less likely will be compliance and dietary fibre.' As a response, dietary guidelines, with dietary g ~ i d e 1 i n e s . l ~ ' ~ which recognise the need to change from the traditional emphasis on deficiency prevention to the avoidance of overconsumption, were f o r m ~ l a t e d . ~ ~ ~Methods The contribution the food-service industry is makThe objectives of the study were: ing to the Australian diet has been recognised to determine the role the food-service industry nati~nally.~.~ Additionally, the size and structure of plays in the acquisition of food by individuals and the food-service industry in Australia has been docthe related likelihood of compliance with the umented.6 However, little is known about the influAustralian dietary guidelines ence of the industry on the food choice of to identify the factors influencing decisions by consumers and the corresponding implications for food-service industry operators about the prodpolicy and program formulation to achieve dietary ucts they offer. change. This paper presents findings from a study The study involved three separate methods of data undertaken in Brisbane to determine the influence collection and analysis: a consumer survey; a survey of the food-service industry on compliance with the of food-service industry operators; and face-to-face Australian dietary guidelines.' interviews with key informants. Results were The food-service industry can be described as analysed and compared (triangulated) . I 6 Foods those commercial and institutional establishments included all foods prepared in food-service industry that prepare and offer foods for consumption by the establishments, and excluded prepackaged or offpublic. It has been estimated that in 1991 there were the-shelf foods, including confectionery, soft drinks, 58 076 food-service industry outlets operating in biscuits, ice cream and potato crisps. Australia; the majority were cafes, restaurants and takeaway outlets. On average, 25 per cent of all the Objectiue 1 meals and snacks consumed in Australia were preThe telephone survey was conducted by using a ranpared at food-service establishments.6 domdigit dialling technique. The sampling frame In general, takeaway foods have been found to be was all households in Brisbane city with a telephone. high in fat (particularly saturated fat), salt and simA pool of 9042 randomly generated telephone numbers was screened for contact with 1683 households. Details of the screening procedure are shown in Correspondence to Dr P.W.J. Harvey, Nutrition Program, Figure 1. Australian Centre for International and Tropical Health and The respondent was the first person to answer the Nutrition, Edith Cave11 Building, Royal Brisbane Hospital, Herston 4029. Fax (07) 3257 1253. telephone. He or she was asked to recall all the AUSTRALIAN AND NEW ZEAIAND JOURNAL O PUBLIC HEALTH 1997 F VOL. 21 NO. 5 HUGHES ET AL. 51 78 nonexistent 21 12 nonhouseholds 69 unanswered after 10 attempts to contact 455 mresponses mat and interview guide were standardised. The questions were based on the respondent’s concerns about how food-service industry operators purchase, prepare and sell food in Brisbane and how improvements could be made. This was done to determine the stakeholder’s own priorities and hence the influence of the person interviewed on the food-service industry’s consumers, operators and government. All interviews were recorded on audiotape and written notes were also taken. Responses were categorised manually into issues emerging from the data. F‘ ure 1: Screening the survey sample fm randomly generated r tetphone numbers in Brisbane. foods eaten (not quantities) during the day before the interview, where they were prepared and by whom. Alpha-numeric NUTTAB food codes were assigned to each food recorded.” Demographic details about the respondent and other persons in the household were also gathered. Chi-squared tests were used to determine statistical significance of differences in proportions. A logistic regression model was developed to determine the independent, adjusted effects of age, sex, employment and education for those who had consumed foods prepared by the food-service industry (at least once during the day before the telephone call) compared with others. The variables in the logistic regression model were then tested for effect modification (interactions). Objective 2 Information was collected in two stages. First was a telephone survey of food-service industry operators consisting entirely of open-ended questions. The sampling frame was all businesses listed in the 1994 Brisbane yellow pages telephone directory under the headings ‘restaurants’, ‘cafes’ and ‘takeaways’. Businesses were then randomly selected and cony tacted b telephone and the operators were asked if they would participate in the survey. From the 81 telephone numbers dialled, 69 operators were contacted and 57 agreed to participate in the survey. A scripted introduction was used for each proposed interview, and was followed by an interview, which was semistructured to promote consistency in the questioning procedure. The questions focused on factors influencing purchasing, preparing and selling food. The same person (R.H.) conducted all interviews. Responses were recorded manually and categorised into issues relating to the ways food-service industry operators purchased, prepared and sold