Dole Food Company’s Five a Day Campaign: A Critique and a Cure – Jason Itzkowitz
A CRITIQUE OF DOLE FOOD COMPANY’S FIVE A DAY CAMPAIGN
This is a critique in response to Dole’s Five a Day Campaign which is aimed to encourage all Americans to eat a minimum of five servings of fruits and vegetables a day. This intervention began in 1991 and ended in 2003 (2). This campaign was ineffective because throughout these years, America has witnessed an increase of diseases such as heart disease and obesity. These were diseases in which Dole aimed to reduce, through its main message to encourage America to eat five to nine servings of fruits and vegetables a day (2). Dole Food Company is a founding member of this national Five a Day Campaign for better health program. Through nutritional education programs, they simply encourage children and their families to eat five to nine servings of vegetables and fruits a day. Educational materials and programs include five a day supermarket tours, Dole’s five a day website, five a day friends e-mail, and a Fun with Fruits and Vegetables Kids Cookbook (2).
Although this public health intervention is an effort to encourage healthy eating habits and decrease America’s serious obesity epidemic, it is ineffective and is flawed in many ways. First, the intervention is strictly individually based as it advocates that everyone must proactively on their own, take the initiative to eat a total of at least five servings of vegetables and fruits a day. This is far too simplistic and ignores many of the problems with enacting an intervention that is solely individually based. Second, it does not take into consideration the role of social factors that inevitably influences eating behaviors. Issues like socio-economic factors and social norms both impact diet. This study fails to acknowledge these endeavors and their impact on health. Finally, this campaign is ineffective because it is culturally incompetent and fails to consider the role of culture on diet. This campaign is consequently flawed because of these three claims. It will become quite apparent as to why in this paper.
Dole’s public health effort advocates for the individual to make the decision to eat five servings of vegetables and fruit a day. It is positive that this company raised awareness about healthy eating habits by promoting that people consume a sufficient amount of daily fruits and vegetables. However, their approach is flawed as their campaign will consequently result in a great deal of wasted time and money. To tell someone to eat their fruits and vegetables a day is far too simplistic. Diet and eating behaviors are complex conceptions. There are many factors at play that impact healthy eating habits. Everyone has their own unique lives and obstacles that may prevent them from eating a healthy diet. For example, an individual may hold such a stressful job that causes him/her to seek unhealthy candies in order to alleviate his/her anxiety. Although this person may take Dole’s health campaign seriously and evaluate the benefits of eating a minimum of five servings of vegetables and fruits a day, he/she may still not conform to the campaign’s goals because of this stressful job. In this campaign, it is up to the individual to take the initiative to enroll in Dole’s educational programs like the five a day supermarket tours. The reality is that many families and children will not get themselves to do so due to a lack of time and motivation.
Another reason why Dole’s intervention effort is flawed, due to its sole focus on the individual, is because individuals can be predictably irrational. This campaign assumes that individuals will observe their message to eat five servings of fruits and vegetables a day and will consequently make the rational decision to take on these eating behaviors due to its benefits. An individual may intend to comply with this message after perceiving that fruits and vegetables lead to weight loss and reduces the risks of certain diseases like cancer and CHD. However, because people can be irrational, this does not mean that this person will rationally make the decision to take on this novel behavior. For example, even though a person may intend to attend a five a day supermarket tour with the hope that it will encourage them to eat healthier, they may not rationally make the decision to do so. Due to the complexity of human nature, people can be irrational in this fashion. Because this campaign assumes that people are rational and will intend to follow through with their decision to consume this sufficient amount of fruits and vegetables, it is consequently flawed.
My argument declaring the ineffectiveness of this campaign due to its sole focus on the individual, leads me to my next claim which suggests Dole’s failure to consider important social factors that inevitably influence such healthy eating behaviors. Its focus on the individual overlooks the fact that behaviors like diet are made in the context of a complex ecological social environment. Socio-economic status is a higher level factor that has an impact on health behaviors and health outcomes. According to Haan et al in their study, “Poverty and Health” (1987), “Socioeconomic position is one of the most persistent and ubiquitous risk factors known. Members of lower socioeconomic groups experience higher incidence and mortality rates and poorer survival rates for most major chronic diseases” (4). It is therefore safe to say that the higher one’s socioeconomic status, the more these individuals will take on healthy behaviors like healthy diet, and the less they will experience an adverse health outcome like obesity or CHD. If “John,” the CEO of Dole, has access and money for foods like fruits and vegetables (which can sometimes be expensive), it can conveniently wind up in his house refrigerators. On the other hand, there is “Joe” who holds a minimum wage job and struggles to eat three healthy meals a day. This impoverished individual may take Dole’s campaign extremely seriously, and he may desire to eat nine servings of fruits and vegetables a day. However, due to his job that barely pays him enough money for monthly rent, he just cannot afford to eat nine servings of vegetables and fruits a day. Joe may also not be able to afford a computer which is essential for Dole’s campaign since many of its educational materials are through email and on the internet.
Another external factor is geographic location. In lower socioeconomic communities, supermarkets like Trader Joes that promote healthy eating habits and mainly sell healthy foods like fresh fruits and vegetables are simply not present. People like Joe would love to go there, but he lives in a working class neighborhood. The closest Trader Joes to him is about an hour away from him. Joe could take public transportation to this location but it would require him to change train lines and would take up too much time because he has to work every day. Also, he just cannot afford to take the train back and forth because that is money he usually relies on for his lunch. Joe, who is an advocate for the Five a Day Campaign, and desires to follow through with its message, is simply deterred from doing so. Unfortunately, Joe cannot adhere to the campaign because society’s structural forces of money, access, and geography simply restrict him from doing so. What Joe does have are three fast food joints (comprised of foods with high sodium and trans fats) within his distance so it is convenient and inexpensive for him to eat his meals. Why would he therefore put in all of that effort, time, and money to go to Trader Joes? Our friend John on the other hand, has a five minute car ride from Trader Joes which resides a few miles from his mansion on the ocean. John who believes in the Five a Day Campaign can consequently meet the intervention’s daily goals because of his location next to a supermarket that sells healthy foods and advocates for healthy eating habits. He also has the money to afford an endless amount of fruits and vegetables a day. He can also afford all of the campaign’s materials like the cookbook and a computer which allows him to participate in Dole’s website and email offers.
Although many individuals perceive the benefits of Dole’s campaign and would follow through with their intention to eat up to nine servings of vegetables and fruits a day, there is that barrier of socio-economic status which can restrict one from doing so. In my opinion, this is unfortunate because the majority of America’s population is in this position. I believe that this is a main reason as to why America has an obesity and heart disease epidemic.
