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Cognitive Factors Associated with Frequency of Eating Out and Eating Takeout among Latinas

Open AccessPublished:October 04, 2020DOI:https://doi.org/10.1016/j.jand.2020.08.089

      Abstract

      Higher frequency of eating outside the home can be an unhealthy behavior that may contribute to higher rates of obesity among Latinas, a disproportionately affected group. There is a growing need to understand potentially modifiable factors (eg, dispositional mindfulness, self-efficacy, nutrition knowledge) associated with higher frequency of eating outside the home in this population. This study assessed associations of cognitive factors (ie, dispositional mindfulness, self-efficacy of eating and purchasing healthy foods, nutrition knowledge) with frequency of eating out among Latinas. A secondary analysis was performed of data from a cross-sectional study of Latinas between February and May 2015. The study comprised a convenience sample of 218 Spanish- or English-literate Latinas, between the ages of 18 and 55 years, who lived in South or East Los Angeles and self-identified as the primary person responsible for grocery shopping in the household. Most participants identified as foreign-born Mexican Americans. Frequency of eating out was assessed as the outcome variable, and three cognitive variables (mindfulness disposition, self-efficacy, nutrition knowledge) served as independent variables. Multinomial models assessed the association between cognitive factors and frequency of eating out. Models were adjusted for age, English-speaking ability, income, having an obesity-related disease (ie, overweight or obesity, diabetes, high blood pressure, cardiovascular disease), household size, and education level. For every 1-unit increase in mindfulness disposition, the risk of a participant eating out every week compared with every month decreased by a factor of 0.42 (relative risk ratio [RRR] = 0.58, P < 0.01). For every 1-unit increase in self-efficacy, the risk of a participant eating out every week compared with every month decreased by a factor of 0.32 (RRR = 0.68, P < 0.05), and the risk of a participant eating out every 2 weeks compared with every month decreased by a factor of 0.44 (RRR = 0.56, P < 0.05). For every 1-unit increase in nutrition knowledge, the risk of a participant eating out every week compared with every month increased by a factor of 1.42 (RRR = 1.42, P < 0.01). Lower dispositional mindfulness was associated with higher frequency of eating out when comparing individuals who ate out at least every week with those who ate out once a month or less or every 2 weeks. Lower self-efficacy was associated with eating out more when comparing those who ate out once a month or less with those who ate out at least every week or every 2 weeks. Lower nutrition knowledge was associated with lower frequency of eating out for participants who ate out once a month or less compared with those who ate out at least every week.

