Running head: BUSY SCHEDULES AND PURCHASE OF FAST FOOD

The Relationship between the Busy Schedules of Touro Graduate Students and Their Purchase of Fast Food Touro University Nevada Justin T. Christman, Mariana E. Hall, Ryan V. Hua, Susan C. Kaiser, Hayley J. Meredith, Brandon M. Roberson and Nicole A. Sellers

BUSY SCHEDULES AND PURCHASE OF FAST FOOD Introduction Previous research has suggested that busy lifestyles and stress might influence dietary choices. However, it is not clear whether diet has an influence on stress levels or whether stress affects our food choices. It seems very likely that busy lifestyles may result in unhealthy diets due to the convenience of affordable and time efficient fast food service. This is a cause of concern because research studies have linked unhealthy food choices with poor physical health as well as negative moods that include depression. Research has explored the relationship of stress and fast food consumption although it is difficult to determine whether stressed individuals crave unhealthy food, or those who eat more fast food become more easily stressed due to the taxing effect of poor diet on the body. The research team at the University of California found that persistent stress can lead to chronic overproduction of cortisol which activates circuits in the brain associated with cravings for foods high in fat and energy content. Maranos article explains that because stress is very taxing on the body, a diet high in fat content is more effective to adequately fuel the body and even allows for the storage of energy reserves that can be tapped into during stressful times. However, even though sugary and fatty foods may result in immediate and temporary feelings of well-being and improved function, over time these eating habits can be detrimental to health (Marano, 2003). Furthermore, studies have shown that people are more vulnerable to compulsive eating with impaired production of dopamine, a neurotransmitter associated with pleasure and reward feelings. Although at times the drive to eat unhealthy food can overpower health concerns, neuroplasticity suggests that the brain can be retrained to crave healthy foods instead (Healthy eating, 2009). According to Adam and Epel, chronic stimulation of the hypothalamic-pituitaryadrenal (HPA) axis and its resulting glucocorticoid excess may play a role in the development of

BUSY SCHEDULES AND PURCHASE OF FAST FOOD visceral obesity. Long term stimulation of the reward pathways of the brain by either stress induced HPA stimulation, intake of highly palatable food or both could result in neurobiological modifications that promote compulsive overeating (Adam & Epel, 2007). Other studies have found that when under stress, individuals may not only overeat but, also consume foods with higher caloric and fat content. Psychological research has shown that carbohydrate consumption is associated with improved mood whereas breakfasts low in carbohydrate and high in protein resulted in reports of increased anger. Liu et al. explored the association between stress, depression and food consumption among Chinese college students. Their results suggested that perceived stress increased with low consumption of fresh fruits, whereas it decreased with higher consumption of ready to eat and snack foods. Depression symptoms decreased with consumption of fruits and increased with consumption of fast food (Liu et al., 2007). Similar results were found in a cross-sectional study that examined first year students in three European countries, namely Germany, Poland, and Bulgaria. The frequency of food consumption was measured in relation to mental health indicators such as stress and depression. The results showed a relationship between food consumption frequencies, mental health and gender. Whereas stress and depression had no effect on the food preferences of males, stressed females increased their consumption of sweets and fast foods and ate less fruits and vegetables. In other words, the two genders appear to respond differently to perceived stress, with females having a tendency to use food as a coping mechanism (Mikolajczyk et al., 2009). In contrast, a different study showed that men ate out more frequently than women; perhaps because more women agreed with the statement, the nutrition content of food is important to me. (Morse, 2009). Another study shows that there is a positive correlation between stress and food