Socioeconomic status is an important factor that this campaign blatantly overlooks. Instead of mundanely stating that everyone ought to eat a minimum of five servings of vegetables and fruits a day, there needs to be a campaign that promotes healthy eating behaviors that takes into consideration many complex social factors like socioeconomic status. Perhaps there ought to be a campaign which advocates for lowering the prices of fruits and vegetables and one that raises the importance of placing stores like Trader Joes in unprivileged communities. Such an intervention ought to be accomplished so that those of lower socioeconomic status have access and can afford such healthy foods which prevent adverse disease outcomes and lead to happier, healthier lives.
In addition, under this “social factors argument,” the Five a Day Campaign fails to take into consideration social norms. In certain communities or networks, the perceived norm may not be to ingest a sufficient amount of fruits and vegetables day in and day out. Especially in underprivileged communities, this expectation to eat in such a healthy manner may not be taken as seriously as it should be. This could be due to issues mentioned earlier like access, money and geography. Nevertheless, if eating up to nine servings of vegetables and fruits a day is perceived as abnormal in a clique or community, individuals will most likely not violate this hidden rule even if there is a campaign that advocates this message. A group of so called macho roommates, for example, may create the norm that it is “uncool” to eat fruits and vegetables and link its consumption with being effeminate. With the fear of looking womanly or “untough,” not one man may even buy any fruits or vegetables to put in their common refrigerator. Although each of these men may have seen the Five a Day Campaign ad on billboard on their way to the bar and may take it seriously, they simply will not consume a sufficient amount of fruits and vegetables with the fear that they will be ostracized from their group of roommates/friends. Moreover, the Five a Day Campaign fails to be effective due to the Social Expectations Theory (1).
Perhaps if the campaign implemented an element that addresses social norms it could somewhat be effective. Through an advertising campaign for example, their five a day ad could link eating vegetables and fruits with being manly and tough. Through its promise that eating up to nine servings of vegetables and fruits a day will make a man tough and rugged, it could work to normalize healthy eating behaviors in the male population. Nevertheless, this campaign fails to address issues like social norms and socioeconomic status. This last section aims to critique this campaign effort and reveal its last flaw which fails to address the components of culture and stigmatization in contemporary American society.
In the United States, where this campaign had reigned, there are many diverse belief systems and cultures. Some cultures may view the notion of health differently from another and may place a low value on eating up to nine servings of fruits and vegetables and some may not. Different cultures have unique norms about eating habits and what constitutes a healthy diet (3). This Five a Day Campaign is strictly from the point of view of what Americans believe comprises a good diet. American institutions such as the Surgeon General of the United States and the U.S Public Health Service all support and advocate for this campaign (2). Its platform is strictly what they think is the best diet for all Americans. This United States population includes citizens that can place different meanings on health and diet due to their unique culture.
Moreover, this campaign is run by American public health authorities and experts. Thus, its message to eat up to nine servings of vegetables and fruits a day is what Americans perceive as a good and healthy diet. Another person from a different culture may not feel the same way. In fact, some cultures view a large body type as being a positive endeavor as it echoes high self-esteem (3). Therefore, this culture may not place a high emphasis on eating fruits and vegetables because eating them will result in lean body types.
Also, another culture may not understand this message because it is strictly from an American’s perspective. Due to deeply embedded norms about food, diet, and eating, one from a foreign culture living in the United States may not comprehend this message and its intentions because their own culture places different values on what constitutes a healthy diet. For example, in Marsh et al’s study (2007), “Childhood Obesity Gender Actual-Ideal Body Image Discrepancies and Physical Self-Concept in Hong Kong Children: Cultural Differences of Moderation,” reveals that the Chinese culture values eating in moderation and accepts the notion of obesity more than western cultures like the United States (5).
In addition, one from a different culture may view this campaign as oppressive and as a means to coerce minorities into conforming to the American culture’s way of healthy eating. In this light, this campaign could have an opposite effect on such individual. He/she may purposely not conform to their message as a way of rebelling to the mainstream values of a culture who is attempting to tell them what to do. An individual may go out of their way and purposely not eat any vegetables or fruits at all in order to preserve their cultural pride and to prove that this American approach of a healthy diet is not superior to their own. In this light, the Five a Day Campaign is culturally incompetent as its goals and messages are strictly from an American perspective and fails to consider the many unique belief systems which reside in the country where this intervention takes place. It is culturally insensitive because this is a campaign that is addressed solely to the typical American. Eating a sufficient amount of fruits and vegetables a day has been constructed and maintained as an American norm regarding healthy diet. It may not be the same case for many unique cultures in America’s “melting pot.” Although American public health officials may have thought that this one approach may fit the entire American community, it simply does not. Being in America, one would think that such a campaign would be sensitive to other cultures. In order to promote a higher consumption of fruits and vegetables a day which leads to a healthy diet, more research on culture and the many belief systems that dwell in America must be accomplished.
The last issue which falls under my culture argument is the notion of stigmatization. This Five a Day Campaign overlooks this fact totally. There are those in America who are obese and overweight who may be stigmatized and feel inferior. Although there s a large number of obese Americans, obese individuals are not looked highly upon and can be discriminated against in the United States (7). Some gain the stigma that they are lazy due to a lack of exercise or that they lack self-control in their eating habits. This stigma in American culture where this Five a Day Campaign resides could prevent such an obese individual from adhering to its message (7). The reason is because stigmatization usually produces a sense of low self-esteem and hopelessness (7). Even though an obese individual may perceive the benefits of eating up to nine servings of fruits and vegetables a day, he/she may feel that doing so won’t matter. He/she may feel that nothing will solve their problem and that they may as well keep eating unhealthy because putting in the effort to conform to interventions, like the Five a Day Campaign, simply will not help.
The study, “Stigma, Obesity, and The Health of Nation’s Children,” by Puhl and Latner (2007), reveals that stigmatization in American obese children tend to result in negative health outcomes (7). To tackle the problem of obesity in their opinion is to solve the problems of weight stigmatization. The authors review stigma-reduction efforts that have been proven to improve attitudes toward obese children. They suggest that abolishing weight stigma in youths and enhancing their positive attitude consequently increases their chances of overcoming obesity and leads to better physical outcomes (7).
