Food Preparation Behaviors Research Articles

Utility of eButton images for identifying food preparation behaviors and meal-related tasks in adolescents

BackgroundFood preparation skills may encourage healthy eating. Traditional assessment of child food preparation employs self- or parent proxy-reporting methods, which are prone to error. The eButton is a wearable all-day camera that has promise as an objective, passive method for measuring child food preparation practices.PurposeThis paper explores the feasibility of the eButton to reliably capture home food preparation behaviors and practices in a sample of pre- and early adolescents (ages 9 to 13).MethodsThis is a secondary analysis of two eButton pilot projects evaluating the dietary intake of pre- and early adolescents in or around Houston, Texas. Food preparation behaviors were coded into seven major categories including: browsing, altering food/adding seasoning, food media, meal related tasks, prep work, cooking and observing. Inter-coder reliability was measured using Cohen’s kappa and percent agreement.ResultsAnalysis was completed on data for 31 participants. The most common activity was browsing in the pantry or fridge. Few participants demonstrated any food preparation work beyond unwrapping of food packages and combining two or more ingredients; actual cutting or measuring of foods were rare.ConclusionsAlthough previous research suggests children who “help” prepare meals may obtain some dietary benefit, accurate assessment tools of food preparation behavior are lacking. The eButton offers a feasible approach to food preparation behavior measurement among pre- and early adolescents. Follow up research exploring the validity of this method in a larger sample, and comparisons between cooking behavior and dietary intake are needed.

Social disparities in food preparation behaviours: a DEDIPAC study

BackgroundThe specific role of major socio-economic indicators in influencing food preparation behaviours could reveal distinct socio-economic patterns, thus enabling mechanisms to be understood that contribute to social inequalities in health. This study investigated whether there was an independent association of each socio-economic indicator (education, occupation, income) with food preparation behaviours.MethodsA total of 62,373 adults participating in the web-based NutriNet-Santé cohort study were included in our cross-sectional analyses. Cooking skills, preparation from scratch and kitchen equipment were assessed using a 0–10-point score; frequency of meal preparation, enjoyment of cooking and willingness to cook better/more frequently were categorical variables. Independent associations between socio-economic factors (education, income and occupation) and food preparation behaviours were assessed using analysis of covariance and logistic regression models stratified by sex. The models simultaneously included the three socio-economic indicators, adjusting for age, household composition and whether or not they were the main cook in the household.ResultsParticipants with the lowest education, the lowest income group and female manual and office workers spent more time preparing food daily than participants with the highest education, those with the highest income and managerial staff (P < 0.0001). The lowest educated individuals were more likely to be non-cooks than those with the highest education level (Women: OR = 3.36 (1.69;6.69); Men: OR = 1.83 (1.07;3.16)) while female manual and office workers and the never-employed were less likely to be non-cooks (OR = 0.52 (0.28;0.97); OR = 0.30 (0.11;0.77)). Female manual and office workers had lower scores of preparation from scratch and were less likely to want to cook more frequently than managerial staff (P < 0.001 and P < 0.001). Women belonging to the lowest income group had a lower score of kitchen equipment (P < 0.0001) and were less likely to enjoy cooking meal daily (OR = 0.68 (0.45;0.86)) than those with the highest income.ConclusionLowest socio-economic groups, particularly women, spend more time preparing food than high socioeconomic groups. However, female manual and office workers used less raw or fresh ingredients to prepare meals than managerial staff. In the unfavourable context in France with reduced time spent preparing meals over last decades, our findings showed socioeconomic disparities in food preparation behaviours in women, whereas few differences were observed in men.