      Keywords

      Research Question: Are mindfulness disposition, self-efficacy, and nutrition knowledge associated with frequency of eating out and eating takeout among Latinas?
      Key Findings: This cross-sectional observational study enrolled 218 Latinas recruited from Head Start programs and churches in Los Angeles, California. Multinomial models were used to compute relative risk ratios (RRR). For every 1-unit increase in mindfulness disposition, the risk of a participant eating out every week compared with every month decreased by a factor of 0.42 (RRR = 0.58, P < 0.01). For every 1-unit increase in self-efficacy, the risk of a participant eating out every week compared with every month decreased by a factor of 0.32 (RRR = 0.68, P < 0.05) and the risk of a participant eating out every 2 weeks compared with every month decreased by a factor of 0.44 (RRR = 0.56, P < 0.05). For every 1-unit increase in nutrition knowledge, the risk of a participant eating out every week compared with every month increased by a factor of 1.42 (RRR = 1.42, P < 0.01).
      Obesity is a major public health problem among Latinos, who constitute more than 18% of the US population and are the largest minority group in the United States.
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      Mexican Americans, the largest US Latino group, have among the highest rates of obesity, especially among women. Between 2013 and 2016, age-adjusted estimates of overweight or obesity among women older than 20 years were 64.6% for non-Latina Whites, 78.8% for Latinas, and 84.5% for Mexican Americans.
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      The impact of restaurant consumption among US adults: Effects on energy and nutrient intakes.
      which may have negative consequences for health status if consumed excessively.
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      Consequently, the frequency of eating out has been linked to adverse health outcomes such as prehypertension or hypertension
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      and a higher prevalence of overweight and obesity.
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      Fast-food consumption and obesity among Michigan adults.
      Frequency of fast food consumption among Latinas remains underexplored.
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      Social cognitive theory (SCT) emphasizes the important role of cognitive processes in behavior.
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      In SCT, a person weighs cognitive, social, and environmental factors before motivation turns into action. Cognitive processing requires individuals to draw on their state of knowledge to be aware of a behavior and have a sense of self-efficacy to perform the behavior.
      • Bandura A.
      Human agency in social cognitive theory.
      Studies of primarily non-Latino samples have found cognitive factors (eg, mindfulness, self-efficacy) to be associated with food consumption behaviors (eg, emotional eating, overeating, preparing meals at home, percentage of calories from nutritious foods).
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      • Wojcik J.R.
      Self-regulation, self-efficacy, outcome expectations, and social support: Social cognitive theory and nutrition behavior.
      Dispositional mindfulness is considered an individual capacity characterized by a focused, nonevaluative attention to and awareness of current events.
      • Brown K.W.
      • Ryan R.M.
      The benefits of being present: Mindfulness and its role in psychological well-being.
      ,
      • Baer R.A.
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      • Hopkins J.
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      • Toney L.
      Using self-report assessment methods to explore facets of mindfulness.
      A systematic review found that dispositional mindfulness is associated with lower disordered eating.
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      • Jones L.
      Dispositional mindfulness and psychological health: A systematic review.
      Self-efficacy may be another important cognitive factor associated with frequency of eating out, including an association with healthier food choices.
      • Morin P.
      • Demers K.
      • Turcotte S.
      • Mongeau L.
      Association between perceived self-efficacy related to meal management and food coping strategies among working parents with preschool children.
      ,
      • Anderson E.S.
      • Winett R.A.
      • Wojcik J.R.
      Self-regulation, self-efficacy, outcome expectations, and social support: Social cognitive theory and nutrition behavior.
      ,
      • Fitzgerald A.
      • Heary C.
      • Kelly C.
      • Nixon E.
      • Shevlin M.
      Self-efficacy for healthy eating and peer support for unhealthy eating are associated with adolescents’ food intake patterns.
      Self-efficacy of meal management (eg, meal planning, choosing healthy and nutritious foods at the grocery store, cooking for the family) may be associated with healthier home-based food behaviors.
      • Morin P.
      • Demers K.
      • Turcotte S.
      • Mongeau L.
      Association between perceived self-efficacy related to meal management and food coping strategies among working parents with preschool children.
      The literature on associations between nutrition knowledge and healthy food consumption behaviors
      • Spronk I.
      • Kullen C.
      • Burdon C.
      • O’Connor H.
      Relationship between nutrition knowledge and dietary intake.
      has yielded conflicting findings. These associations may depend on various factors (eg, group studied, nutrition knowledge assessment tool used, diet-related outcomes examined).
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      The benefits of being present: Mindfulness and its role in psychological well-being.
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      • Spronk I.
      • Kullen C.
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      Relationship between nutrition knowledge and dietary intake.
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      • Vasconcelos S.M.
      • Correia L.O.
      • Ferreira R.C.
      Nutrition knowledge assessment studies in adults: A systematic review.
      More work is needed to assess the relationship between cognitive factors and frequency of eating out among Latinas.
      This study used baseline data from a convenience sample of Latina adults. Participants were primarily of Mexican American heritage and recruited from environments with lower access to healthy foods and high access to unhealthy food options.
      • Kipke M.D.
      • Iverson E.
      • Moore D.
      • et al.
      Food and park environments: Neighborhood-level risks for childhood obesity in east Los Angeles.
      ,
      • Lewis L.B.
      • Sloane D.C.
      • Nascimento L.M.
      • et al.
      African Americans’ access to healthy food options in South Los Angeles restaurants.
      In the context of upstream factors that limit healthy food availability, individual factors were explored that may be associated with frequency of eating out. This study sought to address a gap in the literature by investigating whether potentially modifiable cognitive factors of dispositional mindfulness, self-efficacy, and nutrition knowledge are associated with frequency of eating out among participants. In this paper, frequency of eating out includes frequency of eating takeout.
      The study’s hypotheses included the following: (1) Lower mindfulness will be associated with higher frequency of eating out; (2) Lower self-efficacy related to eating and purchasing healthy foods will be associated with higher frequency of eating out; and (3) Lower nutrition knowledge will be associated with higher frequency of eating out.

      Methods

      Data

      Dataset

      This study involved secondary analyses of cross-sectional data from baseline surveys completed by Latinas in South and East Los Angeles.
      • Amaro H.
      • Cortes D.E.
      • Garcia S.
      • Duan L.
      • Black D.S.
      Video-based grocery shopping intervention effect on purchasing behaviors among Latina shoppers.
      The parent study employed convenience sampling to recruit adult women who are the food-shopping gatekeepers in the household. Participants were sampled from two communities with a high proportion of lower-income Mexican American households,
      • Kipke M.D.
      • Iverson E.
      • Moore D.
      • et al.
      Food and park environments: Neighborhood-level risks for childhood obesity in east Los Angeles.
      lower access to grocery stores, and a high density of fast-food restaurants.
      • Kipke M.D.
      • Iverson E.
      • Moore D.
      • et al.
      Food and park environments: Neighborhood-level risks for childhood obesity in east Los Angeles.
      ,
      • Lewis L.B.
      • Sloane D.C.
      • Nascimento L.M.
      • et al.
      African Americans’ access to healthy food options in South Los Angeles restaurants.
      The study was deemed exempt by the [blinded for review] Institutional Review Board. Participants in the parent study provided verbal consent, and the study protocol received review board approval.

      Procedures

      From February to May 2015, women were recruited from Head Start programs via Head Start program directors and from churches via recruitment presentations during Sunday services. Eligibility criteria included being Spanish- or English-literate Latinas, between the ages of 18 and 55 years, living in South or East Los Angeles, and self-identifying as the primary person responsible for household grocery shopping. Potential participants were screened via phone, and those who met study criteria were invited to participate in a nutritional video intervention.
      • Amaro H.
      • Cortes D.E.
      • Garcia S.
      • Duan L.
      • Black D.S.
      Video-based grocery shopping intervention effect on purchasing behaviors among Latina shoppers.
      Eligible participants were notified of the location, date, and time of the study, during which a bilingual–bicultural staff member orally administered paper-and-pencil surveys to 218 participants in their preferred language before the intervention. Analyses for the current paper were based on baseline data collected before the intervention from the convenience sample of participants of the parent study, and thus intervention effects are not relevant to this paper. Results on intervention effects were reported in a previous publication.
      • Amaro H.
      • Cortes D.E.
      • Garcia S.
      • Duan L.
      • Black D.S.
      Video-based grocery shopping intervention effect on purchasing behaviors among Latina shoppers.