Similarly, the main issue here is not the simple consumption of fruits and vegetables, but rather augmenting these obese individuals self esteem and giving them hope that they can lose weight and become healthy by adhering to such a healthy diet. Dole’s Five a Day Campaign does not mention anything that could possibly increase self-efficacy and confidence within such individuals in order to get them to consume up to nine servings of vegetables and fruits a day. In fact, the campaign is pretty boring in my opinion and lacks any type of motivational factor to get the American population (never mind obese individuals) to conform to this healthy diet. If this Five a Day Campaign had any type of “jolt” or any interesting techniques to motivate individuals who may feel hopeless in their attempts to eat up to nine servings of vegetables and fruits a day, they would increase self-efficacy and confidence for those who desire to adhere to their intervention. This would consequently abolish the negative effects that stigmatization could have on their health campaign.
These three prior arguments reveal that Dole’s Five a Day Campaign is flawed and ineffective. The intervention’s sole focus on the individual, its lack of attention to social factors, and its ignorance to culture are three major reasons as to why this campaign has been unsuccessful in solving serious American health problems like heart disease and obesity. In 1991, when this campaign began, 10-14% of individuals in most states were considered obese, or in other words, they had a BMI of greater than or equal to 30 (6). In 2003, when this campaign ended, 20-24% of individuals in most states met the criterion of being obese. In fact, in 2003, there were four states in which over 25% of the people were obese (6). Moreover, while this intervention took effect, America actually grew fatter. In my opinion, those behind this campaign put no effort into researching how they could make their cause effective. Instead of investigating certain cultural and social factors, for example, all the campaign designers really did was simplistically and mundanely state, “eat a minimum of five servings of vegetables and fruits a day.”
In my opinion, Dole really did not care about making America healthier with their message. Instead, they sought to advertise their product “Dole.” Instead of a health campaign, it was more like an advertising campaign for their own selfish interests to sell their products like pineapples. By linking their company with a health campaign and revealing that they were connected to agencies like the American Board of Public Health, they believed that the American public would view their company as health conscious and as benevolent. Also, their campaign for individuals “to eat up to nine servings of fruits and vegetables a day” was designed so that people simply buy products that Dole sells which are unsurprisingly fruits and vegetables. Although they may be viewed in the public eye as one who advocates for better health and has products which will ameliorate America’s well-being, they’re intention is to solely sell a product.
This company could have put more time, effort, and money into researching important issues like social and cultural factors in order to make their campaign effective. However, they probably felt that they did not need to. They simply did what was good enough to help their own corporate cause and profits. This is so because their goal is not to improve the public’s health but rather to sell a product.
Moreover, I believe that corporations like Dole should not promote such health campaigns. Precious institutions like schools and universities ought to design campaigns as they have the research tools, they will put in the time and effort, and they also have the heart to truly improve America’s public health. Such institutions like Boston University, uncontaminated by American consumer culture, have designed effective interventions that focus not only on the individual, but also on social and cultural factors. These campaigns usually prove to be successful and therefore ought to be implemented in order to solve many of America’s important public health problems like obesity.
A CURE FOR DOLE FOOD COMPANY’S FIVE A DAY CAMPAIGN
As we have examined, Dole’s Five a Day Campaign was extremely flawed because it was based solely at the individual level and it neglects many important social and cultural factors. This paper focuses on addressing these problems in order to make this campaign effective. Here, I will fill in the holes of the Five a Day Campaign by considering the Social Networking Theory, Social Expectations Theory, socio-economic status, cultural competence and awareness, and stigmatization.
As assessed, Dole’s campaign’s sole focus on the individual results in an ineffective and unsuccessful intervention. To merely tell someone to eat a minimum of five servings of fruits and vegetables is too simplistic and mundane. Being strictly at the individual level, Dole’s campaign effort assumes that people will rationally decide to take on these eating behaviors because of its benefits. Although an individual may intend to eat up to nine servings of vegetables and fruits a day, this does not mean that a person will rationally make the decision to do so.
To address this issue, the Five a Day Campaign ought to implement the Social Networking Theory (3). The researchers of this intervention ought to identify people in certain networks like employees in a restaurant. For example, this campaign ought to be targeted to specific groups like workers at a Burger King. Responsibility should be placed on the manager who is someone these employees look up to and obey. These employees can make the effort to abide by the rules of Dole’s Five a Day Campaign in a communal effort. Perhaps the boss will command her workforce to come in with at least five servings of vegetables and fruits to eat throughout the day. Here, the individuals of this network are working towards the same goal which is to eat a sufficient amount of fruits and vegetables a day. Doing this only increases confidence within the group and augments their self-efficacy that they can adhere to this intervention. They will all gain a sense of accomplishment, they will feel healthier, and grow more connected as a group while being apart of a communal effort. Also, in this fashion, this campaign will work to be successful on a greater number of people at the same time.
In addition, Dole’s five a day campaign ignores many important social factors. First, this intervention takes place in a complex ecological social environment. It is therefore essential, that we consider social factors like socio-economic status and social norms. This campaign overlooks the fact that many Americans cannot afford such healthy foods and cannot travel to certain supermarkets comprised of healthy foods like Trader Joes. Individuals in impoverished neighborhoods are located far from such stores and simply do not have access to healthy foods. Traveling a far distance to a Trader Joe’s for many can be time consuming and expensive. Even if one wanted to abide by the Five a Day Campaign, they may not be able to due society’s many structural barriers.
Thus, within this campaign, there ought to be a strong element of advocacy in regards to socioeconomic status. The intervention should advocate lowering the prices of fruits and vegetables in general, and it ought to raise awareness about building stores like a Trader Joes in underprivileged communities. They ought to promote the fact that fruits and vegetables are extremely important due to their health benefits and thus ought to be affordable to everyone. In addition, perhaps Dole as a corporation could open up small stores in all communities where fruits and vegetables are cheap and conveniently accessible. This could not only work to make Americans healthier, but also it would certainly contribute to Dole’s advertising efforts and profits.
Also, in some communities the perceived norm may not be to consume a sufficient amount of fruits and vegetables. In underprivileged communities, for example, where fast food joints like Macdonald’s and Burger King reside, the expectation to eat up to nine servings of fruits and vegetables a day may not be taken as serious as it should be. If eating this amount of fruits and vegetables a day is viewed as abnormal in a community, these individuals will most likely not violate this concealed norm even if there is the Five a Day Campaign that supports this message.
