Whole Grains/Lean Protein Message Testing ... - AZ Health Zone€¦ · benefits and barriers to...

Whole Grains/Lean Protein Message Testing Study

Report Prepared for:

Arizona Department of Health Services / AzNN Moses Anshell

August 2010

MA/AzNN: Whole Grains/Lean Protein Message Testing Report Page 2

Table of Contents

I. Background & Methodology....................................................3

II. Executive Summary .................................................................4

III. Summary of Findings – Whole Grains ..................................10

A. Perceptions of Whole Grains.............................................10

B. At-Home Usage.................................................................13

C. Packaging .........................................................................16

D. Assessment of Positioning Statements .............................17

IV. Summary of Findings – Lean Proteins..................................24

A. Perceptions of Lean Proteins ............................................24

B. At-Home Usage.................................................................26

C. Packaging .........................................................................28

D. Assessment of Positioning Statements .............................29

Appendix

A. Focus Group Discussion Guide


I. Background & Methodology Background The Arizona Nutrition Network and Moses Anshell are in the process of developing campaign messaging for FY 2011, which will include whole grains and lean protein. Prior to doing so, they commissioned WestGroup Research to conduct formative research with the target audience regarding these topics. The overall objective of the research was to ascertain eating habits related to whole grains and lean protein, identify benefits and barriers to eating these foods, and to obtain reactions to positioning statements designed to encourage greater consumption of whole grains and lean protein. Methodology To meet these objectives WestGroup conducted focus group discussions with moms in the target audience in each of five key cities (Phoenix, Tucson, Yuma, Flagstaff and Winslow). The groups included a mix of moms representing different stages in the Stages of Change continuum (as defined by the Transtheoretical Model) in consumption of both whole grain foods and lean protein. In addition, participant moms met the following criteria:

• Are between 18 and 49 years of age. • Have children between the ages of 2 and 11. • Are SNAP eligible.

Focus group participants were recruited from lists of respondents who participated in the July 2010 Behavior Model Research Study and who indicated they were interested in participating in a future focus group study. Eight groups were held – two in each of the key cities - between July 27 and August 6, 2010. Five groups were conducted in English and three groups were conducted in Spanish. Wendy Godfrey of WestGroup Research moderated the English-speaking groups and Fernando Cordova of Spanish Media & Translation Services moderated the Spanish-speaking groups. Participants were given $60 as a thank you for their participation. Following are the results of the research.


II. Executive Summary Whole Grains__________________________________________________________ • In general, moms understand that whole grain foods are supposed to be good for

you. Some say they have more nutrients, while others say whole grains are a good source of fiber. However, most know little about the specific vitamins and minerals included in whole grain foods or why they are good for you. That said, moms were able to identify some of the ultimate benefits of eating whole grains, with helping to improve digestion, helping with heart health, and helping to control weight named most frequently. Some also believe that whole grains give you energy and lower cholesterol.

• There is quite a bit of confusion among whole grain, whole wheat, multigrain, and

stone-ground. Moms seem to use whole grain and whole wheat interchangeably, while they are uncertain whether or not multigrain is whole grain. They are also unclear about products that don’t say ‘100% whole grain’ or ‘100% whole wheat’ - are they truly whole grain or whole wheat?

• Most moms report they have whole grain foods at home, with whole grain/whole

wheat bread and oatmeal being named most often. And, most say they include whole grains (these two, specifically) in their regular eating habits. Interestingly, some moms who prefer whole grain/whole wheat bread themselves still serve white bread to their children because their children like the taste better. However, others say they serve whole wheat bread to their children so they will develop healthy eating habits.

• Moms are most likely to look on the front of the package to learn if something is

whole grain or not. Most will look for ‘100% whole grain,’ or ‘100% whole wheat,’ but others say they look for ‘whole grain,’ ‘multigrain,’ and ‘lowers cholesterol.’ Others mentioned the Heart Healthy or red heart logo, with still others saying they look for the wheat stalk on the package. A few read the ingredient label on the back of the package.

• The biggest barriers to eating whole grains include not liking the taste (or someone

in their family not liking the taste), not understanding what whole grains are, not knowing how to prepare them, not liking to try new things, and cost.

o According to these moms, whole grain or whole wheat bread costs two or

three times as much as white bread. Whole Grains Positioning Statements______________________________________ Focus group participants reviewed the following positioning statements relating to whole grains:


Healthy/Good for All

• Eating whole grains is an important part of eating healthy.

• Moms today are eating more whole grains than non-whole grains, and making healthy changes for their families.

• Eating whole grains is a healthy choice for everyone in your family.

Good Taste

• Whole grains taste great and have more vitamins and minerals.

Vitamins and Minerals

• Whole grains have more necessary vitamins and minerals for eating healthy.

• Whole grains offer more fiber, vitamins, and minerals - which are important to eating healthy.

Easy to Switch

• Substituting more whole grains is a healthy step anyone can take.

• Making half of your grains whole is a healthy step anyone can take.

• Substituting more whole grains is easy and healthy for your family.

• The Healthy/Good for All was the most broadly appealing positioning statement for

whole grains. Almost all moms liked the emphasis on healthy eating and the reference to families. Moms also liked the inferred link between healthy eating and being healthy. However, while some moms liked the phrase ‘Moms today are eating more whole grains. . .,’ many found it bothersome. Those who liked it agreed that moms do most of the shopping and make most of the food choices for their families. Those who didn’t care for it maintain that it’s too limiting to assume all moms shop and make food choices for their families. What about the dads, grandparents, and even the kids? Others who objected to this phrase maintain they do not care what other moms are doing – they make decisions based on what they think is best for their family. In addition, a few found the reference to ‘non-whole grains’ confusing.