Food skills confidence and household gatekeepers' dietary practices

IntroductionHousehold food gatekeepers have the potential to influence the food attitudes and behaviours of family members, as they are mainly responsible for food-related tasks in the home. The aim of this study was to determine the role of gatekeepers' confidence in food-related skills and nutrition knowledge on food practices in the home. MethodsAn online survey was completed by 1059 Australian dietary gatekeepers selected from the Global Market Insite (GMI) research database. Participants responded to questions about food acquisition and preparation behaviours, the home eating environment, perceptions and attitudes towards food, and demographics. Two-step cluster analysis was used to identify groups based on confidence regarding food skills and nutrition knowledge. Chi-square tests and one-way ANOVAs were used to compare the groups on the dependent variables. ResultsThree groups were identified: low confidence, moderate confidence and high confidence. Gatekeepers in the highest confidence group were significantly more likely to report lower body mass index (BMI), and indicate higher importance of fresh food products, vegetable prominence in meals, product information use, meal planning, perceived behavioural control and overall diet satisfaction. Gatekeepers in the lowest confidence group were significantly more likely to indicate more perceived barriers to healthy eating, report more time constraints and more impulse purchasing practices, and higher convenience ingredient use. Other smaller associations were also found. ConclusionHousehold food gatekeepers with high food skills confidence were more likely to engage in several healthy food practices, while those with low food skills confidence were more likely to engage in unhealthy food practices. Food education strategies aimed at building food-skills and nutrition knowledge will enable current and future gatekeepers to make healthier food decisions for themselves and for their families.

DIFFERENTIATION BASED ON GENDER IN IRANIAN FOOD CULTURE

The purpose of this study is to reveal how gender differentiation in the food preparation and consumption behaviors crystallizes in Iran. To this end, observations were made in Tehran, the capital city of Iran, for a period of one month in 2014. Apart from the observations, in order to be able to determine gender differentiations and gender roles in regard to food preparation and consumption, interviews were also held with ten people from different jobs, genders and ages using a semi-structured interview form. As a result of the observations and interviews, it can be stated that modernizations has taken place especially in regard to eating out. However, it was found that traditional gender patterns and gender roles continue with regard to food preparation and consumption at home. In short, the food is seen as a woman’s thing. Keywords: Iran, gender, gender roles, food culture

Factors influencing food preparation behaviours: findings from focus groups with Mexican-American mothers in southern California.

The purpose of the present study was to explore food preparation behaviours, attitudes, meal planning and shopping among Mexican-American mothers. Data were collected through four focus groups with mothers of Mexican origin/ancestry who considered themselves to be the primary food preparer. Topics included food preparation behaviours and influencers (culture, family, attitudes, barriers, meal planning and shopping). Data were analysed using a qualitative grounded theory approach. All focus groups were audio recorded, transcribed verbatim and coded for themes. Data were collected in southern California, USA in 2013. Of the sample of twenty-one Mexican-American mothers, thirteen were born outside the USA and the mean household size was five members. Participants reported that food was often prepared using traditional staples and food preparation behaviours were learned from maternal family members. Participants also suggested that health was influenced by foods eaten and how they were prepared. Salient factors influencing food preparation behaviours included culture and tradition, maternal family members' food preparation behaviours, food preparation self-efficacy and attitudes towards healthy eating. Time and busy schedules were cited as barriers. Future interventions should consider utilizing family-based approaches and teaching culturally relevant food preparation skills, especially to youth, while reinforcing more healthful dietary practices.

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<h3>ABSTRACT</h3> <h3>Background</h3> Diarrheal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. This article describes a protocol for a cluster randomized trial to evaluate the effectiveness of a multi-faceted community-based educational intervention that aims to improve food safety and hygiene behaviours and enhance child nutrition. <h3>Methods</h3> We will conduct a mixed-methods, parallel cluster randomised controlled trial with baseline measures. 120 clusters comprising small urban and rural communities will be recruited in equal numbers and randomly allocated in a 1:1 ratio to either treatment or control arms. Participants will be mother-child dyads (27 per cluster period) with children aged 6 to 24 months. Data collection will comprise a day of observation and interviews with each participating mother-child pair and will take place at baseline and four and 15 months post-intervention. The primary analysis will estimate the effectiveness of the intervention on changes to complementary food safety and preparation behaviours, food and water contamination, and diarrhoea. Secondary outcomes include maternal autonomy, enteric infection, nutritional content of meals, and child anthropometry. A secondary structural equation analysis will be conducted to examine the causal relationships between the different outcomes. <h3>Conclusions</h3> The trial will provide evidence on the effectiveness of community-based behavioural change and educational interventions designed to reduce the burden of diarrhoeal disease in the under fives, and how effectiveness varies across different contexts.