Moreover, in order to make this intervention successful, Dole must consider the notion of social norms and implement the Social Expectation Theory (1). Through an advertisement, for example, Dole could link eating up to nine fruits and vegetables a day with success, love, and happiness. They could have many advertisements promising these endeavors that targets all social classes. For example, they could have an advertisement where a handsome man and a beautiful woman in a working class community are on their lunch break smiling and eating a meal comprised of rich, colorful vegetables. Of course, the couple is in love and appears extremely happy. Such an ad would promise that anyone who eats a minimum of five servings of fruits and vegetables a day will encounter love and happiness. Here, Dole could advertise their fruits and vegetables products in their commercials and also advocate their positive health message. Through these promises embedded within their advertisements, the campaign could work to normalize healthy eating behaviors in any given population. Once again, it would not only work to make America a healthier country, but it would also work to strengthen the profits of Dole Corporation.
The next issue that Dole’s campaign fails to address is culture. This intervention dwells in America where there are many diverse belief systems and cultures. Different cultures have distinct norms about what constitutes a healthy diet. As we have assessed, this campaign is strictly from the perspective of what Americans believe makes up a good diet. Thus, one from another culture in America may not understand Dole’s message, because of deeply ingrained norms regarding diet, food, and eating behaviors.
In order to fix this problem, Dole must employ researchers working on this campaign from different cultures, and hire those who are culturally competent and sensitive to others’ belief systems. Many cultures may view eating vegetables and fruits as important but may perceive the way Dole advocates the consumption of them as wrong and strange. Those designing this intervention must incorporate the main cultures that reside in the United States. In the campaign’s programs and materials, researchers must develop techniques that address these cultures. In order to accomplish this, extensive research should be done on the many cultures that comprise America’s “melting pot.” For example, the designers could implement recipes comprised of a sufficient amount of fruits and vegetables in accordance with specific cultures way of cooking and eating. For example, the Five a Day Campaign could be culturally sensitive to an Indian style of cooking and offer recipes that implements a variety of vegetables mixed with Indian spices like curry.
Also, because this intervention is strictly from an American point of view, some minorities may feel that this campaign is a means of coercing them into conforming to the American’s way of diet. One from a different culture may purposely not adhere to such an intervention because they do not want to be told what to do by the mainstream culture. They may also refuse to follow this effort in order to maintain their cultural pride and to prove that this American approach of eating healthy is not superior to their own. This is simply a matter of oppression. In order to address this potential problem, Dole should hire researchers working on this campaign from all different cultures and backgrounds. In addition, they should make light of the fact that they have employed a diverse group of experts, and emphasize the fact that it has been constructed by individuals from a variety of unique cultures. By revealing that this campaign is from the viewpoint of an array of different belief systems, their efforts to be culturally competent and sensitive would show. Moreover, the campaign should be designed in a way that is non-intimidating to cultures who may not be able to comprehend its messages, and who may feel that the campaign designers are attempting to acculturate them to America’s belief system. In this light, individuals from all backgrounds in America could abide by this campaign which advocates for the beneficial pursuit of a healthy diet.
The last issue that needs to be addressed is stigmatization. The Five a Day Campaign completely overlooks this fact. Especially in America, where the obesity epidemic is prevalent, those who are overweight or obese may feel inferior. Many are stigmatized as being lazy or as lacking self control in their eating habits. Such a stigma produces a sense of hopelessness and low self-esteem (7). This only works to hinder an obese person from adhering to this five a day campaign message which must be heard. As Puhl and Latner (2007), suggest, enhancing a positive attitude and increasing hope within children who are obese is the only way to eliminate stigmatization and thus augment self-efficacy to lose weight (7).
Similarly, this campaign must implement a sense of motivation or a “jolt” to those who may feel hopeless in their attempts to eat up to nine vegetables and fruits a day. For example, they should construct operant conditioning techniques. If an obese person eats up to nine servings of fruits and vegetables everyday for four months and then loses weight, Dole should give them free gift certificates to their food products. (Of course, the individual would have to come into a clinic and weigh themselves and then come in four months afterwards to monitor and evaluate their progress.)
In addition, the campaign ought to have language within it that encourages everyone, especially overweight and obese individuals in order to achieve its goals. It must stress the fact that it is never too late to change one’s diet and to eat healthy. This would only increase hope and confidence within obese individuals and eliminate stigma. Even if the person is not obese, such motivational efforts would work to increase the confidence for those who desire to comply with this intervention.
As Michael Siegel suggests in his work, “The Importance of Formative Research in Public Health Campaigns: An Example From the Area of HIV Prevention Among Gay Men (Appendix 3-A),” the campaign to encourage gay men to wear condoms was ineffective because gay men and their homosexual relationships (especially sexual relationships) are looked down upon in society and are viewed as abnormal (8). This stigma causes hopelessness for them to change their risky behaviors. He suggests that if gay men’s relationships were tolerated and appreciated, such stigmatization would be abolished.
Similarly, if Dole worked to eliminate such stigmas like laziness in obese individuals in American culture, their campaign would be successful and useful. If Dole increased the hope of such individuals in their campaign and encouraged them to have a positive attitude, such stigmatization would be eliminated and the acquirement of healthy eating behaviors would result. This could only work to make America a healthier society and curb its epidemic of obesity.
After criticizing Dole’s Five a Day Campaign was essential, the next task was to go back and mend its holes. Criticizing and commenting on such a campaign is essential but it is extremely necessary to go back and to cure its flaws. These prior solutions to the unsuccessful Five a Day Campaign will work to make this intervention successful and useful in any community. By addressing the problem of being solely at the individual with the Social Networking Theory and by considering social and cultural factors, this campaign would work to make America a healthier place to live.
REFERENCES:
1. DeFleur, M.L (1989). “Chapter 8: Socialization and Theories of Indirect Influence.” Theories of Mass Communication. New York: Longman Inc.
2. “Dole 5 A Day” (2004). Dole Food Company, Inc.
3. Edberg, M (2007). Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Boston, MA: Jones and Bartlett Publishers.
4. Haan, M et al (1987). Poverty and health. American Journal of Epidemiology, Vol. 125(6), pp.989-998.
5. Marsh, H. et al (2007). Childhood obesity, gender, actual-ideal body image discrepancies, and the physical self-concept in Hong Kong children: Cultural differences in the value of moderation. Developmental Psychology, Vol. 43(3), pp.647-662.
6. “Obesity in America.org.”.
7. Puhl, R.M and Latner, J.D (2007). Stigma, obesity, and the health of the nation’s children. Psychological Bulletin, Vol. 133(4), pp. 557-580.
8. Siegel M. The importance of formative research in public health campaigns: An example from the area of HIV prevention among gay men (appendix 3-A), pp. 66-69. In: Siegel M, Dover L. Marketing Public Health: Strategies to Promote Social Change.