      Variables

      The dependent variable was frequency of eating out: “On average, how many times a week does your family eat out or eat takeout?” Items were measured on a 6-point scale: (1) every day, (2) a few times a week, (3) every week, (4) every two weeks, (5) once a month, and (6) less than monthly. Because of few responses, “every day,” “a few times a week,” and “every week” were collapsed to create “at least every week.” Responses of “once a month” and “less than monthly” were collapsed to create “once a month or less.” Next, responses were reverse coded, so that higher values reflected greater frequency of eating out. The final outcome variable was coded as (1) once a month or less, (2) every two weeks, and (3) at least every week. Response categories were informed by past work indicating lower frequency of eating out among lower-income populations
      • Zagorsky J.L.
      • Smith P.K.
      The association between socioeconomic status and adult fast-food consumption in the U.S.
      and accounted for potentially varying levels of eating out based on acculturation.
      • Ayala G.X.
      • Baquero B.
      • Klinger S.
      A systematic review of the relationship between acculturation and diet among Latinos in the United States: Implications for future research.
      Cognitive factors were explored to determine their association with frequency of eating out. The mindfulness construct was measured using the Mindfulness Attention Awareness Scale,
      • Carlson L.E.
      • Brown K.W.
      Validation of the Mindful Attention Awareness Scale in a cancer population.
      which has psychometric validation.
      • MacKillop J.
      • Anderson E.J.
      Further psychometric validation of the Mindful Attention Awareness Scale (MAAS).
      Internal reliability in this sample was 0.91, reflecting high internal consistency. The 15-item scale measures a participant’s receptive state of mind, using Likert-style questions with response options ranging from 1 (almost always) to 6 (almost never). Mean scores were computed, wherein higher scores indicated higher levels of dispositional mindfulness. Example items are: “I break or spill things because of carelessness, not paying attention, or thinking of something else” and “I snack without being aware that I’m eating.”
      The second cognitive variable was self-efficacy of healthy food consumption and purchasing behaviors measured with the Self-Efficacy of Eating and Purchasing Healthy Foods Scale.
      • Pawlak R.
      • Colby S.
      Benefits, barriers, self-efficacy and knowledge regarding healthy foods: Perception of African Americans living in eastern North Carolina.
      This variable featured 24 items, with responses ranging from 1 (not at all confident) to 5 (very confident). The overall scale internal reliability was 0.91, reflecting high internal reliability. Mean scores were computed, with higher scores indicating higher self-efficacy to eat and purchase healthy foods.
      The last cognitive variable was nutrition knowledge, measured using five true-or-false questions assessing knowledge of MyPlate recommendations outlined in Dietary Guidelines for Americans 2015.
      U.S. Department of Agriculture. MyPlate. 2015.
      Selected nutrition knowledge questions were used in previous studies
      • Amaro H.
      • Cortes D.E.
      • Garcia S.
      • Duan L.
      • Black D.S.
      Video-based grocery shopping intervention effect on purchasing behaviors among Latina shoppers.
      ,

      Cortés DE, Vega R, Domínguez D. Improving food purchasing selection among Spanish-speaking Hispanic families. Poster presented at: 142nd Annual Meeting of the American Public Health Association, November 19, 2014, New Orleans, LA.

      to assess nutrition knowledge among Spanish-speaking women. Items were: (a) When shopping for grains, it is better to choose whole-wheat grains; (b) Frozen vegetables are not included in the MyPlate Method; (c) Fish, meat, and chicken can be included in the protein section of the MyPlate Method; (d) Pasta and bread can be included in the grains section of the MyPlate Method; and (e) Yogurt, cheese, and butter can be included in the dairy section of the MyPlate Method. Correct answers were summed, creating scores ranging from 0 to 5. Higher scores indicated higher nutrition knowledge.
      Covariates included household income, educational attainment, English-speaking ability, having an obesity-related disease (ie, diabetes, obese or overweight, heart disease, high blood pressure), household size, and age. Income was assessed by asking, “What is the monthly income for your household?” Response options were (1) less than $500; (2) $500–$700; (3) $701–$900; (4) $901–$1,100; (5) $1,101–$1,300; (6) $1,301–$1,500; and (7) more than $1,500. Education level was a dichotomous variable (0 = less than high school diploma, 1 = high school diploma or higher). Language ability was assessed by asking participants, “Do you speak: (1) only Spanish; (2) mostly Spanish; (3) both English and Spanish; (4) mostly English; and (5) only English?” To capture language ability, responses were collapsed into Spanish-dominant (responses of “only Spanish” or “mostly Spanish”; coded as 0) and English-speaking ability (responses of “both English and Spanish,” “mostly English,” or “only English”; coded as 1). Having an obesity-related disease was captured by asking, “Has anyone in your family been told by a doctor that they: (a) have diabetes; (b) are obese or overweight; (c) have heart disease; (d) have high blood pressure? Circle all that apply.” Participants were then asked to indicate who in their family had an obesity-related disease. Responses for self were tabulated (0 = respondent does not have an obesity-related disease, and 1 = respondent has at least one obesity-related disease). Household size was determined by asking, “How many people live in your house, including you?” Numeric responses were provided by participants. Age was collected by asking participants to write down their age in years.

