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Objective: To identify how qualitative research has contributed to understanding the ways people in developed countries interpret healthy eating. Design: Bibliographic database searches identified reports of qualitative, empirical studies published in English, peer-reviewed journals since 1995. Data Analysis: Authors coded, discussed, recoded, and analyzed papers reporting qualitative research studies related to participants' interpretations of healthy eating. Results: Studies emphasized a social constructionist approach, and most used focus groups and/or individual, in-depth interviews to collect data. Study participants explained healthy eating in terms of food, food components, food production methods, physical outcomes, psychosocial outcomes, standards, personal goals, and as requiring restriction. Researchers described meanings as specific to life stages and different life experiences, such as parenting and disease onset. Identity (self-concept), social settings, resources, food availability, and conflicting considerations were themes in participants' explanations for not eating according to their ideals for healthy eating. Implications: People interpret healthy eating in complex and diverse ways that reflect their personal, social, and cultural experiences, as well as their environments. Their meanings include but are broader than the food composition and health outcomes considered by scientists. The rich descriptions and concepts generated by qualitative research can help practitioners and researchers think beyond their own experiences and be open to audience members' perspectives as they seek to promote healthy ways of eating. (Contains 4 tables.)

Objective: How work conditions relate to parents' food choice coping strategies. Design: Pilot telephone survey. Setting: City in the northeastern United States (US). Participants: Black, white, and Hispanic employed mothers (25) and fathers (25) randomly recruited from low-/moderate-income zip codes; 78% of those reached and eligible participated. Main Outcome Measures: Sociodemographic characteristics; work conditions (hours, shift, job schedule, security, satisfaction, food access); food choice coping strategies (22 behavioral items for managing food in response to work and family demands (ie, food prepared at/away from home, missing meals, individualizing meals, speeding up, planning). Analysis: Two-tailed chi-square and Fisher exact tests (P [less than or equal to] 0.05, unless noted). Results: Half or more of respondents often/sometimes used 12 of 22 food choice coping strategies. Long hours and nonstandard hours and schedules were positively associated among fathers with take-out meals, missed family meals, prepared entrees, and eating while working; and among mothers with restaurant meals, missed breakfast, and prepared entrees. Job security, satisfaction, and food access were also associated with gender-specific strategies. Conclusions and Implications: Structural work conditions among parents such as job hours, schedule, satisfaction, and food access are associated with food choice coping strategies with importance for dietary quality. Findings have implications for worksite interventions but need examination in a larger sample. (Contains 2 tables.)

Objective: The study sought to develop an understanding of how employed mothers constructed time for food provisioning for themselves and their families. Design: A grounded theory approach and semistructured, in-depth interviews. Setting: A metropolitan area of approximately 1 million people in the northeastern United States. Participants: Thirty-five low-wage employed mothers were purposively recruited to vary in occupation, race/ethnicity, education, household composition, and age using workplace, community, convenience, and snowball sampling. Phenomenon of Interest: Low-wage employed mothers' constructions of time for food. Analysis: Interview transcripts were analyzed using the constant comparative method. Results: Most mothers expressed feelings of time scarcity. Mothers described 3 timestyles that reflected how they constructed time. Timestyles reflected mothers' experiences of strain and time scarcity, usual time management strategies, and sense of control over time. Mothers prioritized feeding their children but wanted to complete meals quickly in order to move on to other tasks. Conclusions and Implications: Recognizing issues of time scarcity and individual differences of timestyles and time management strategies can help researchers better understand food choice practices and assist practitioners in identifying practical food provisioning strategies for low-wage employed mothers. Food policies and recommendations should be evaluated for their relevance to the time scarcity and work strain issues that these mothers faced. Key Words: timestyle, time scarcity, food choice (J Nutr Educ Behav. 2007;39:18-25)