foods. Second, in-depth, face-to-faceinterviews were conducted with 10 purposefully selected key informants representing stakeholders with interests in the foodservice industry. Those interviewed held executive positions within the food-service industry, government or consumer organisations and were involved in policy, planning and/or promotion. Again the for540 Results Consumer suruq results There were 1228 respondents (64 per cent female). Of those interviewed, 40 per cent (47 per cent male, 36 per cent female) had consumed food prepared by the food-service industry at least once on the day before the survey. Most of these foods (89 per cent) were prepared in restaurants or cafes (50.2 per cent) and takeaway shops (38.8 per cent) and were in the form of fast food and snacks. A large proportion of the food eaten away from home (74 per cent) was eaten during the day time. Males consistently consumed a statistically greater proportion of foodservice industry meals or snacks than females across all meal times, with the exception of breakfast ( P < 0.05). Over 33 per cent of all males interviewed consumed foods prepared by the food-service industry for lunch. Univariate analysis of demographic variables revealed that the most frequent consumers of prepared foods were tertiary-educated, student males and the 18- to 24years age group. When other variables were controlled for in a logistic regression model, the 18- to 24years age group was approximately twice as likely as the 25- to 64years age group, and nearly three times more likely than the 65-andover age group, to consume food-service-industryprepared foods. Females were nearly 30 per cent less likely to consume food-service industry-prepared-foods than males (odds ratio (OR) 0.71). When the effects of sex, age and education were controlled for, employment status and use of prepared foods were not associated. There were no statistically significant interactions between any of the variables ( P = 0.8). Therefore, the cumulative odds ratios were ranked. The consumption of food-service-industry-prepared foods declined with age (Table 1).The smallest proportion of any population group consuming foodservice-industry-prepared foods occurred in those aged 65 years and over. The proportions of users of food prepared by the food-service industry consuming fruit, vegetables and dairy products were significantly lower than the corresponding proportions of those using only home-prepared foods (Table 2). Of the total survey sample, significantly less fruit and more meat was consumed by males than females ( P < 0.05) and the proportion of those consuming fruit, vegetables and test for dairy foods increased with increasing age linear trend, P < 0.05). (x‘ AUSTRALIAN AND NEW ZEALAND JOURNAL O PUBLIC HEALTH 1997 voc. 21 F NO. FOOD-SERVICE INDUSTRY AND CHANGE Table 1 : Consumption of foods prepared by the foodservice industry, by age, sex and education, in Brisbane: ranked odds ratios Age group (years) Sex Education’ Odds ratio 1 .oo 0.72 18-24 18-24 25-64 25-64 265 265 Note: (a) Highest level of M F M F T S T S T S T S T S T S Most factors influencing the operators’ offerings were locally and/or personally influenced, including knowledge of the business and food purchasing and preparation techniques. Customer preferences, position of the outlet, advertising and the number of competing businesses were identified as the strongest influences on an operator’s choice of foods, but poor knowledge of business management, food preparation and presentation were also barriers identified as shaping food choices. Only one operator saw government regulation as a barrier. Nutrition and health were not identified by any respondent as being an important determinant of the types of food they offered. education attained: T = tertiary; S = completed secondary school. Table 2: Numbers of persons consuming major food groups, in Brisbane: comparison of those consuming food prepared by the food-service industry with those consuming food prepared at home Source Fadservice industry n Yo Home Food group Cereals Fruit Vegetables Dairy foods Meat Total ‘ P < 0.05, P < 0.01 t 98.0 56.8t 84.9’ 75.6’ 88.4 100.0 Operator survey results The 69 responding operators represented 8 restaurants, 24 takeaway shops, 2 hotel restaurants and 23 combined restaurants and takeaway outlets. Takeaway food was available for purchase in 47 (82 per cent) of these. Single independent outlets accounted for 77 per cent (44) of all outlets, with the remainder (23 per cent) being either franchised or part of a chain of outlets owned by companies or individuals. Most businesses (65 per cent) operated seven days per week. There were differences among operators in hours of operation, busy periods and popular foods, which indicated that each operation tended to the needs of the locality or to a specific clientele. Some food preparation methods used by operators were consumer driven. Many outlets had responded to the customer’s desire to see and purchase freshly prepared foods and therefore displayed as much as possible. Key informant interviews Key informants unanimously agreed that operator training, licensing, outlet registration and accreditation were the best ways of improving the performance (in terms of management, nutrition and food safety) of food-service-industry operations. However, they differed in their ideas on training, licensing