      Statistical Analysis

      All analyses were conducted using Stata software (Version 15.1, 2017, StataCorp, College Station, TX).
      Variables were screened for extreme values. Higher outliers identified in the covariate household size were within the possible range and kept in the analyses because it is common to have a multifamily structure in one household. Variance inflation factor and tolerance values were computed to verify no signs of potential multicollinearity between independent variables and covariates in the models. Means and standard deviations (mean ± SD) of participant characteristics were calculated. Associations between frequency of eating out response categories and participant characteristics were tested using nonparametric Kruskal-Wallis tests for continuous variables and χ2 tests for categorical variables. Missing data were handled using multiple imputation by chained equations with 20 iterations. Data were imputed for variables with <1% to 16% of missing data. Ordinal logistic regression was not used because the proportional odds assumption for ordered logit models was not met. To assess the association between cognitive factors and frequency of eating out, multinomial logistic regressions models were computed to estimate relative risk ratios (RRR) for each cognitive factor, controlling for individual factors. The mlogit command that produces RRR in Stata is appropriate for cross-sectional data.
      • Long J.S.
      • Freese J.
      Regression Models for Categorical Dependent Variables Using Stata.
      RRR represents the ratio of the probability a participant selected an outcome category (eg, at least every week, every 2 weeks) over the probability of choosing the referent category (eg, once a month or less). Supplemental analysis in which models were recoded with a referent group of “every 2 weeks” were conducted to capture all possible pairwise comparisons. An example of the computed model is as follows.
      In(P(Frequencyofeatingout=Atleasteveryweek)P(Frequencyofeatingout=Onceamonthorless))=α+b1(cognitivefactor)+b2(income)+b3(highschooldiplomaorgreater)+b4(Englishspeakingability)+b5(obesityrelateddisease)+b6(householdsize)+b7(age)


      In this equation, cognitive factor represents the variables of dispositional mindfulness, self-efficacy, and nutrition knowledge, which were run separately in the models.
      For all tests, a two-tailed value of P < 0.05 was considered statistically significant. Pooled estimates of 20 imputed datasets and robust standard errors are reported. Analyses were conducted on both original and imputed data to ensure that significant findings did not differ.