Integrating their work and family lives is an everyday challenge for employed parents. Competing demands for parents' time and energy may contribute to fewer meals prepared or eaten at home and poorer nutritional quality of meals. Thus, work-family spillover (feelings, attitudes, and behaviors carried over from one role to another) is a phenomenon with implications for nutrition and health. The aim of this theory-guided constructivist research was to understand how low-wage employed parents' experiences of work-family spillover affected their food choice coping strategies. Participants were 69 black, white and Latino mothers and fathers in a Northeastern US city. We explored participants' understandings of family and work roles, spillover, and food choice strategies using open-ended qualitative interviews. Data analysis was based on the constant comparative method. These parents described affective, evaluative, and behavioral instances of work-family spillover and role overload as normative parts of everyday life and dominant influences on their food choices. They used food choice coping strategies to: (1) manage feelings of stress and fatigue, (2) reduce the time and effort for meals, (3) redefine meanings and reduce expectations for food and eating, and (4) set priorities and trade off food and eating against other family needs. Only a few parents used adaptive strategies that changed work or family conditions to reduce the experience of conflict. Most coping strategies were aimed at managing feelings and redefining meanings, and were inadequate for reducing the everyday hardships from spillover and role overload. Some coping strategies exacerbated feelings of stress. These findings have implications for family nutrition, food expenditures, nutritional self-efficacy, social connections, food assistance policy, and work place strategies. Keywords: Work-family; Food choice; Low wage; Parents; US

Objective: To understand participant-perceived outcomes of community nutrition education programs by low income adults. Design: A grounded theory approach using qualitative interviews. Setting: Rural and urban communities in New York State and Pennsylvania. Participants: 18 current and past participants in nutrition education programs for low income adults. Phenomena of Interest: Participants' perceived outcomes of community nutrition education programs. Analysis: Qualitative analysis derived from the constant comparative method. Results: Participants described program experiences in three linked thematic areas: (1) a range of motives for program enrollment; (2) current roles, challenges and resources as program contexts; and (3) participant-perceived outcomes experienced throughout the program that were linked to their motives for enrolling. Short- and medium-term outcomes, especially social outcomes, were important to participants; positive experiences were linked to later behavior change by participants, even among those who did not initially report change. Conclusions and Implications: Participant-perceived outcomes and program satisfaction were linked to enrollment motives and modified by whether participants' current worlds provided resources to put learning into practice. Participant inputs such as enrollment motives and resources should be included in planning models, assessed at multiple points, matched to expected program outcomes, and used to guide teaching. Key Words: nutrition education, program evaluation, low income adults, qualitative

Objective: Conceptual understanding of how management of food and eating is linked to life course events and experiences. Design/Setting: Individual qualitative interviews with adults in upstate New York. Participants: Fourteen men and 11 women with moderate to low incomes. Phenomenon: Food choice capacity. Analysis: Constant comparative method. Results: A conceptual model of food choice capacity emerged. Food choice capacity represented participants' confidence in meeting their standards for food and eating given their food management skills and circumstances. Standards (expectations for how participants felt they should eat) were based on life course events and experiences. Food management skills (mental and physical talents to keep food costs down and prepare meals) were sources of self-esteem for many participants. Most participants had faced challenging and changing circumstances (income, employment, social support, roles, health conditions). Participants linked strong food management skills with high levels of food choice capacity, except in the case of extreme financial circumstances or the absence of strong standards. Implications for Research and Practice: Recognizing people's experiences and perspectives in food choice is important. Characterizing food management skills as durable, adaptive resources positions them conceptually for researchers and in a way that practitioners can apply in developing programs for adults. KEY WORDS: qualitative, biographical, life course, food choice, capacity, food management, cooking, food shopping

The goal of this study was to understand dietetics and nutrition professionals' experiences of their practice roles. Qualitative interviews using a grounded theory design covered practitioners' perceptions of their professional roles, role enactment, and practice context. Twenty-four dietetics and nutrition practitioners varying in their work settings, length of professional experience, education, and community type were recruited through professional contacts in New York State. Interview transcripts were analyzed using the constant comparative method of qualitative data analysis. An ecological model of practice in context emerged in which participants described daily practice satisfactions and challenges arising out of interactions among their personal characteristics, client characteristics, the work setting, and the food and nutrition and health care systems. Practice satisfactions related to positive interactions and measurable outcomes of work with clients and coworkers, recognition for expert and helper roles, and involvement in disease prevention. Practice challenges centered on others' misunderstandings of the dietary change process, assessment of practice outcomes, others' respect for expertise, keeping up-to-date, client and coworker expectations, isolation from peers, and the food environment. An ecological model of dietetics and nutrition practice as experienced in community settings draws attention to the need to address challenges in the multiple contexts that frame that practice. J Am Diet Assoc. 2004;104:787-792.