This is a critique in response to Dole’s Five a Day Campaign which is aimed to encourage all Americans to eat a minimum of five servings of fruits and vegetables a day. This intervention began in 1991 and ended in 2003 (2). This campaign was ineffective because throughout these years, America has witnessed an increase of diseases such as heart disease and obesity. These were diseases in which Dole aimed to reduce, through its main message to encourage America to eat five to nine servings of fruits and vegetables a day (2). Dole Food Company is a founding member of this national Five a Day Campaign for better health program. Through nutritional education programs, they simply encourage children and their families to eat five to nine servings of vegetables and fruits a day. Educational materials and programs include five a day supermarket tours, Dole’s five a day website, five a day friends e-mail, and a Fun with Fruits and Vegetables Kids Cookbook (2).
Although this public health intervention is an effort to encourage healthy eating habits and decrease America’s serious obesity epidemic, it is ineffective and is flawed in many ways. First, the intervention is strictly individually based as it advocates that everyone must proactively on their own, take the initiative to eat a total of at least five servings of vegetables and fruits a day. This is far too simplistic and ignores many of the problems with enacting an intervention that is solely individually based. Second, it does not take into consideration the role of social factors that inevitably influences eating behaviors. Issues like socio-economic factors and social norms both impact diet. This study fails to acknowledge these endeavors and their impact on health. Finally, this campaign is ineffective because it is culturally incompetent and fails to consider the role of culture on diet. This campaign is consequently flawed because of these three claims. It will become quite apparent as to why in this paper.
Dole’s public health effort advocates for the individual to make the decision to eat five servings of vegetables and fruit a day. It is positive that this company raised awareness about healthy eating habits by promoting that people consume a sufficient amount of daily fruits and vegetables. However, their approach is flawed as their campaign will consequently result in a great deal of wasted time and money. To tell someone to eat their fruits and vegetables a day is far too simplistic. Diet and eating behaviors are complex conceptions. There are many factors at play that impact healthy eating habits. Everyone has their own unique lives and obstacles that may prevent them from eating a healthy diet. For example, an individual may hold such a stressful job that causes him/her to seek unhealthy candies in order to alleviate his/her anxiety. Although this person may take Dole’s health campaign seriously and evaluate the benefits of eating a minimum of five servings of vegetables and fruits a day, he/she may still not conform to the campaign’s goals because of this stressful job. In this campaign, it is up to the individual to take the initiative to enroll in Dole’s educational programs like the five a day supermarket tours. The reality is that many families and children will not get themselves to do so due to a lack of time and motivation.
Another reason why Dole’s intervention effort is flawed, due to its sole focus on the individual, is because individuals can be predictably irrational. This campaign assumes that individuals will observe their message to eat five servings of fruits and vegetables a day and will consequently make the rational decision to take on these eating behaviors due to its benefits. An individual may intend to comply with this message after perceiving that fruits and vegetables lead to weight loss and reduces the risks of certain diseases like cancer and CHD. However, because people can be irrational, this does not mean that this person will rationally make the decision to take on this novel behavior. For example, even though a person may intend to attend a five a day supermarket tour with the hope that it will encourage them to eat healthier, they may not rationally make the decision to do so. Due to the complexity of human nature, people can be irrational in this fashion. Because this campaign assumes that people are rational and will intend to follow through with their decision to consume this sufficient amount of fruits and vegetables, it is consequently flawed.
My argument declaring the ineffectiveness of this campaign due to its sole focus on the individual, leads me to my next claim which suggests Dole’s failure to consider important social factors that inevitably influence such healthy eating behaviors. Its focus on the individual overlooks the fact that behaviors like diet are made in the context of a complex ecological social environment. Socio-economic status is a higher level factor that has an impact on health behaviors and health outcomes. According to Haan et al in their study, “Poverty and Health” (1987), “Socioeconomic position is one of the most persistent and ubiquitous risk factors known. Members of lower socioeconomic groups experience higher incidence and mortality rates and poorer survival rates for most major chronic diseases” (4). It is therefore safe to say that the higher one’s socioeconomic status, the more these individuals will take on healthy behaviors like healthy diet, and the less they will experience an adverse health outcome like obesity or CHD. If “John,” the CEO of Dole, has access and money for foods like fruits and vegetables (which can sometimes be expensive), it can conveniently wind up in his house refrigerators. On the other hand, there is “Joe” who holds a minimum wage job and struggles to eat three healthy meals a day. This impoverished individual may take Dole’s campaign extremely seriously, and he may desire to eat nine servings of fruits and vegetables a day. However, due to his job that barely pays him enough money for monthly rent, he just cannot afford to eat nine servings of vegetables and fruits a day. Joe may also not be able to afford a computer which is essential for Dole’s campaign since many of its educational materials are through email and on the internet.
Another external factor is geographic location. In lower socioeconomic communities, supermarkets like Trader Joes that promote healthy eating habits and mainly sell healthy foods like fresh fruits and vegetables are simply not present. People like Joe would love to go there, but he lives in a working class neighborhood. The closest Trader Joes to him is about an hour away from him. Joe could take public transportation to this location but it would require him to change train lines and would take up too much time because he has to work every day. Also, he just cannot afford to take the train back and forth because that is money he usually relies on for his lunch. Joe, who is an advocate for the Five a Day Campaign, and desires to follow through with its message, is simply deterred from doing so. Unfortunately, Joe cannot adhere to the campaign because society’s structural forces of money, access, and geography simply restrict him from doing so. What Joe does have are three fast food joints (comprised of foods with high sodium and trans fats) within his distance so it is convenient and inexpensive for him to eat his meals. Why would he therefore put in all of that effort, time, and money to go to Trader Joes? Our friend John on the other hand, has a five minute car ride from Trader Joes which resides a few miles from his mansion on the ocean. John who believes in the Five a Day Campaign can consequently meet the intervention’s daily goals because of his location next to a supermarket that sells healthy foods and advocates for healthy eating habits. He also has the money to afford an endless amount of fruits and vegetables a day. He can also afford all of the campaign’s materials like the cookbook and a computer which allows him to participate in Dole’s website and email offers.
Although many individuals perceive the benefits of Dole’s campaign and would follow through with their intention to eat up to nine servings of vegetables and fruits a day, there is that barrier of socio-economic status which can restrict one from doing so. In my opinion, this is unfortunate because the majority of America’s population is in this position. I believe that this is a main reason as to why America has an obesity and heart disease epidemic.