BUSY SCHEDULES AND PURCHASE OF FAST FOOD consumption. As stress increases, so does food consumption for both males and females combined. A separated test was performed by separating males and females. Unlike most studies in the past where females had a significant correlation and males did not, this study shows that the males had a significant correlation whereas females did not (Crooks, Gower, and Hand). Constrained budgets coupled with busy lifestyles that include overworking, lack of sleep, and little time to relax can make people vulnerable to both stress and poor eating habits. Due to fast food being both cheap and convenient, stressed individuals who are trying to save money and time might be more prone to develop unhealthy eating habits that include high consumption of fast food. College students fit this description, leading this research to examine whether lengthy hours of study contribute to an increase in the consumption of fast food in first year Touro University occupational therapy students. The researchers hypothesize that busier students who spend more time studying will consume fast food more frequently. This topic is important because, as the literature review has suggested, fast food could have a negative impact not only in physical health but mental health as well. The topic is especially relevant for occupational therapy students who will become health practitioners and are expected to become role models of balanced and healthy lifestyles. Additionally, we will explore other variables that may have an impact on dietary choices such as gender, age, and living arrangement. Methods This was a quantitative and descriptive study as it merely gives information about the eating habits of graduate students. It was a quasi-experiment because there was no control group and no variables were manipulated. The method used to recruit participants was word of mouth

BUSY SCHEDULES AND PURCHASE OF FAST FOOD within the class. For the collection of data, a calendar was distributed and participants were instructed to record hours of study as well as occurrence of fast food purchased daily for the period of two weeks. Fast food restaurants were defined as any restaurant or facility that has a drive-thru or that offers delivery service. Initially, within the sample, six were male and 23 were female. However, there were three subjects who did not return their survey forms and one subject was excluded due to a parttime enrollment status. The final sample included five males and 21 females for a total of 26 subjects. For the category of gender, males were assigned to the numerical value of 1 and females were assigned to the numerical value of 2. Subjects were grouped according to age with those 25 and below assigned to a numerical value of 1, and 26 and above assigned to a numerical value of 2. Lastly, subjects were asked to classify their living arrangement as either living alone (assigned numerical value 1) or living with another (assigned numerical value 2). The participants in the study completed the survey within a month of it being distributed. Although the study was provided with clear instructions to return it within two weeks after it was dispersed, participants may have been unable to complete the survey in a timely manner because of prioritizing school assignments over the study. Additionally, the survey was conducted during a very busy school schedule and carried out in conjunction with other research projects. Results The statistical significance (p-value) calculated by a t-test for all of the data collected is displayed in Table 1. Table 1: P-Values of the Occurrence of Fast Food Purchased Compared to Other Variables

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Occurrence of Fast Food Purchased and Hours Studied Outside of Class Mean responses for the occurrence of fast food purchased ranged from 0 to 28 over week one, and 0 to 29 over week two. Mean hours studied outside of class ranged from 10 to 48 over week one, and 0 to 29 over week two. The researchers divided the population into two groups, those who purchased fast food two or less times and three or more times. The population was also divided into two groups based on hours studied outside of class, those who studied 13 hours or less and 14 hours or more. Visual analysis of all data points for the combined groups per week, statistical and association between occurrence of fast food purchased and hours studied outside of class are illustrated in Figures 1 and 2. Figure 1: Occurrence of Fast Food Purchased and Hours Studied per Person Week 1

BUSY SCHEDULES AND PURCHASE OF FAST FOOD

Figure 2: Occurrence of Fast Food Purchased and Hours Studied per Person Week 2

BUSY SCHEDULES AND PURCHASE OF FAST FOOD

Occurrence of Fast Food Purchased and Age The ages of the participants were divided into two group; 25 and younger and 26 and older. Visual analysis of all data points, and association between occurrence of fast food purchased and hours studied outside of class are illustrated in Figures 3 and 4.