      Results

      Ninety-nine women (45%) reported eating out weekly or more, 38 participants (17%) reported eating out every 2 weeks, and 75 participants (34%) reported eating out once a month or less. The average age of participants was 39.3 ± 10 years. Many participants were born in Mexico (61%) and predominantly spoke Spanish (67%). Participants’ age varied significantly by frequency of eating out. Table 1 presents the sample characteristics of 218 Latinas reported by frequency of eating out.
      Table 1Characteristics by frequency of eating out or eating takeout in a convenience sample of 218 Latinas from Los Angeles, CA
      Results reflect two-tailed significance test from Kruskal-Wallis and χ2 tests.
      Sample total (N = 218)Once a month or less (n = 75)Every 2 weeks (n = 38)At least every week (n = 99)χ2 (P)
      Language,
      Language was coded as 0 for Spanish dominant (responses of “only Spanish” or “mostly Spanish”); and 1 for English-speaking ability (responses of “both English and Spanish,” “mostly English,” or “only English”).
      n (%)
      3.87 (0.15)
       Only Spanish or mostly Spanish146 (67.0)52 (69.3)29 (76.3)59 (59.6)
       English speaking ability70 (32.1)22 (29.3)9 (23.7)39 (39.4)
       Missing2 (1)1 (1.4)01 (1)
      Education,
      Education coded as (0) less than high school diploma or (1) high school diploma or GED or higher.
      n (%)
      4.13 (0.13)
       Less than high school diploma100 (45.9)41 (54.7)14 (36.8)40 (40.4)
       High school diploma115 (52.3)34 (45.3)23 (60.5)57 (57.6)
       Missing3 (1.4)01 (2.6)1 (1)
      Monthly household income, n (%)5.55 (0.06)
       Less than $50021 (9.6)9 (12.0)1 (2.6)10 (10.1)
       $500–$70019 (8.7)10 (13.3)6 (15.8)3 (3.0)
       $701–$90016 (7.3)7 (9.3)2 (5.2)6 (6.1)
       $901–$1,10029 (13.3)14 (18.7)5 (13.2)10 (10.1)
       $1,101–$1,30024 (11.0)7 (9.3)5 (13.2)10 (10.1)
       $1,301–$1,50024 (11.0)7 (9.3)5 (13.2)12 (12.1)
       More than $1,50050 (22.9)17 (22.7)7 (18.4)28 (28.3)
       Missing35 (16.1)6 (8.0)7 (18.4)20 (20.2)
      Place of birth,
      Place of birth coded as (0) foreign born or (1) US born.
      n (%)
      1.83 (0.40)
       United States39 (17.9)11 (14.7)6 (15.8)22 (22.2)
       Mexico133 (61.0)44 (58.7)27 (71.1)59 (59.6)
       El Salvador27 (12.4)12 (16.0)4 (10.5)10 (10.1)
       Guatemala13 (6.0)6 (8.0)1 (2.6)4 (4.0)
       Honduras3 (1.4)1 (1.3)02 (2.0)
       Peru1 (< 1)001 (1.0)
       Missing2 (1)1 (1.3)03 (3.0)
      Age (years), mean ± SD39.3 ± 9.9840.9 ± 9.9845.8 ± 9.639.1 ± 9.67.02 (0.03)
       Missing1 (0.47)01 (2.6)0
      Household size, n (%)4.49 (1.7)4.3(1.5)4.4 (1.9)4.7 (1.8)4.18 (0.12)
       Missing0000
      Having an obesity-related disease, n (%)62 (28.4)26 (34.7)8 (21.1)28 (28.3)3.4 (0.18)
      No obesity-related disease, n (%)148 (67.9)43 (57.3)30 (78.9)69 (69.7)
       Missing8 (3.7)6 (8)02 (2.0)
      Mindfulness,
      Mindfulness Attention Awareness Scale,31 with 16 items and responses ranging from 1 (almost always) to 6 (almost never). Mean scores were computed. Higher scores indicated higher levels of dispositional mindfulness.
      mean ± SD
      4.6 ± 1.064.8 ± 0.954.86 ± 0.774.3 ± 1.188.34 (0.02)
       Missing1 (< 1)001 (< 1)
      Self-efficacy,
      Self-Efficacy of Eating and Purchasing Healthy Foods Scale,33 with 24 items and responses ranging from 1 (not at all confident) to 5 (very confident). Mean scores were computed. Higher scores reflect higher self-efficacy.
      mean ± SD
      3.5 ± 0.693.6 ± 0.673.4 ± 0.623.4 ± 0.715.82 (0.05)
       Missing1 (< 1)1 (< 1)00
      Nutrition knowledge,
      Nutrition knowledge was measured by five true-or-false questions related to US Department of Agriculture MyPlate guidelines. Correct responses were summed, with higher scores indicating higher nutrition knowledge.
      mean ± SD
      3.6 ± 1.083.5 ± 1.103.7 ± 1.053.9 ± 1.076.94 (0.03)
       Missing1 (< 1)001 (< 1)
      a Results reflect two-tailed significance test from Kruskal-Wallis and χ2 tests.
      b Language was coded as 0 for Spanish dominant (responses of “only Spanish” or “mostly Spanish”); and 1 for English-speaking ability (responses of “both English and Spanish,” “mostly English,” or “only English”).
      c Education coded as (0) less than high school diploma or (1) high school diploma or GED or higher.
      d Place of birth coded as (0) foreign born or (1) US born.
      e Mindfulness Attention Awareness Scale,
      • Carlson L.E.
      • Brown K.W.
      Validation of the Mindful Attention Awareness Scale in a cancer population.
      with 16 items and responses ranging from 1 (almost always) to 6 (almost never). Mean scores were computed. Higher scores indicated higher levels of dispositional mindfulness.
      f Self-Efficacy of Eating and Purchasing Healthy Foods Scale,
      • Pawlak R.
      • Colby S.
      Benefits, barriers, self-efficacy and knowledge regarding healthy foods: Perception of African Americans living in eastern North Carolina.
      with 24 items and responses ranging from 1 (not at all confident) to 5 (very confident). Mean scores were computed. Higher scores reflect higher self-efficacy.
      g Nutrition knowledge was measured by five true-or-false questions related to US Department of Agriculture MyPlate guidelines. Correct responses were summed, with higher scores indicating higher nutrition knowledge.