Characteristics of Youth Food Preparation in Low-Income, African American Homes: Associations with Healthy Eating Index Scores

This study explores food preparation behaviors, including types of food prepared, methods of preparation, and frequency of preparation of low-income urban African American youth ages 9–15 in Baltimore City (n = 289) and analyzes a potential association to diet quality as measured through Healthy Eating Index 2010 (HEI) scores. Overall, the youth prepared their own food 6.7 ± 0.33 times per week without significant differences between age groups or genders as measured through pairwise comparison of means. Cereal, noodles, and sandwiches were amongst the foods prepared most frequently. Linear regression analysis found youth food preparation frequency was not significantly associated with total HEI (p = 0.59), sodium (p = 0.58), empty calories (p = 0.96), or dairy scores (p = 0.12). Younger age was associated with higher total HEI scores (p = 0.012) and higher dairy scores (p = 0.01) and female gender was associated with higher total HEI scores (p = 0.03), higher sodium scores (p = 0.03), and lower dairy scores (p = 0.008).

Household-level dynamics of food waste production and related beliefs, attitudes, and behaviours in Guelph, Ontario

It has been estimated that Canadians waste $27 billion of food annually, and that half of that waste occurs at the household level (Gooch et al., 2010). There are social, environmental, and economic implications for this scale of food waste, and source separation of organic waste is an increasingly common municipal intervention. There is relatively little research that assesses the dynamics of household food waste (particularly in Canada). The purpose of this study is to combine observations of organic, recyclable, and garbage waste production rates to survey results of food waste-related beliefs, attitudes, and behaviours at the household level in the mid-sized municipality of Guelph, Ontario. Waste weights and surveys were obtained from 68 households in the summer of 2013. The results of this study indicate multiple relationships between food waste production and household shopping practices, food preparation behaviours, household waste management practices, and food-related attitudes, beliefs, and lifestyles. Notably, we observed that food awareness, waste awareness, family lifestyles, and convenience lifestyles were related to food waste production. We conclude that it is important to understand the diversity of factors that can influence food wasting behaviours at the household level in order to design waste management systems and policies to reduce food waste.

The relationship between food literacy and dietary intake in adolescents: a systematic review.

The aim of the present systematic review was to investigate the evidence on the association between food literacy and adolescents' dietary intake. The review included searches of six databases with no restriction on the year of publication or language. The studies eligible for review were from five countries/regions: USA (n 6), Europe (n 4), Australia (n 1), Middle East (n 1) and South Africa (n 1). Adolescents aged 10 to 19 years. Thirteen studies were eligible for inclusion. None of the studies investigated all aspects of food literacy. Eight studies reported a positive association between food literacy and adolescents' dietary intake. For example, adolescents with greater food knowledge and frequent food preparation behaviours were shown to have healthier dietary practices. Three studies found a mixed association of food literacy and adolescents' dietary intake. For example, adolescents who frequently helped to prepare dinner had healthier dietary intake, but food shopping tasks were associated with less healthy food choices. Two studies found no association between measures of food literacy and adolescents' dietary intake. Food literacy may play a role in shaping adolescents' dietary intake. More rigorous research methods are required to effectively assess the causality between food literacy and adolescents' dietary intake in order to confirm the extent of the relationship. Evidence recommends public health practitioners and policy makers consider new public health strategies that focus on increasing understanding of food literacy in adolescence.

Educational needs assessment and practices of grocery store food handlers through survey and observational data collection

Grocery store associates in deli/bakery departments prepare and serve an increasing number of ready-to-eat (RTE) foods and full meals. The shift to more convenience foods and take-home meals highlights the need for effective food safety training programs in retail grocery establishments to prevent foodborne illness. Through qualitative and quantitative methods, food safety knowledge, training preferences, needs, and current practices of grocery stores deli/bakery food handlers in Southwest and Southern Virginia were explored. Deli employees (n = 78) completed a 34 question survey eliciting information on demographics, food safety training needs, preferences and knowledge. In an additional phase of this project, a subset of those originally surveyed (n = 15) were observed for food handling practices (6 h per person). Observational data collection focused on cross-contamination, glove use and hand washing. Most grocery store deli/bakery food handlers reported wanting frequent hands-on, interactive one-on-one training lasting less than 2 h. The target audience's largest knowledge gaps included correct temperatures for cooking, reheating and cooling foods. Observed behaviors did not correlate with food safety knowledge. For example, greater than 95% of participants reported using correct hand washing techniques; however, observational behavior data showed less than 50% of hand washing events observed were correct. Additionally, food handlers were observed not washing hands prior to putting gloves on as well as practicing bare hand contact with RTE foods. The creation of short, hands-on or interactive trainings for retail grocery food handlers that focuses on changing food handling and preparation behaviors may enhance the food handler's safe food handling practices.