and registration methods. Professional and trade qualifications (including nutrition), foodsafety requirements and business management experience were suggested as bases for industry or trade accreditation for food-service-industry operators. Upgrading registrations and accreditation of outlets were also suggested to improve food-service operations. Some informants observed that changes in consumer behaviour might have initiated corresponding changes in the way some operators presented their foods. However, most felt that consumer perceptions were also fashioned by operators presenting services other than food, and that some choices of consumers depend more on the service and less on the types of food offered. These services included the provision of easy access and parking, fast and courteous service, home delivery, cleanliness, special offers, entertainment and gambling. Most informants felt that the major factors influencing operators’ decisions were economic, not nutritional. They saw finance as the only barrier to entry into the food-service industry; no skills in business management or food service were required. As a consequence, some informants were concerned about the risk to health posed by inexperience in food handling. Respondents also felt that consumption patterns had changed with economic conditions, but the general trend had been towards more informal eating habits. Food service was seen as a little-understood and often overlooked link in the food chain. Some informants felt that not only more knowledge. but more control, would be required if government were to ensure a safe, sustainable and nutritious food supply. Discussion A large proportion (40 per cent) of the Brisbane population consumed food-service-industry-prepared foods on the day before being interviewed, and males, the young and tertiary-educated persons were the most frequent consumers. The proportion VOL. AUSTRALIAN AND NEW ZEAIAND JOURNAL O PUBLIC HEALTH 1997 F 21 NO. 5 HUGHES ET AL of food-service industry consumers is larger than previously reported but may still be an underestimation. Other studies have reported between 25 and 33 per cent of the population consuming foods prepared by the food-service i n d ~ s t r y . ~ , ~ ~ ’ * ~ ’ ~ Previous studies may have underestimated proportions of consumers of food-service-industry-prepared food because most have been concerned with the consumption of food eaten away from home rather than the consumption of food prepared away from home. Additionally, previous studies have not used random-digit dialling telephone techniques. Telephone interviews allowed probing that revealed respondents’ difficulties in differentiating between the consumption of food eaten away and food pepared away from home. In addition, some respondents did not easily recall the contribution the food-service industry made to their dietary intake. For example, interviewers had to remind many respondents that consumption of snacks and sandwiches provided at their places of employment or home deliveries were foods prepared by the foodservice industry. Telephone interviews may be superior to mailed surveys and equal in accuracy to personal interviews in this regard.20-22 Additionally, telephone interviews are less invasive than face-toface interviews, resulting in more relaxed and frank responses. The group of respondents consuming food-service-industry-prepared foods were significantly less likely to have eaten fruit, vegetables or dairy foods on the day prior to the survey (Table 2). Therefore, this group is less likely to have complied with Australian dietary guideline 2, ‘Eat plenty of breads and cereals (preferably wholegrain), vegetables (including legumes) and fruits’.‘ As the proportion of the population eating food-service-industry-prepared foods increases, the proportion of the population likely to comply with this guideline will decrease. Similar findings have been reported in a study from the United States14and work done in a rural community in Q~eensland.’~ Elsewhere, young adults have been shown to have less interest in nutritional matters than older g r o ~ p s . ~ ~ ~ ‘ ~ Other studies found older adults to be more concerned about nutrition and health,z6~z7 and this seems to be reflected in the foods consumed by those aged 65 years and over in this study (Table 2). Additionally, the 65-years-and-over group was found to consume the least amount of food-service-industry-prepared foods (Table 1). Nevertheless, there are indications that aged persons do not modify their diets until the presence of various medical conditions force a change.**Perhaps fewer aged people consume food-service-industry-prepared foods because food service has played only a minor role in forming lifelong food habits. In previous studies women have been found to be more concerned than men about food quality and health.