BUSY SCHEDULES AND PURCHASE OF FAST FOOD Figure 3: Occurrence of Fast Food Purchased and Age Week 1

Figure 4: Occurrence of Fast Food Purchased and Age Week 2

BUSY SCHEDULES AND PURCHASE OF FAST FOOD Occurrence of Fast Food Purchased and Gender The gender distribution of the participants in the Touro University Nevada OT15 cohort is not equally divided. There were 21 females and five males that participated in this study. Visual analysis of all data points, association between occurrences of fast food purchased and gender are illustrated in Figures 5 and 6. Figure 5: Occurrence of Fast Food Purchased and Gender Week 1

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BUSY SCHEDULES AND PURCHASE OF FAST FOOD Figure 6: Occurrence of Fast Food Purchased and Gender Week 2

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Occurrence of Fast Food Purchased and Living Arrangement Visual analysis of all data points, and association between occurrence of fast food purchased and living arrangement are illustrated in Figures 7 and 8. Figure 7: Occurrence of Fast Food Purchased and Living Arrangement Week 1

BUSY SCHEDULES AND PURCHASE OF FAST FOOD Figure 8: Occurrence of Fast Food Purchased and Living Arrangement Week 2

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Data Analysis The hypothesis that a busier school schedule and demanding hours of studying would contribute to increased purchase of fast food was confirmed because there was an association between the two variables. The data analyses were conducted using Microsoft Excel, and visual analysis of graphic displays of the data were primarily used. Level and trend were also assessed during inspection of the characteristics of the data. Level was computed by the mean of all data points within each week. Paired t-tests were used to assess the statistical significance of associations between variables. Bivariate analyses were conducted to compare occurrence of fast food purchased against hours studied outside of class, age of participant, gender of participant, and living arrangement.

BUSY SCHEDULES AND PURCHASE OF FAST FOOD Eight bivariate models were run to test the associations between occurrence of fast food purchased and the four other variables. The first model included occurrence of fast food purchased as the dependent variable and hours studied outside of class as the independent variable. The results showed that there was a significant association when the occurrence of fast food purchased and the number of hours studied outside of class were compared during week one, but not in week two. The p-value of week one was 0.03 and the p-value of week two was 0.79. The second model excluded hours studied outside of class, and compared the occurrence of fast food purchase and age of the participants. Associations between the occurrence of fast food and age were statistically significant in weeks one and two, but more so in week one with pvalues of 0.01 and 0.03 respectively. The third model compared the occurrence of fast food purchased and gender of the participants. The associations between the two variables were statistically significant in weeks one and two with p-values of 0.02 and 0.04. However, it was unclear if there was a statistically significant difference between the two genders and their occurrence of fast food purchased. The final model compared the occurrence of fast food purchased and the living arrangement of the participants. In week two, the data showed that those who classified themselves as living alone also purchased fast food more frequently than those who live with another showing a significant p-value of 0.03. A significant association was not shown in week one with a p-value of 0.17. Discussion and Implications for Practice This study confirmed the initial hypothesis that there is a correlation between busy schedules, in this case, extensive hours of studying and fast food consumption. Students

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BUSY SCHEDULES AND PURCHASE OF FAST FOOD consumed more fast food during the first week than in the second week and studied more hours during that same week as well. There were several tests and assignments due during the first week which contributed to a busier schedule and may have resulted in increased fast food purchased. With regards to the hypothesis for this study that considers busy schedules and fast food purchases, it is safe to conclude that there is a significant relationship between the two. However, the kind of relationship in terms of which one comes first or why these two are related is not certain. More studying does not necessarily result in increased fast food purchased, but perhaps purchasing fast food resulted in having more hours available to study due to not having to cook. Another case in which fast food purchase could result in more study time is the example of the tired student who is falling asleep but becomes more alert after having a caffeinated soft drink and sugary treats and therefore is able to stay awake until late at night to put in more hours of study. The opposite could also be true and busy schedules could result in higher fast food consumption in order to save time. The idea that busy schedules result in increased unhealthy eating habits was strongly supported. The implications of these results for the lifestyle of college students are very important because obtaining high grades at the expense of health and well-being is not a good trade off. Even if the students make time for relaxation in order to minimize stress by adopting unhealthy diets for the sake of time, they may suffer the negative consequences related to poor nutrition as indicated by the background research literature included in this paper. The comparison between the two age groups could not be determined because not all of the subjects included their age on the survey. It is also possible that the results may have been