Healthier Home Food Preparation Methods and Youth and Caregiver Psychosocial Factors Are Associated with Lower BMI in African American Youth ,

AbstractObesity disproportionately affects African American (AA) children and adolescents and leads to an increased risk of adult chronic diseases. Eating few meals at home has been implicated as a cause of obesity among youth, but to our knowledge, previous studies have not specifically investigated this relationship in AA adolescents or looked at both thehealthfulness and frequency of home meals in AA households. The objective of the present study was to investigate the relationship between home food preparation and adolescent BMI in a sample of 240 AA adolescents aged 10–15 y and their caregivers. Multiple linear regressions were used to model psychosocial characteristics, household factors, and adolescent and caregiver food preparation behaviors as predictors of adolescent BMI, and psychosocial and householdfactors as predictors of food preparation behavior. Adolescents in the sample had a mean BMI-for-age percentile of 70.4,and >90% of the sample families received at least one form of food assistance. Adolescent children of caregivers who used healthier cooking methods were more likely to use healthy cooking methods themselves (P = 0.02). Having more meals prepared by a caregiver was predictive of higher BMI-for-age percentile in adolescents (P = 0.02), but healthier cooking methods used by the caregiver was associated with reduced risk of adolescent overweight or obesity (P , 0.01).Meals prepared at home in AA households do not necessarily promote healthy BMI in youth. Family meals are a promising adolescent obesity prevention strategy, but it is important to target both frequency and healthfulness of meals prepared at home for effective health promotion in AA families.

Balancing nutrition, luxury, and time constraints in food preparation choices

PurposeThe purpose of this paper is to examine how nutritional concerns, luxurious tastes, and the value of time affect time allocation decisions for food preparation.Design/methodology/approachA time allocation model is developed and tested with Tobit and Heckman's sample selection models using the 2003‐2007 American Time Use Survey data.FindingsIndividuals concerned more with nutrition or price than luxury devote more time to preparing food‐cooked‐at‐home. High family income and long hours worked increase time allocated to food‐away‐from‐home, indicating that a preference for luxury and the opportunity cost of time outweigh nutritional concerns. High education reduces time spent preparing food‐cooked‐at‐home, yet increases both participation in this activity and time spent obtaining food‐away‐from‐home, suggesting that a preference for luxury and the opportunity cost of time dominate nutritional preference. Time allocation decisions on food preparation vary greatly by race and ethnicity.Originality/valueThe results of this study confirm that the time allocation decisions regarding food preparation are largely affected by an individual's luxury preference, nutritional consciousness, and the value of time, all of which are influenced by education. The findings from this study indicate factors that influence consumers' time allocation decisions regarding food choice and their current food preparation behavior, and thus provide useful insights to nutritionists, dietitians, health practitioners, and policy makers for finding better ways to improve nutritional education, food choices and dietary habits that promote healthier diets and eating habits.

Healthy food intentions and higher socioeconomic status are associated with healthier food choices in an Inuit population

Changing food behaviours amongst Canadian Inuit may contribute to rising chronic disease prevalence, and research is needed to develop nutritional behaviour change programmes. The present study examined patterns of food acquisition and preparation behaviours amongst Inuit adults in Nunavut and associations with psychosocial and socioeconomic factors. Developed from behavioural theories and community workshops, Adult Impact Questionnaires were conducted with adult Inuit (≥19 years) from randomly selected households in three remote communities in Nunavut, Canada, to determine patterns of healthy food knowledge, self-efficacy and intentions, frequencies of healthy and unhealthy food acquisition and healthiness of preparation methods. Associations between these constructs with demographic and socioeconomic factors were analysed using multivariate linear regressions. Amongst 266 participants [mean (SD) age 41.2 (13.6) years; response rates 69-93%], non-nutrient-dense foods were acquired a mean (SD) of 2.9 (2.3) times more frequently than nutrient-dense, and/or low sugar/fat foods. Participants tended to use preparation methods that add fat. Intentions to perform healthy dietary behaviours was inversely correlated with unhealthy food acquisition (β=-0.25, P<0.001), and positively associated with healthy food acquisition (β=0.22, P<0.001) and healthiness of preparation methods (β=0.15, P=0.012). Greater healthy food knowledge and self-efficacy were associated with intentions (β=0.21, P=0.003 and β=0.55, P<0.001, respectively). Self-efficacy was associated with healthier preparation (β=0.14, P=0.025) and less unhealthy food acquisition (β=-0.27, P<0.001), whilst knowledge was associated with acquiring healthy foods (β=0.13, P=0.035). Socioeconomic status was positively associated with healthy preparation and food acquisition behaviours. Interventions to improve diet in Nunavut Inuit should target healthy food intentions, knowledge and self-efficacy. Behaviour change strategies emphasising economic benefits of a healthy diet should be employed to target individuals of low socioeconomic status.