*5~2g~30 High-income-earning women have been shown to be leading the way in selecting healthy diets.29However, in other studies, the awayfrom-home eating patterns of this same socioeconomic group of women have been found to have significantly different nutrient intakes (higher fat and cholesterol) from their at-home eating patterns, and up to 12 per cent were consuming 66 per cent of their energy away from home.31 The effect on nutrient adequacy depends on how frequently eating away from home occurs.32 Perhaps the awareness of nutrition issues among women involves only foods eaten at home by the whole family, possibly because they have greater control themselves over home consumption. However, when eating away from home, they either have little control over the nutritional value of the foods they consume or they do not regard it as significant. Results show that most foods prepared by the food-service industry (80 per cent) were consumed during the day time as fast food and snacks, not as structured meals. This observation is consistent with what Emerson described as ‘functional eating’.33 This trend was confirmed by food-service-industry operators and key informants. The largest food component of food service is now low-priced, quickly served foods, not meals.34It is not surprising, therefore, that takeaway and fast-food outlets make up the largest sector of the industry in Queensland. The cafe-restaurant sector is next largest. However, results from a Brisbane study show most cafes and restaurants also sell takeaway food.’ Likelihood o compliance with the Australian dietary f guidelines Three issues influencing compliance with the Australian dietary guidelines emerged from this study. 1. There seems to be an inverse relationship between use of prepared foods and compliance with the dietary guidelines. 2. Choices available to the consumer are determined by a dynamic interaction between the consumers of food-service-industry-prepared foods and operators. Results from the operator’s survey and key informant interviews show that operators respond to consumer demands while also attempting to fashion consumer food choice. The choice of foods offered by food-service-industry operators is driven out of economic necessity, not concern for nutrition. Therefore, the ability of consumers to make healthy choices is limited to those that coincidentally improve business for the operator. This is reinforced by the actions of some operators who offer services other than food. The major attractions of many food-service-industry venues are entertainment, poker machines and sport, not food. 3. The success of public health nutrition education programs will be limited if supportive environmental changes are not made to the food-serviceindustry food supply. The thrust of public health nutrition policy in the past has focused on nutrition education, but the effectiveness of this in initiating dietary change in the population without corresponding structural changes has been quest i ~ n e d Continuing nutrition education pro. ~ ~ ~ ~ grams have resulted in increased consumer NO. AUSTRALIAN AND NEW ZEALAND JOURNAL O PUBLIC HEALTH 1997 vot. 21 F FOOD-SERVICE INDUSTRY AND CHANGE knowledge about associations between nutrition and chronic disease. This knowledge has resulted in some behaviour change, but these changes appear to be in the types of foods selected and the way they are prepared at home only. There has been little behaviour change in the food-service sector. The results of this study show that the motivation driving operators’ selection of menu relates to taste, palatability and increasing costs. As a consequence, operators attempt to define food quality in those terms. In addition, ‘safe, clean food’ seems to be a marketable feature, especially for the larger operators: key informants identified food safety as an issue. This is consistent with the incidence of food poisoning in Queensland having increased dramatically over recent years.36 contrast, consumer conBy cerns about food quality have focused more on nutrition, additives and contamir~ants.~’-~~ Changes to the food supply can be achieved through policy and programs directed at food-service operators and staff. The major influences on the choice of foods operators offer were a mixture of their own perceptions and the demands of their customers. Government intervention was not seen as a barrier to improvement of trade by most operators interviewed. If programs directed at food-service operators aim at improving food quality as defined by the operators (taste, appearance, palatability), then aspects of food quality as defined by those in public health nutrition (food safety, nutritional quality) and by consumers (nutrition, additives and contaminants) could also be addressed. The most desirable means of doing this is through an integrated form of training and/or business accreditation for operators in the food-service industry. Already there have been programs and projects aimed at improving the food-service industry’s compliance with dietary guidelines elsewhere in A u ~ t r a l i aMost of these programs have involved .~~ local government, media coverage and rewards and training for food-service-industry operators. The food-service industry is a rapidly expanding industry and, accordingly, deserves more attention from public health nutrition professionals than it has received in the past. To achieve dietary guideline recommendations, nutrition education programs need to be supported across sectors to encourage changes in the supply of food-service-industry-prepared foods. An effective means of modifymg the food supply is to encourage food suppliers in a way that addresses their core business concerns simultaneously with the goals of health professionals.

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Aug 1, 1997

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