      For every 1-unit increase in mindfulness disposition, the risk of a participant eating out at least every week compared with every month decreased by a factor of 0.42 (RRR = 0.58, P < 0.01), whereas the risk of a participant eating out every 2 weeks compared with every month did not significantly differ (RRR = 1.00, P = 0.99). For every 1-unit increase in mindfulness disposition, the risk of a participant eating out at least every week compared with every 2 weeks decreased by a factor of 0.42 (RRR = 0.58, P < 0.05). In other words, when compared with those who ate out once a month or less, the risk of eating out at least every week decreased as mindfulness disposition scores increased. When compared with those who ate out every 2 weeks, the risk of eating out at least every week decreased as mindfulness disposition scores increased.
      For every 1-unit increase in self-efficacy, the risk of a participant eating out every week compared with every month decreased by a factor of 0.32 (RRR = 0.68, P < 0.05), and the risk of a participant eating out every 2 weeks compared with every month decreased by a factor of 0.44 (RRR = 0.56, P < 0.05). For every 1-unit increase in self-efficacy, the risk of a participant eating out at least once a week compared with every 2 weeks did not significantly differ (RRR = 1.20, P = 0.35). When compared with those who ate out once a month or less, the risk of eating out every 2 weeks and the risk of eating out once a month or less decreased as self-efficacy increased.
      For every 1-unit increase in nutrition knowledge, the risk of a participant eating out every week compared with every month increased by a factor of 1.42 (RRR = 1.42, P < 0.01), whereas the risk of a participant eating out every 2 weeks compared with every month did not significantly differ (RRR = 1.16, P = 0.44). For every 1-unit increase in nutrition knowledge, the risk of a participant eating out at least every week compared with participants eating out every 2 weeks did not significantly differ (RRR = 1.23, P = 0.30). In other words, when compared with those who ate out once a month or less, the risk of eating out at least every week increased as nutrition knowledge scores increased.
      Table 2 shows results of multinomial logistic regressions testing associations between cognitive variables and frequency of eating out after controlling for demographic characteristics, with “once a month” as the referent group.
      Table 2Associations between cognitive factors and frequency of eating out or eating takeout in a convenience sample of 218 Latinas from Los Angeles, CA
      Results reflect two-tailed significance test values from multinomial logistic regressions.
      OutcomeMindfulness
      Mindfulness Attention Awareness Scale,31 with 16 items and responses ranging from 1 (almost always) to 6 (almost never). Mean scores were computed. Higher scores indicated higher levels of dispositional mindfulness.
      Self-efficacy
      Self-Efficacy of Eating and Purchasing Healthy Foods Scale,33 with 24 items and responses ranging from 1 (not at all confident) to 5 (very confident). Mean scores were computed. Higher scores reflect higher self-efficacy.
      Nutrition knowledge
      Nutrition knowledge was measured by five true-or-false questions related to US Department of Agriculture MyPlate guidelines, with higher scores indicating higher nutrition knowledge.
      RRR
      Relative risk ratio (relative risk of a participant choosing the category compared with the referent category).
      (95% CI)
      RRR
      Relative risk ratio (relative risk of a participant choosing the category compared with the referent category).
      (95% CI)
      RRR
      Relative risk ratio (relative risk of a participant choosing the category compared with the referent category).
      (95% CI)
      Frequency of eating out
      Models of the association between cognitive factors (ie, mindfulness, self-efficacy, nutrition knowledge) and frequency of eating out were adjusted for age, English-speaking ability, income, having an obesity-related disease (ie, overweight or obesity, diabetes, high blood pressure, cardiovascular disease), household size, and education level.
       Once a month or lessReferentReferentReferent
       Every 2 weeks1.00 (0.62, 1.62)0.56
      P < 0.05.
      (0.35, 0.89)
      1.16 (0.78, 1.71)
       At least once a week0.58
      P < 0.01.
      (0.40, 0.83)
      0.68
      P < 0.05.
      (0.47, 0.98)
      1.42
      P < 0.05.
      (1.03, 1.98)
      a Results reflect two-tailed significance test values from multinomial logistic regressions.
      b Mindfulness Attention Awareness Scale,
      • Carlson L.E.
      • Brown K.W.
      Validation of the Mindful Attention Awareness Scale in a cancer population.
      with 16 items and responses ranging from 1 (almost always) to 6 (almost never). Mean scores were computed. Higher scores indicated higher levels of dispositional mindfulness.
      c Self-Efficacy of Eating and Purchasing Healthy Foods Scale,
      • Pawlak R.
      • Colby S.
      Benefits, barriers, self-efficacy and knowledge regarding healthy foods: Perception of African Americans living in eastern North Carolina.
      with 24 items and responses ranging from 1 (not at all confident) to 5 (very confident). Mean scores were computed. Higher scores reflect higher self-efficacy.
      d Nutrition knowledge was measured by five true-or-false questions related to US Department of Agriculture MyPlate guidelines, with higher scores indicating higher nutrition knowledge.
      e Relative risk ratio (relative risk of a participant choosing the category compared with the referent category).
      f Models of the association between cognitive factors (ie, mindfulness, self-efficacy, nutrition knowledge) and frequency of eating out were adjusted for age, English-speaking ability, income, having an obesity-related disease (ie, overweight or obesity, diabetes, high blood pressure, cardiovascular disease), household size, and education level.
      P < 0.05.
      ∗∗ P < 0.01.