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BUSY SCHEDULES AND PURCHASE OF FAST FOOD skewed if these values had been determined due to an outlying subject from the 25 years or younger group purchasing fast food 28 times during each of the two weeks. It was also difficult to determine differences between genders because the ratio of males to females was not proportionate. The sample group was predominantly female and the background research suggests that females eating habits can be dependent on stress, which was not measured in this study. No assumptions could be made based on living arrangements alone, because there are too few commonalities between each household. Also cohabitation does not imply that people intermingle at meal time. The term living arrangement includes many confounding variables that were not considered. Strengths and Limitations The variables applied to this research study were objective with their definitions clearly stated. The number of hours studied were defined as the amount of time outside of the classroom dedicated to studying for exams or working on class-related projects. Fast food was clearly defined as anything purchased at a drive-thru restaurant or prepared foods purchased elsewhere and taken home to eat. Additionally, researchers were readily available throughout the two weeks of the study if further clarification was needed. The other variables of age, gender, and living arrangements were straight forward and required no further explanations. The participants in this study constituted a specific graduate population with the data they were asked to record being a part of their natural, not contrived, environment. Participants were simply asked to note daily behaviors and not asked to make any changes to their daily routines for the purpose of this study.

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BUSY SCHEDULES AND PURCHASE OF FAST FOOD One of the limitations of this study was the small, self-contained sample size, providing low external validity, making the results not applicable to the general population of graduate students. Twenty-nine students, or approximately 78% of the occupational therapy 2015 Touro University Nevada cohort, were given a survey at the beginning of the two week study. Of the 29 surveys, only 26 were returned, several of which were incomplete. Another limitation of the method of research used is that the accuracy of the data was not verifiable. Although participants were asked to keep a daily log, it is possible that some participants recorded all of their data at the end of the two weeks (or after four weeks, depending on when they returned their survey), relying on memory for completion of the data. This data could also be skewed due to students not wanting to admit, consciously or subconsciously, how much fast food they actually purchase, or how many hours are truly devoted to study time. Despite the limited number of participants, a fairly wide range of ages was included, both male and female. However, the ratio of males to females was 5 to 21. The group studied also had a variety of living arrangements from single and living alone, to living with a spouse or significant other, to living with one or more roommates. Suggestions for future research would include delivering surveys weekly rather than bimonthly. A more careful consideration of direct relationships between two variables may help eliminate the amount of data to be analyzed, as well as increasing the studied population to create more significant and generalizable results.

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BUSY SCHEDULES AND PURCHASE OF FAST FOOD References Adam, T. C., Epel, E. S., (2007). Stress, Eating and the Reward system. Journal of Physiology and Behavior(91), 449-458 Crooks, Z., Gower, B., & Hand, C. (n.d.). The relationship between stress and eating in collegeaged students. URC. http://www.kon.org/urc/v7/crooks.html Liu, C., Xie, B., Chou, C., Koprowski, C., Zhou, D., Palmer, P., Sun, P., Guo, Q., Duan, L., Sun, X.,Johnson, C. A.(2007). Perceived Stress, Depression and Food Consumption Frequency in the College Students of China Seven Cities. Physiology & Behavior, 92 (2007), 748754. doi: 10.1016/j.physbeh.2007.05.068 Marano, H. E. (2013, November 21). Stress and eating. Psychology Today. http://www.psychologytoday.com/articles/200311/stress-and-eating Mikolajczyk, R. T., Ansari, W. E., Maxwell, A. E. (2009). Food consumption frequency and perceived stress and depressive symptoms among students in three European countries. Nutritional Journal, 8 (2009), doi: 10.1186/1475-2891-8-31 Morse, K. L., & Driskell, J. A. (2009). Observed Sex Differences In Fast-food Consumption and Nutrition Self-assessments and Beliefs of College Students. Nutrition Research, 29(3), 173-179. The Examiner. (2009, August 19). Healthy eating guidelines for busy people. http://www.modernghana.com/lifestyle/1043/16/healthy-eating-guidelines-for-busypeople.html

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