Socioeconomic status is an important factor that this campaign blatantly overlooks. Instead of mundanely stating that everyone ought to eat a minimum of five servings of vegetables and fruits a day, there needs to be a campaign that promotes healthy eating behaviors that takes into consideration many complex social factors like socioeconomic status. Perhaps there ought to be a campaign which advocates for lowering the prices of fruits and vegetables and one that raises the importance of placing stores like Trader Joes in unprivileged communities. Such an intervention ought to be accomplished so that those of lower socioeconomic status have access and can afford such healthy foods which prevent adverse disease outcomes and lead to happier, healthier lives.
In addition, under this “social factors argument,” the Five a Day Campaign fails to take into consideration social norms. In certain communities or networks, the perceived norm may not be to ingest a sufficient amount of fruits and vegetables day in and day out. Especially in underprivileged communities, this expectation to eat in such a healthy manner may not be taken as seriously as it should be. This could be due to issues mentioned earlier like access, money and geography. Nevertheless, if eating up to nine servings of vegetables and fruits a day is perceived as abnormal in a clique or community, individuals will most likely not violate this hidden rule even if there is a campaign that advocates this message. A group of so called macho roommates, for example, may create the norm that it is “uncool” to eat fruits and vegetables and link its consumption with being effeminate. With the fear of looking womanly or “untough,” not one man may even buy any fruits or vegetables to put in their common refrigerator. Although each of these men may have seen the Five a Day Campaign ad on billboard on their way to the bar and may take it seriously, they simply will not consume a sufficient amount of fruits and vegetables with the fear that they will be ostracized from their group of roommates/friends. Moreover, the Five a Day Campaign fails to be effective due to the Social Expectations Theory (1).
Perhaps if the campaign implemented an element that addresses social norms it could somewhat be effective. Through an advertising campaign for example, their five a day ad could link eating vegetables and fruits with being manly and tough. Through its promise that eating up to nine servings of vegetables and fruits a day will make a man tough and rugged, it could work to normalize healthy eating behaviors in the male population. Nevertheless, this campaign fails to address issues like social norms and socioeconomic status. This last section aims to critique this campaign effort and reveal its last flaw which fails to address the components of culture and stigmatization in contemporary American society.
In the United States, where this campaign had reigned, there are many diverse belief systems and cultures. Some cultures may view the notion of health differently from another and may place a low value on eating up to nine servings of fruits and vegetables and some may not. Different cultures have unique norms about eating habits and what constitutes a healthy diet (3). This Five a Day Campaign is strictly from the point of view of what Americans believe comprises a good diet. American institutions such as the Surgeon General of the United States and the U.S Public Health Service all support and advocate for this campaign (2). Its platform is strictly what they think is the best diet for all Americans. This United States population includes citizens that can place different meanings on health and diet due to their unique culture.
Moreover, this campaign is run by American public health authorities and experts. Thus, its message to eat up to nine servings of vegetables and fruits a day is what Americans perceive as a good and healthy diet. Another person from a different culture may not feel the same way. In fact, some cultures view a large body type as being a positive endeavor as it echoes high self-esteem (3). Therefore, this culture may not place a high emphasis on eating fruits and vegetables because eating them will result in lean body types.
Also, another culture may not understand this message because it is strictly from an American’s perspective. Due to deeply embedded norms about food, diet, and eating, one from a foreign culture living in the United States may not comprehend this message and its intentions because their own culture places different values on what constitutes a healthy diet. For example, in Marsh et al’s study (2007), “Childhood Obesity Gender Actual-Ideal Body Image Discrepancies and Physical Self-Concept in Hong Kong Children: Cultural Differences of Moderation,” reveals that the Chinese culture values eating in moderation and accepts the notion of obesity more than western cultures like the United States (5).
In addition, one from a different culture may view this campaign as oppressive and as a means to coerce minorities into conforming to the American culture’s way of healthy eating. In this light, this campaign could have an opposite effect on such individual. He/she may purposely not conform to their message as a way of rebelling to the mainstream values of a culture who is attempting to tell them what to do. An individual may go out of their way and purposely not eat any vegetables or fruits at all in order to preserve their cultural pride and to prove that this American approach of a healthy diet is not superior to their own. In this light, the Five a Day Campaign is culturally incompetent as its goals and messages are strictly from an American perspective and fails to consider the many unique belief systems which reside in the country where this intervention takes place. It is culturally insensitive because this is a campaign that is addressed solely to the typical American. Eating a sufficient amount of fruits and vegetables a day has been constructed and maintained as an American norm regarding healthy diet. It may not be the same case for many unique cultures in America’s “melting pot.” Although American public health officials may have thought that this one approach may fit the entire American community, it simply does not. Being in America, one would think that such a campaign would be sensitive to other cultures. In order to promote a higher consumption of fruits and vegetables a day which leads to a healthy diet, more research on culture and the many belief systems that dwell in America must be accomplished.
The last issue which falls under my culture argument is the notion of stigmatization. This Five a Day Campaign overlooks this fact totally. There are those in America who are obese and overweight who may be stigmatized and feel inferior. Although there s a large number of obese Americans, obese individuals are not looked highly upon and can be discriminated against in the United States (7). Some gain the stigma that they are lazy due to a lack of exercise or that they lack self-control in their eating habits. This stigma in American culture where this Five a Day Campaign resides could prevent such an obese individual from adhering to its message (7). The reason is because stigmatization usually produces a sense of low self-esteem and hopelessness (7). Even though an obese individual may perceive the benefits of eating up to nine servings of fruits and vegetables a day, he/she may feel that doing so won’t matter. He/she may feel that nothing will solve their problem and that they may as well keep eating unhealthy because putting in the effort to conform to interventions, like the Five a Day Campaign, simply will not help.
The study, “Stigma, Obesity, and The Health of Nation’s Children,” by Puhl and Latner (2007), reveals that stigmatization in American obese children tend to result in negative health outcomes (7). To tackle the problem of obesity in their opinion is to solve the problems of weight stigmatization. The authors review stigma-reduction efforts that have been proven to improve attitudes toward obese children. They suggest that abolishing weight stigma in youths and enhancing their positive attitude consequently increases their chances of overcoming obesity and leads to better physical outcomes (7).