      Discussion

      This is the first study known to the authors to investigate the association between cognitive factors (ie, mindfulness disposition, self-efficacy, and nutrition knowledge) and frequency of eating outside the home among Latinas. As hypothesized, lower dispositional mindfulness was associated with higher frequency of eating out when comparing individuals who ate out at least every week with those who ate out once a month or less or every 2 weeks. Lower self-efficacy was associated with eating out more often when comparing those who ate out once a month or less with those who ate out at least every week or every 2 weeks. Contrary to hypothesis 3, lower nutrition knowledge was associated with lower frequency of eating out for participants who ate out once a month or less compared with those who ate out at least every week.
      Although no identified previous studies investigated the relationship between dispositional mindfulness and eating outside the home, extant evidence indicates that mindfulness disposition is associated with healthy eating (eg, less impulsive eating, reduced caloric consumption, and healthier snack choices)
      • Jordan C.H.
      • Wang W.
      • Donatoni L.
      • Meier B.P.
      Differences I. Mindful eating: Trait and state mindfulness predict healthier eating behavior.
      and less binge and emotional eating.
      • Katterman S.N.
      • Kleinman B.M.
      • Hood M.M.
      • Nackers L.M.
      • Corsica J.A.
      Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: A systematic review.
      Furthermore, empirical support is growing regarding mindfulness-based interventions as a promising behavioral treatment for obesity-related eating behaviors,
      • O’Reilly G.A.
      • Cook L.
      • Spruijt-Metz D.
      • Black D.S.
      Mindfulness-based interventions for obesity-related eating behaviours: A literature review.
      ,
      • Katterman S.N.
      • Kleinman B.M.
      • Hood M.M.
      • Nackers L.M.
      • Corsica J.A.
      Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: A systematic review.
      with long-lasting effects.
      • Schaefer J.T.
      • Magnuson A.B.
      A review of interventions that promote eating by internal cues.
      Timmerman and Brown
      • Timmerman G.M.
      • Brown A.
      The effect of a mindful restaurant eating intervention on weight management in women.
      found that a mindful eating intervention (compared with a wait list control) among women who ate out an average of 5.6 times per week resulted in less weight gain, lower caloric intake, and lower fat intake. Promising trends also indicate that the intervention may have favorable effects on food consumption while eating out (ie, lower caloric and fat intake per restaurant visit and fewer barriers to managing intake when eating out). Finally, results are consistent with Ali and coworkers’
      • Ali Z.
      • Wong K.
      • Egan H.
      • Cook A.
      • Mantzios M.
      All you can eat buffets, obesity, mindfulness, and mindful eating: An exploratory investigation.
      finding that weekly frequency of eating at all-you-can-eat buffets was associated with lower scores on the awareness subscale of dispositional mindfulness. This study provides preliminary findings that support the importance of further investigating the association between mindfulness and frequency of eating out in randomized intervention and longitudinal studies.
      The association between lower self-efficacy of eating and purchasing healthy foods and higher frequency of eating out was in the expected direction. Past work has highlighted the important role of self-efficacy in healthy food consumption behaviors.
      • Anderson E.S.
      • Winett R.A.
      • Wojcik J.R.
      Self-regulation, self-efficacy, outcome expectations, and social support: Social cognitive theory and nutrition behavior.
      ,
      • Amaro H.
      • Cortes D.E.
      • Garcia S.
      • Duan L.
      • Black D.S.
      Video-based grocery shopping intervention effect on purchasing behaviors among Latina shoppers.
      Findings from this study are consistent with past work that found facets of self-efficacy to be associated with eating outside the home.
      • Morin P.
      • Demers K.
      • Turcotte S.
      • Mongeau L.
      Association between perceived self-efficacy related to meal management and food coping strategies among working parents with preschool children.
      A Canada-based study found low self-efficacy of meal management (ie, meal planning, choosing healthy foods in the grocery store, cooking for the family) was associated with higher fast-food consumption.
      • Morin P.
      • Demers K.
      • Turcotte S.
      • Mongeau L.
      Association between perceived self-efficacy related to meal management and food coping strategies among working parents with preschool children.
      Future work that explores the role of self-efficacy in frequency of eating outside the home with longitudinal data should investigate which aspects of self-efficacy (eg, meal management vs eating and purchasing healthy foods) are most strongly associated with food consumption behavior.
      Among the women in this sample, results show those with lower nutrition knowledge were more likely to eat out less than monthly compared with every week or more. Findings were significant in the opposite direction of that hypothesized. Despite nutritional programming implemented at Head Start programs, from which part of the sample was recruited, lower nutrition knowledge was significantly associated with lower frequency of eating out after controlling for individual variables. Possibly nutrition knowledge ineffectively affects healthy food consumption behavior in communities with powerful structural influences such as high density of fast food exposure.
      • Moore L.V.
      • Diez Roux A.V.
      • Nettleton J.A.
      • Jacobs D.R.
      • Franco M.
      Fast-food consumption, diet quality, and neighborhood exposure to fast food: The multi-ethnic study of atherosclerosis.
      Some literature has documented inconsistent findings when examining the association of nutrition knowledge with dietary intake
      • Spronk I.
      • Kullen C.
      • Burdon C.
      • O’Connor H.
      Relationship between nutrition knowledge and dietary intake.
      and body mass index (BMI).
      • Barbosa L.B.
      • Vasconcelos S.M.
      • Correia L.O.
      • Ferreira R.C.
      Nutrition knowledge assessment studies in adults: A systematic review.
      For example, one study found higher nutrition knowledge to be associated with higher BMI.
      • Barbosa L.B.
      • Vasconcelos S.M.
      • Correia L.O.
      • Ferreira R.C.
      Nutrition knowledge assessment studies in adults: A systematic review.
      Similarly, this study found lower nutrition knowledge to be associated with lower frequency of eating out. Future studies among similar populations also should examine diet quality and quantity to better understand the effect of nutrition knowledge on food consumption behavior.
      SCT’s concept of reciprocal determinism—the interaction among personal factors, environmental factors, and behavior—has been underused in studies seeking to understand food consumption behavior. This study sought to understand cognitive factors associated with frequency of eating out by selecting individuals from similar geographic and food environments while controlling for personal characteristics. Possibly unmeasured environmental (eg, density of fast food options) or individual (eg, food preference) factors were more highly influential for women in this sample than cognitive variables measured in this study. Future studies exploring food consumption behaviors should consider the interaction between environmental and personal factors (eg, cognitive) that motivate behavior.