Lower status jobs, high workloads and lack of control at work have been associated with less healthful diets, but the ways through which work is connected to food choices are not well understood. This analysis was an examination of workers' experience of the relationship of their jobs to their food choices. Fifty-one multi-ethnic, urban, low- and moderate-income adults living in Upstate New York in 1995 participated in a qualitative interview study of fruit and vegetable choices and discussed employment and food choices. The workers who participated in this study described a dynamic relationship between work and food choices that they experienced in the context of their other roles and values. These workers presented a relationship that was characterized by positive and negative spillover between their jobs and their ability to fulfill family roles and promote personal health, linked by a spectrum of food choice strategies. Participants' narratives fit into three different domains: characterizations of work and their resources for food choice, strategies used to manage food choices within the constraints of work, and affect related to the negative and positive spillover of these strategies on family roles and on personal food choices. Characterizations of work as demanding and limiting or demanding and manageable differentiated participants who experienced their food choice strategies as a source of guilt and dissatisfaction (negative spillover) from those who experienced food choices as a source of pride and satisfaction (positive spillover). Ideals and values related to food choice and health were balanced against other values for family closeness and nurturing and personal achievement. Some participants found work unproblematic. These findings direct attention to a broad conceptualization of the relationship of work to food choices in which the demands and resources of the work role are viewed as they spill over into the social and temporal context of other roles and values. Keywords: Food choice; Work; Employment roles; Family roles; United States

Objective: The study sought to develop a theoretical understanding of identities related to eating. Design: A grounded theory approach and open-ended, indepth interviews were used to examine identity and eating from the perspectives of adults. Participants: Seventeen middle-class, white adults (nine women, eight men) were purposively recruited to vary in gender, age, household composition, and ways of eating using convenience and snowball sampling. Data Analysis: Interview transcripts were analyzed using the constant comparative method Results: Identities involved in participants' food choices related to usual or preferred eating behaviors, personal traits, reference groups, and social categories. Participants varied in the number, type, and complexity of identities involved in eating. Identities were reported to be both stable and dynamic over time and were shaped by participants' life course experiences. Participants varied in the attention they paid to evaluation and monitoring of identities related to eating, the extent to which they enacted identities in eating, and how they managed identity conflicts. Implications: The concept of identity may help researchers understand food choice processes and assist practitioners in recognizing the multiple meanings that people bring to and derive from eating. Key Words: identity, food choice, health behavior, grounded theory, social influences, food behavior (J Nutr Educ Behav. 2002;34:128-139.)

This investigation examined influences on the dietary experiences among coronary heart disease patients in an intensive lifestyle heart program. This exploratory study relied on semistructured qualitative interviews performed over a 4-month data collection period. Purposeful sampling recruited 19 men and 4 women. A cross-sectional design selected participants at several time points in program participation. The Constant Comparative Method was used for analyzing the qualitative data. The study identified several types of factors that program participants reported to be influences shaping their diet change experiences. Personal factors influencing dietary change included preprogram experiences such as cardiac surgery and diet history, as well as emotional disposition, diet strategies, physical state, and views about the program, diet, and heart disease. Social relationships (immediate family, friends and relatives, and other program members) and situational contexts (eating out, job flexibility, and times of crises) also were influences. Participants reported that each of these influences either facilitated or complicated their dietary changes. These findings provide nutrition educators with information that can assist in developing personalized approaches for helping individuals who seek dietary change.