Similarly, the main issue here is not the simple consumption of fruits and vegetables, but rather augmenting these obese individuals self esteem and giving them hope that they can lose weight and become healthy by adhering to such a healthy diet. Dole’s Five a Day Campaign does not mention anything that could possibly increase self-efficacy and confidence within such individuals in order to get them to consume up to nine servings of vegetables and fruits a day. In fact, the campaign is pretty boring in my opinion and lacks any type of motivational factor to get the American population (never mind obese individuals) to conform to this healthy diet. If this Five a Day Campaign had any type of “jolt” or any interesting techniques to motivate individuals who may feel hopeless in their attempts to eat up to nine servings of vegetables and fruits a day, they would increase self-efficacy and confidence for those who desire to adhere to their intervention. This would consequently abolish the negative effects that stigmatization could have on their health campaign.
These three prior arguments reveal that Dole’s Five a Day Campaign is flawed and ineffective. The intervention’s sole focus on the individual, its lack of attention to social factors, and its ignorance to culture are three major reasons as to why this campaign has been unsuccessful in solving serious American health problems like heart disease and obesity. In 1991, when this campaign began, 10-14% of individuals in most states were considered obese, or in other words, they had a BMI of greater than or equal to 30 (6). In 2003, when this campaign ended, 20-24% of individuals in most states met the criterion of being obese. In fact, in 2003, there were four states in which over 25% of the people were obese (6). Moreover, while this intervention took effect, America actually grew fatter. In my opinion, those behind this campaign put no effort into researching how they could make their cause effective. Instead of investigating certain cultural and social factors, for example, all the campaign designers really did was simplistically and mundanely state, “eat a minimum of five servings of vegetables and fruits a day.”
In my opinion, Dole really did not care about making America healthier with their message. Instead, they sought to advertise their product “Dole.” Instead of a health campaign, it was more like an advertising campaign for their own selfish interests to sell their products like pineapples. By linking their company with a health campaign and revealing that they were connected to agencies like the American Board of Public Health, they believed that the American public would view their company as health conscious and as benevolent. Also, their campaign for individuals “to eat up to nine servings of fruits and vegetables a day” was designed so that people simply buy products that Dole sells which are unsurprisingly fruits and vegetables. Although they may be viewed in the public eye as one who advocates for better health and has products which will ameliorate America’s well-being, they’re intention is to solely sell a product.
This company could have put more time, effort, and money into researching important issues like social and cultural factors in order to make their campaign effective. However, they probably felt that they did not need to. They simply did what was good enough to help their own corporate cause and profits. This is so because their goal is not to improve the public’s health but rather to sell a product.
Moreover, I believe that corporations like Dole should not promote such health campaigns. Precious institutions like schools and universities ought to design campaigns as they have the research tools, they will put in the time and effort, and they also have the heart to truly improve America’s public health. Such institutions like Boston University, uncontaminated by American consumer culture, have designed effective interventions that focus not only on the individual, but also on social and cultural factors. These campaigns usually prove to be successful and therefore ought to be implemented in order to solve many of America’s important public health problems like obesity.
A CURE FOR DOLE FOOD COMPANY’S FIVE A DAY CAMPAIGN
As we have examined, Dole’s Five a Day Campaign was extremely flawed because it was based solely at the individual level and it neglects many important social and cultural factors. This paper focuses on addressing these problems in order to make this campaign effective. Here, I will fill in the holes of the Five a Day Campaign by considering the Social Networking Theory, Social Expectations Theory, socio-economic status, cultural competence and awareness, and stigmatization.
As assessed, Dole’s campaign’s sole focus on the individual results in an ineffective and unsuccessful intervention. To merely tell someone to eat a minimum of five servings of fruits and vegetables is too simplistic and mundane. Being strictly at the individual level, Dole’s campaign effort assumes that people will rationally decide to take on these eating behaviors because of its benefits. Although an individual may intend to eat up to nine servings of vegetables and fruits a day, this does not mean that a person will rationally make the decision to do so.
To address this issue, the Five a Day Campaign ought to implement the Social Networking Theory (3). The researchers of this intervention ought to identify people in certain networks like employees in a restaurant. For example, this campaign ought to be targeted to specific groups like workers at a Burger King. Responsibility should be placed on the manager who is someone these employees look up to and obey. These employees can make the effort to abide by the rules of Dole’s Five a Day Campaign in a communal effort. Perhaps the boss will command her workforce to come in with at least five servings of vegetables and fruits to eat throughout the day. Here, the individuals of this network are working towards the same goal which is to eat a sufficient amount of fruits and vegetables a day. Doing this only increases confidence within the group and augments their self-efficacy that they can adhere to this intervention. They will all gain a sense of accomplishment, they will feel healthier, and grow more connected as a group while being apart of a communal effort. Also, in this fashion, this campaign will work to be successful on a greater number of people at the same time.
In addition, Dole’s five a day campaign ignores many important social factors. First, this intervention takes place in a complex ecological social environment. It is therefore essential, that we consider social factors like socio-economic status and social norms. This campaign overlooks the fact that many Americans cannot afford such healthy foods and cannot travel to certain supermarkets comprised of healthy foods like Trader Joes. Individuals in impoverished neighborhoods are located far from such stores and simply do not have access to healthy foods. Traveling a far distance to a Trader Joe’s for many can be time consuming and expensive. Even if one wanted to abide by the Five a Day Campaign, they may not be able to due society’s many structural barriers.
Thus, within this campaign, there ought to be a strong element of advocacy in regards to socioeconomic status. The intervention should advocate lowering the prices of fruits and vegetables in general, and it ought to raise awareness about building stores like a Trader Joes in underprivileged communities. They ought to promote the fact that fruits and vegetables are extremely important due to their health benefits and thus ought to be affordable to everyone. In addition, perhaps Dole as a corporation could open up small stores in all communities where fruits and vegetables are cheap and conveniently accessible. This could not only work to make Americans healthier, but also it would certainly contribute to Dole’s advertising efforts and profits.
Also, in some communities the perceived norm may not be to consume a sufficient amount of fruits and vegetables. In underprivileged communities, for example, where fast food joints like Macdonald’s and Burger King reside, the expectation to eat up to nine servings of fruits and vegetables a day may not be taken as serious as it should be. If eating this amount of fruits and vegetables a day is viewed as abnormal in a community, these individuals will most likely not violate this concealed norm even if there is the Five a Day Campaign that supports this message.