Understanding the older food consumer. Present day behaviours and future expectations

The main aim of this study was to determine whether Baby boomers know how they would manage to maintain a healthy diet on lower incomes in retirement. A cross-sectional survey was conducted at two shopping centres in Melbourne, Australia with 352 respondents. Contingency table analyses (using chi-square tests) were used to examine differences in present and future cooking habits between gender, age and socio-economic groups as well as anticipated changes to food shopping if they had less money in the future. The findings suggest that the most common food preparation behaviours were making meals from scratch ingredients (∼80% of participants) or using a combination of fresh and convenience foods (∼55% of participants), with socio-economic and demographic factors significantly influencing specific behaviours. Nearly 50% responded that if they had reduced income they would make a change to their food shopping habits. The most common changes were to the types of food purchased and seeking out special offers or cheaper brands. The results suggest that when faced with a lower standard of living, people will make changes to their food consumption habits. The challenge facing health promotion practitioners, is to ensure that these changes are well informed, leading to healthy options.

Utilizing Task Clarification and Self-Monitoring to Increase Food Temperature Checks Among Restaurant Staff

A within-group reversal design was employed to evaluate the effects of task clarification and self-monitoring on low frequency food preparation behaviors of 16 kitchen employees who worked at one location of a nation-wide restaurant chain. An informal functional assessment was conducted prior to intervention to identify variables responsible for the low frequency of food temperature checks. Based on the assessment results, task clarification and self-monitoring treatments were implemented. The results showed that the mean percentage of appropriate food temperature checks in the first baseline phase was 14%, 17% in the task clarification phase, 51% in the self-monitoring phase, and 31% in the second baseline phase. The results suggest that task clarification alone, in this situation, was not sufficient to effectively increase performance and self-monitoring is a viable approach to increase low frequency food preparation behaviors such as conducting food temperature checks.

Why do consumers deviate from best microbiological food safety advice? An examination of ‘high-risk’ consumers on the island of Ireland

The objectives of this paper are 2-fold, firstly to profile and identify ‘high risk’ demographic groups on the island of Ireland and secondly to investigate, with these groups, their knowledge of microbiological food safety and the microbiological food safety handling and preparation behaviours they engage in. A representative survey ( n=1025) was undertaken with quotas for age and social class. There was a total of 73 sampling points. Four ‘high-risk’ groups were identified using univariate analysis of variance: (1) 18–34 single males, non-students, without home economics training; (2) 18–24-year-old female homemakers without home economics training; (3) 45+ female homemakers with home economics training; and (4) 65+ males who are either widowed/divorced/separated (W/D/S). Time and financial constraints limited the number of groups (1/3/4), which could be qualitatively investigated in a meaningful way to 3. The findings indicated that these ‘high-risk’ groups were willing to engage in a range of behaviours that deviate from best practise guidelines. Personal (overconfidence; lack of interest), environmental (technological) and lifestyle (time and energy investment) characteristics were identified as the source cause of such deviating behaviour.

Food Preparation by Young Adults Is Associated with Better Diet Quality

Objective To describe food-preparation behaviors, cooking skills, resources for preparing food, and associations with diet quality among young adults. Design Cross-sectional analyses were performed in a sample of young adults who responded to the second wave of a population-based longitudinal study. Measures pertaining to food preparation were self-reported and dietary intake was assessed by a food frequency questionnaire, both by a mailed survey. Subjects/setting Males (n=764) and females (n=946) ages 18 to 23 years. Statistical Analyses Performed Cross-tabulations and χ 2 tests were used to examine associations between food preparation, skills/resources for preparing foods, and characteristics of young adults. Mixed regression models were used to generate expected probabilities of meeting the Healthy People 2010 dietary objectives according to reported behaviors and skills/resources. Results Food-preparation behaviors were not performed by the majority of young adults even weekly. Sex (male), race (African American), and living situation (campus housing) were significantly related to less frequent food preparation. Lower perceived adequacy of skills and resources for food preparation was related to reported race (African American or Hispanic) and student status (part-time or not in school). The most common barrier to food preparation was lack of time, reported by 36% of young adults. Young adults who reported frequent food preparation reported less frequent fast-food use and were more likely to meet dietary objectives for fat ( P<0.001), calcium ( P<0.001), fruit ( P<0.001), vegetable ( P<0.001), and whole-grain ( P=0.003) consumption. Conclusions To improve dietary intake, interventions among young adults should teach skills for preparing quick and healthful meals.