The objective of this investigation was to understand the diet change processes of participants within a program setting. A theory-oriented approach and semistructured qualitative interviews were performed over a 4-month data collection period. Nineteen men and four women at one site of an intensive heart program were purposely sampled. Participants were selected to represent several time points in program participation. The Constant Comparative Method was used for analyzing the qualitative data. The investigation produced a framework for the diet change process that included three phases: an immersion phase, a transition phase, and a resolution phase. Within each phase, participants clustered into groups based on diet adherence. Each group shared a set of specific characteristics that were associated with their dietary behavior. Trajectories of diet change occurred within the context of the program experience with participants moving from (1) Complete Acceptors to Believers to Adoptors, (2) Deprived Dieters to Contemplators to Accommodators, and (3) Deprived Dieters to Strugglers to Dropouts. The conceptual model suggested by the study may be valuable to other researchers and practitioners interested in understanding or promoting diet change.

Ethnicity is one of the many factors that play a role in food choices. This project examined how ethnicity was enacted in food choices among 86 adults in one U.S. city, purposively recruited to vary in ethnic identity (Black, Latino, White). Qualitative research methods were used to conduct semistructured depth interviews about participants' ethnic identity, food choices, and influences on food consumption. Analysis of these data produced a conceptualization of influences on food choices that spanned the different ethnic groups. Ideals, identities, and roles interacted with each other and the food and eating context in reciprocal and dynamic ways to influence food choice. Differences in ideals, identities, and roles were related to ethnic group affiliation and were most apparent during times of personal transition and in contexts highlighting contrasts. This conceptualization can enhance the ability of nutrition educators working in a multicultural society to identify. processes underlying ethnic food choices and apply this understanding to research and practice.

Objective To examine how life-course experiences and events are associated with current fruit and vegetable consumption in 3 ethnic groups. Design A theoretic model developed from previous qualitative research guided the development of a telephone survey. Data were collected on fruit and vegetable consumption, sociodemographic characteristics, ethnic identity, and life-course events and experiences, including food upbringing, social roles, food skills, dietary changes for health, and practice of food traditions. Subjects/setting Low- to moderate-income adults living in a northeastern US city were selected randomly from 3 ethnic groups: black (n=201), Hispanic (n=191), and white (n=200). Statistical analyses Bivariate and multiple linear regression analysis of associations between life-course variables and fruit and vegetable consumption. Results Black, Hispanic, and white respondents differed significantly in life-course experiences, family roles, sociodemographic characteristics, and place of birth. Explanatory models for fruit and vegetable consumption differed among ethnic groups and between fruits and vegetables. Among black respondents, a college education was positively associated with fruit consumption; education and family roles contributed most to differences in fruit ([R.sup.2] = .16) and vegetable ([R.sup.2] = .09) consumption. Among Hispanic respondents, life-course experiences such as liking fruits and vegetables in youth, making dietary changes for health, and food skills were positively associated with fruit ([R.sup.2] = .25) and vegetable ([R.sup.2] = .35) consumption. Among white respondents, sociodemographic characteristics, such as being married with a young child or single with no child and having a garden as an adult, were positively associated with fruit ([R.sup.2] = .20) and vegetable ([R.sup.2] = .22) consumption. Applications/conclusions An understanding of the determinants of food choice in different subcultural groups can be used to design effective nutrition interventions to increase fruit and vegetable consumption. Experiences such as eating fresh-picked fruits and vegetables while growing up or vegetable gardening as an adult may enhance fruit and vegetable consumption among members of some ethnic groups., Life events and experiences are hypothesized to have a long-lasting influence on food choice (1-3). The life-course perspective highlights continuity and change across the life span, through trajectories or patterns [...]

The food system is a widely used concept, but few systematic frameworks model the full scope and structure of the food and nutrition system. Bibliographic searches, a modified Delphi technique, focus groups and interviews with experts on the topic were conducted to identify existing models of agriculture, food, nutrition, health and environmental systems. These models were examined, classified and synthesized into an integrated conceptual model of the food and nutrition system. Few existing models broadly described the system and most focused on one disciplinary perspective or one segment of the system. Four major types of models were identified: food chains, food cycles, food webs and food contexts. The integrated model developed here included three subsystems (producer, consumer, nutrition) and nine stages (production, processing, distribution, acquisition, preparation, consumption, digestion, transport, metabolism). The integrated model considers the processes and transformations that occur within the system and relationships between the system and other systems in the biophysical and social environments. The integrated conceptual model of the food and nutrition system presents food and nutrition activities as part of a larger context and identifies linkages among the many disciplines that deal with the food and nutrition system. Key words - model, food, nutrition, health, agriculture, diet, systems

Diet is critical to the treatment of patients with coronary heart disease (CHD). The outcomes of diet therapy vary from patient to patient because each of them have different representations of illness, that, in turn, influence dietary behavior. Research suggests that cardiac patients' personal dietary guidelines and beliefs strongly influence long-term outcomes of diet therapy. Illness representations may vary from very rigid to flexible. Nutrition educators should use this information to develop dietary programs for cardiac patients.