Moreover, in order to make this intervention successful, Dole must consider the notion of social norms and implement the Social Expectation Theory (1). Through an advertisement, for example, Dole could link eating up to nine fruits and vegetables a day with success, love, and happiness. They could have many advertisements promising these endeavors that targets all social classes. For example, they could have an advertisement where a handsome man and a beautiful woman in a working class community are on their lunch break smiling and eating a meal comprised of rich, colorful vegetables. Of course, the couple is in love and appears extremely happy. Such an ad would promise that anyone who eats a minimum of five servings of fruits and vegetables a day will encounter love and happiness. Here, Dole could advertise their fruits and vegetables products in their commercials and also advocate their positive health message. Through these promises embedded within their advertisements, the campaign could work to normalize healthy eating behaviors in any given population. Once again, it would not only work to make America a healthier country, but it would also work to strengthen the profits of Dole Corporation.
The next issue that Dole’s campaign fails to address is culture. This intervention dwells in America where there are many diverse belief systems and cultures. Different cultures have distinct norms about what constitutes a healthy diet. As we have assessed, this campaign is strictly from the perspective of what Americans believe makes up a good diet. Thus, one from another culture in America may not understand Dole’s message, because of deeply ingrained norms regarding diet, food, and eating behaviors.
In order to fix this problem, Dole must employ researchers working on this campaign from different cultures, and hire those who are culturally competent and sensitive to others’ belief systems. Many cultures may view eating vegetables and fruits as important but may perceive the way Dole advocates the consumption of them as wrong and strange. Those designing this intervention must incorporate the main cultures that reside in the United States. In the campaign’s programs and materials, researchers must develop techniques that address these cultures. In order to accomplish this, extensive research should be done on the many cultures that comprise America’s “melting pot.” For example, the designers could implement recipes comprised of a sufficient amount of fruits and vegetables in accordance with specific cultures way of cooking and eating. For example, the Five a Day Campaign could be culturally sensitive to an Indian style of cooking and offer recipes that implements a variety of vegetables mixed with Indian spices like curry.
Also, because this intervention is strictly from an American point of view, some minorities may feel that this campaign is a means of coercing them into conforming to the American’s way of diet. One from a different culture may purposely not adhere to such an intervention because they do not want to be told what to do by the mainstream culture. They may also refuse to follow this effort in order to maintain their cultural pride and to prove that this American approach of eating healthy is not superior to their own. This is simply a matter of oppression. In order to address this potential problem, Dole should hire researchers working on this campaign from all different cultures and backgrounds. In addition, they should make light of the fact that they have employed a diverse group of experts, and emphasize the fact that it has been constructed by individuals from a variety of unique cultures. By revealing that this campaign is from the viewpoint of an array of different belief systems, their efforts to be culturally competent and sensitive would show. Moreover, the campaign should be designed in a way that is non-intimidating to cultures who may not be able to comprehend its messages, and who may feel that the campaign designers are attempting to acculturate them to America’s belief system. In this light, individuals from all backgrounds in America could abide by this campaign which advocates for the beneficial pursuit of a healthy diet.
The last issue that needs to be addressed is stigmatization. The Five a Day Campaign completely overlooks this fact. Especially in America, where the obesity epidemic is prevalent, those who are overweight or obese may feel inferior. Many are stigmatized as being lazy or as lacking self control in their eating habits. Such a stigma produces a sense of hopelessness and low self-esteem (7). This only works to hinder an obese person from adhering to this five a day campaign message which must be heard. As Puhl and Latner (2007), suggest, enhancing a positive attitude and increasing hope within children who are obese is the only way to eliminate stigmatization and thus augment self-efficacy to lose weight (7).
Similarly, this campaign must implement a sense of motivation or a “jolt” to those who may feel hopeless in their attempts to eat up to nine vegetables and fruits a day. For example, they should construct operant conditioning techniques. If an obese person eats up to nine servings of fruits and vegetables everyday for four months and then loses weight, Dole should give them free gift certificates to their food products. (Of course, the individual would have to come into a clinic and weigh themselves and then come in four months afterwards to monitor and evaluate their progress.)
In addition, the campaign ought to have language within it that encourages everyone, especially overweight and obese individuals in order to achieve its goals. It must stress the fact that it is never too late to change one’s diet and to eat healthy. This would only increase hope and confidence within obese individuals and eliminate stigma. Even if the person is not obese, such motivational efforts would work to increase the confidence for those who desire to comply with this intervention.
As Michael Siegel suggests in his work, “The Importance of Formative Research in Public Health Campaigns: An Example From the Area of HIV Prevention Among Gay Men (Appendix 3-A),” the campaign to encourage gay men to wear condoms was ineffective because gay men and their homosexual relationships (especially sexual relationships) are looked down upon in society and are viewed as abnormal (8). This stigma causes hopelessness for them to change their risky behaviors. He suggests that if gay men’s relationships were tolerated and appreciated, such stigmatization would be abolished.
Similarly, if Dole worked to eliminate such stigmas like laziness in obese individuals in American culture, their campaign would be successful and useful. If Dole increased the hope of such individuals in their campaign and encouraged them to have a positive attitude, such stigmatization would be eliminated and the acquirement of healthy eating behaviors would result. This could only work to make America a healthier society and curb its epidemic of obesity.
After criticizing Dole’s Five a Day Campaign was essential, the next task was to go back and mend its holes. Criticizing and commenting on such a campaign is essential but it is extremely necessary to go back and to cure its flaws. These prior solutions to the unsuccessful Five a Day Campaign will work to make this intervention successful and useful in any community. By addressing the problem of being solely at the individual with the Social Networking Theory and by considering social and cultural factors, this campaign would work to make America a healthier place to live.
REFERENCES:
1. DeFleur, M.L (1989). “Chapter 8: Socialization and Theories of Indirect Influence.” Theories of Mass Communication. New York: Longman Inc.
2. “Dole 5 A Day” (2004). Dole Food Company, Inc.
3. Edberg, M (2007). Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Boston, MA: Jones and Bartlett Publishers.
4. Haan, M et al (1987). Poverty and health. American Journal of Epidemiology, Vol. 125(6), pp.989-998.
5. Marsh, H. et al (2007). Childhood obesity, gender, actual-ideal body image discrepancies, and the physical self-concept in Hong Kong children: Cultural differences in the value of moderation. Developmental Psychology, Vol. 43(3), pp.647-662.
6. “Obesity in America.org.”
7. Puhl, R.M and Latner, J.D (2007). Stigma, obesity, and the health of the nation’s children. Psychological Bulletin, Vol. 133(4), pp. 557-580.
8. Siegel M. The importance of formative research in public health campaigns: An example from the area of HIV prevention among gay men (appendix 3-A), pp. 66-69. In: Siegel M, Dover L. Marketing Public Health: Strategies to Promote Social Change.
posted by francesca @ 9:54 AM
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