      Strengths and Limitations

      This study focused on Spanish- and English-fluent adult Latinas responsible for household food purchasing who were recruited via community organizations (ie, churches, Head Start programs), yielding participants with primarily low household incomes. Study strengths include pencil-and-paper surveys delivered orally by a bicultural and bilingual staff to increase understanding of survey questions. Food opportunities in communities represented in this study extend beyond fast-food options and include mobile food trucks and street vendors. The wording of the dependent variable question captured nontraditional food establishments (eg, food trucks, food stands).
      The study has some limitations. The dependent variable, frequency of eating out, was self-reported and did not distinguish between fast-food or healthier options or quality of foods consumed. Possibly some participants who reported eating out more frequently chose healthier options at fast-food chains or dine-out restaurants. Although dining out is associated with bigger portion sizes,
      • Lachat C.
      • Nago E.
      • Verstraeten R.
      • Roberfroid D.
      • Van Camp J.
      • Kolsteren P.
      Eating out of home and its association with dietary intake: a systematic review of the evidence.
      a measure of diet quality while eating out would have provided a more objective indication of unhealthy food consumption behavior. Although past work conducted among ethnically diverse populations has noted that higher frequency of eating out may be a predictor of obesity,
      • Garcia G.
      • Sunil T.S.
      • Hinojosa P.
      The fast food and obesity link: Consumption patterns and severity of obesity.
      height and weight data were not collected from study participants, so BMI could not be calculated; therefore, the association between eating out and obesity among study participants could not be examined. This sample had unique community characteristics and was nonrandom. Although many indigenous languages are spoken throughout Latin American countries, this paper focused on Latinas who are literate in Spanish or English. Other limitations include the lack of potential covariates (eg, marital status and employment). Food consumption behavior outside the home is influenced by several factors not measured in this study, including individual (eg, pressure or preferences from household family members to eat out vs home-cooked meals, workplace demands, time constraints) and structural community environments (eg, neighborhood density of fast-food restaurants, availability of grocery stores),
      • Timmerman G.M.
      • Brown A.
      The effect of a mindful restaurant eating intervention on weight management in women.
      ,
      • Ali Z.
      • Wong K.
      • Egan H.
      • Cook A.
      • Mantzios M.
      All you can eat buffets, obesity, mindfulness, and mindful eating: An exploratory investigation.
      ,
      • Unger J.B.
      • Reynolds K.
      • Shakib S.
      • Spruijt-Metz D.
      • Sun P.
      • Johnson C.A.
      Acculturation, physical activity, and fast-food consumption among Asian-American and Hispanic adolescents.
      ,
      • Paeratakul S.
      • Ferdinand D.P.
      • Champagne C.M.
      • Ryan D.H.
      • Bray G.A.
      Fast-food consumption among US adults and children: Dietary and nutrient intake profile.
      which also may affect food consumptions behaviors and goals. Participants were sampled from communities defined a priori as high-risk environments characterized by an overabundance of unhealthy food venues compared with healthy food venues. Findings are likely most generalizable to populations with similar demographic profiles in communities with similar structural influences, such as disproportionately high density of fast-food venues and low availability of healthy and affordable food options. Not all study measures were validated (ie, nutrition knowledge), and validated scales used (ie, Mindfulness Attention Awareness Scale and self-efficacy of eating and purchasing healthy foods) have yet to be validated among Spanish-speaking Latinas.

      Conclusion

      Findings from this study provide a starting point to exploring cognitive factors associated with eating out among Latinas. This study found associations between lower dispositional mindfulness and higher frequency of eating out when comparing individuals who ate out at least every week with those who ate out once a month or less or every 2 weeks. Lower self-efficacy was associated with eating out more when comparing those who ate out once a month or less with those who ate out at least every week or every 2 weeks. Lower nutrition knowledge was associated with lower frequency of eating out for participants who ate out once a month or less compared with those who ate out at least every week. Cognitive factors at the individual level of influence may be more modifiable than sociocultural and structural factors influencing food consumption behaviors. Before addressing cognitive factors associated with food consumption behaviors, future studies should confirm the direction of the association between cognitive factors and frequency of eating out among Latina women of similar socioeconomic status and seek to understand the influence of cognitive factors relative to sociocultural and structural factors among Latina women in similar environments.

      Acknowledgements

      First, we thank the study participants and the funder, the Community Benefits and Sponsorship Program, Keck Medical Center, University of Southern California (grant to HA, principal investigator). We thank the following students from the University of Southern California who assisted in data collection: Maria Alejandra Heman, Edith Jaurequi, Beatriz Sosa-Prado, Lucette Sosa, and Ruth Vergara. The following community partners provided space for data collection: Fathers John Moretta and David Matz of the Los Angeles Catholic Archdiocese; Phillipa Johnson, executive director, USC School for Early Childhood Education; and Theda Douglas, vice president, USC Government Partnerships and Programs. We also thank the following individuals that provided statistical or theoretical guidance and input during early stages of the study: Dr Inna Arnaudova, Dr John Hipp, Dr Candice Odgers, Dr Annie Qu, Dr Annie Ro, Dr Mariana Sanchez and Ms Weize Wang. Eric Lindberg provided editorial services on an early draft of this manuscript. Permission was obtained from those named in the Acknowledgment.

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      Biography

      S. Garcia is a PhD Student, Department of Population Health & Disease Prevention, Program in Public Health, University of California, Irvine.
      C. Valencia is a PhD Student, Department of Population Health & Disease Prevention, Program in Public Health, University of California, Irvine.
      H. Amaro is a Distinguished University Professor and Senior Scholar on Community Health, Herbert Wertheim College of Medicine and Robert Stempel College of Public Health & Social Work, Florida International University, Brewster, MA.