Food shopping and preparation among the 30‐somethings: whose job is it? (The ASH30 study)

PurposeThe paper aims to explore the food shopping and preparation responsibility in a sample of adults, average age 32.5 years.Design/methodology/approachA sample of 198 adults (81 men and 117 women) who were involved in a longitudinal dietary study self‐completed a questionnaire about their food habits. Chi‐squared analysis explored relationships between variables using SPSS (version 10). Open‐ended responses were analysed in QSR NUD*IST using a content analysis framework.FindingsThe majority of respondents were married or co‐habiting (79 per cent), 6 per cent were lone parents, 9 per cent lived alone and the remainder lived with parents and others. Significantly more women than men were responsible for food shopping and preparation (both p&lt;0.001). Within shared households food responsibility was predominately a female dominated area, with a considerably higher proportion of women responsible for food shopping and preparation compared with men. Reasons given for this included aspects of time and work as well as women being more skilled in this task.Research limitations/implicationsThe study was a relatively small and homogenous sample, not necessarily representative of the wider UK population.Practical implicationsIdentifies the enduring gender divide in food responsibility. Findings will be useful to health educators, policy planners and researchers.Originality/valueIn light of the recent focus on diet and health, this paper describes the reported shopping and food preparation behaviours in a sample of adults in their 30s at the beginning of a new century.

Influences of Lifestyle Patterns on Diet

Previous research has demonstrated a clustering of positive health behaviors; individuals with good health practices probably act in a similar way towards other health behaviors. The hypothesis of this study was that lifestyle patterns (smoking, alcohol consumption, and physical activity) influence diet quality and nutrition knowledge, attitudes, beliefs and behaviors. Subjects were 1425 adults who completed USDA's 1994 Continuing Survey of Food Intakes by Individuals and Diet and Health Knowledge Survey. Cluster analysis divided subjects into three groups (Healthy, Moderate and Hedonistic) based on their smoking, alcohol consumption, and physical activity. These groups were compared on their diet quality, knowledge of nutrition, attitudes towards food/nutrition, beliefs about diet and health, and food preparation behaviors using analysis of variance. We found that subjects in the Healthy group (who smoked and drank less, and exercised more) had higher diet quality scores, more positive attitudes, and healthier food preparation behaviors than subjects in the Hedonistic and Moderate groups; and higher knowledge scores and more positive beliefs than the Moderate group. These findings suggest that adults with healthy lifestyle patterns also make good diet choices, and these choices may be influenced by greater knowledge and more positive attitudes and beliefs about nutrition.

A nutritional assessment of homebound elderly in a physician-monitored population.

Nutritional information and support for the elderly are available from many sources. Yet many older adults still remain at risk for malnutrition. This study examined the nutritional status of homebound elderly in a physician-monitored population, with access to health and social services. Older adult patients from the Home Visit Program of the Department of Family Medicine were visited, and an assessment was administered. All patients had primary care physicians who visited patients in their homes, on average, every 3 months. For this survey, the Nutritional Risk Index, the Nutritional Screening Initiative Checklist, an ADL (Activities of Daily Living) assessment, and general history questions were asked. In order to evaluate content of diet, food frequency and a 24-hour diet history were used. Questions on basic nutritional knowledge were asked, and a kitchen survey was used to examine purchasing behavior. Most patients were found to be at high nutritional risk with an average Nutritional Screening Initiative Risk score of 7, but for reasons that varied among patients. Most patients claimed to have a good appetite and enough money for food. The 24-hour diet analysis showed that many individuals did not meet 70% of RDA for major energy sources and fiber. Patient knowledge of the four basic food groups was poor. Since none of the patients shopped for themselves and many did not cook, the nutritional knowledge and food preparation behaviors of caregivers may be important for the nutritional well-being of the patient. An educational program for this population should include the caregiver as well as the patient.