This study examined sport anglers' understanding of the fish contaminant situation in Lake Ontario and their compliance with the related Health Advisory for consumption of sport-caught fish. Anglers (n = 304) completed a mail survey about their knowledge, attitudes, behavioral beliefs, and practices. Multiple regression analysis was used to develop explanatory models for four advisory compliance behaviors: (1) probability of a household's not consuming restricted fish, (2) number of fish consumed by a household, (3) probability that women of childbearing age or children in the household did not consume restricted fish, and (4) probability that recommended trimming techniques were performed when restricted fish was consumed. Knowledge, credence that concern is warranted, and beliefs about health risk were interrelated and positively associated with following the recommended practices. Beliefs about the health benefits, time, and tradition of fishing were negatively associated with advisory compliance, as was a negative perception of how the contaminant situation affected oneself and the community. Anglers were less likely to follow the advisory if they lived far from Lake Ontario, were members of an angler club, and had either low or high incomes. The results give insight into approaches to improving educational strategies to help anglers and their households reduce their exposure to contaminants in sport-caught fish.

This study sought to understand the situational nature of eating and drinking by analyzing 24-hour, nonquantitative recalls of foods and beverages consumed by 21 men and 21 women over 7 consecutive days. Participants lived in Upstate New York and worked in nonmanagerial, nonprofessional positions. They were purposively recruited to meet the employment criteria and vary in age, gender, type of occupation, and household composition. In daily recalls, interviewers asked participants to describe the time, foods, and beverages consumed; location; other people present; thoughts and feelings; activities occurring at that time; and where foods and beverages were acquired/prepared. Analysis of verbatim transcripts of interviews yielded 1448 eating and drinking episodes that were labeled with participants' exact words. Constant comparative analysis of participants' qualitative descriptions resulted in a conceptual framework for eating and drinking episodes whereby each episode was characterized according to several attributes, each having multiple dimensions. For example, time was an attribute that included the dimensions of calendar/clock time, relationship to other activities ('after work,' 'before bed'), and the perception of time ('feeling rushed,' 'killing time'). The attribute of social setting included the dimensions of people (number, relationships, and roles) and social processes ('celebrating,' 'feeding kids,' 'bonding'). Other attributes included location, activities, mental processes, physical condition, and recurrence. The findings encourage educators and researchers to view eating and drinking episodes as multifaceted situations that consist of much more than food and beverage consumption. This study was funded by USDA and NIH.

Food schemas are mental representations of foods that guide food choices. This study sought to identify categories that make up individuals' food schemas and the categories that are most salient in real-life food contexts (eg, dinner at home). Forty-two adults sorted 59 food cards 4 times, 1 time with no context (open sort) and 3 times with location, meal, time, and people specified (context specific sort). Participants labeled food sort piles using their own words. Labels were analyzed using the constant comparative method to identify food categories and food category types. Approximately 200 unique categories emerged from the data. Categories were grouped into category types by the researchers. Some category types were commonly used in all sorts (eg, frequency, meal component). Some categories were more commonly used for 'dinner at home,' demonstrating the social importance of this context (eg, foods for specific people and who food is eaten with). Other categories were used more commonly for 'lunch at work,' suggesting attention to convenience in these contexts (eg, ease/difficulty of the food).When no context was defined, nutrition-related categories such as food groups were used more frequently, suggesting that food groups may not be as salient to participants in real-life eating contexts. This is important because many nutrition education efforts focus on understanding food groups. The findings of this study suggest that understanding food schemas may be useful when developing nutrition education programs and tailored nutrition education messages. This project was funded by NIH and USDA.