• Moms who liked the Good Taste messaging said they like knowing they’re getting

more vitamins and minerals when eating whole grains. This statement addresses the fact that, although moms know whole grains are supposed to be good for them, they


don’t know why. For some moms, the statement that ‘whole grains taste great’ is encouraging as these moms are afraid they will not taste good. However, more moms found this statement unbelievable. These moms don’t believe that something that has vitamins and minerals will taste great, and they know their kids won’t believe that something that is good for them will also taste good. Others who have tried whole grains and don’t like them also say this statement isn’t true. Finally, a few moms want more information on which vitamins and minerals whole grain foods contain.

• Moms who liked Vitamins and Minerals did so because it tells them why whole

grains are healthy. In addition, this statement says that whole grains offer fiber, which was important for many moms to hear. Moms get fiber, more so than they do a general statement about having vitamins and minerals. Also similar to the Good Taste messaging, some moms were concerned about what having vitamins and minerals would do to the taste. A few also objected to the blanket statement that whole grains have the necessary vitamins and minerals, saying that people have individual needs in terms of what’s necessary.

• Focus group participants were fairly evenly divided on the Easy to Switch

messaging. Those who believe switching to whole grains is easy say this statement is true, while those who have tried and not liked whole grains and those who are afraid to try them, don’t think it’s easy at all. In fact, it’s very difficult because whole grains taste different, have a different texture, look different, and are more expensive. Moms who liked this statement tended to focus on concepts such as ‘a healthy step,’ and ‘making half your grains whole,’ saying that even if you can’t switch entirely to whole grains, a partial switch is better than none. However, those who didn’t care for it focused on ‘substituting,’ saying they don’t want to ‘substitute’ something they probably won’t like for something they know they like. Several suggested that other family members wouldn’t want them to substitute whole grains for non-whole grains either.

Implications . . .

� A campaign on whole grains definitely needs to include an education component. There is much confusion about what a whole grain is and is not. In addition, although moms know that whole grains are good for you, they don’t know why.

� Fiber is a really good word to use when talking about whole grains. Moms get

this more than they do a general statement about having vitamins and especially, minerals. They understand that fiber is good for digestion, which resonates particularly well with Hispanics.

� Linking healthy eating to being healthy is important. It may give moms a sense of

having control over their families’ overall wellbeing.


� For those unfamiliar with whole grains, convincing them that they taste good will be a challenge. They are definitely perceived to taste (and look and feel) different than non-whole grains, so perhaps talking about the added flavor in whole grains would be effective.

� Although moms are most likely to cite the difference in price between whole

grain/whole wheat bread and white bread, they are also most likely to include whole grain/wheat bread in their eating habits. Many also include corn tortillas. Pasta seems to be a more difficult transition. Although participants maintain cost is a big factor, the flavor of some whole grain foods (including pasta) is definitely a barrier for some. In addition, whether or not moms receive WIC assistance may have a bearing on the extent to which price is a barrier.

� Helping moms understand how to read ingredients labels would be valuable.

Lean Proteins__________________________________________________________ • For the most part, moms agreed that lean proteins are those that have less fat.

Though most were quick to mention skinless chicken, fish, and ground beef as examples of lean protein, fewer listed eggs, low fat dairy, beans, or lean pork when asked which foods are considered lean proteins. Some moms suggested they have to cook these items (skinless chicken, fish, and ground beef) differently if they are going to maintain their lean quality. That is, they need to bake them instead of fry them, and they shouldn’t add as much butter or grease to the pan. In addition, several suggested they needed to add more seasoning to lean chicken and beef to add flavor that is lost by removing the fat.

o Spanish-speaking moms were unfamiliar with the Spanish word for “lean,”

“magra.” Most either used the English word “lean,” or they used the translation for low fat.

• Most moms agreed that eating lean proteins is healthier than eating other proteins

saying they are better for your heart, they don’t clog your arteries, they help build muscle, and they give you energy.

• Once given the list of lean proteins, moms were most likely to say they include

chicken, eggs, and beans in their diets. Fewer have lean beef, fish, turkey, nuts, or lean pork in their kitchens, and almost no one has tofu. Moms report similar eating habits among their children.

• Moms are most likely to look for the “% fat” designation on a package of ground beef

(e.g., 80%/20%) as well as the sticker that says ‘lean,’ although others just look at the cut of beef to see how much fat or marbling it contains. Almost no one said they look for the grams of protein per serving or any other information that is included on the package.


Lean Proteins Positioning Statements_____________________________________ Focus group participants reviewed the following positioning statements relating to lean proteins: Healthy/Good for All

• Eating lean protein is an important part of eating healthy.

• Moms today are eating more lean protein, and making healthy changes for their families.

• Eating lean protein is a healthy choice for everyone in your family.

Good Taste

• Lean proteins taste great, and have less fat.

Easy to Switch

• Switching to lean proteins is a healthy step anyone can take.

• Switching to lean proteins is easy and healthy for your family.

• Moms had a similar reaction to the Healthy/Good for All positioning when seen with lean proteins as they did when it was coupled with whole grains. They like hearing about healthy eating and love the statements about moms making healthy choices for their families. In addition, moms who are already serving skinless chicken and lower fat hamburger, feel this statement reinforces what they’re already doing.

• The Good Taste message worked much better with lean proteins than it did with

whole grains. For the most part, moms believe lean proteins taste good and most know that lean means less fat. So, this statement is believable and positive. As one participant put it, ‘Something tastes great and it has less fat? What’s not to like about that?’ Those who didn’t care for this statement do not agree that lean proteins taste great, with some saying that it takes a while to get used to the taste and/or that you have to add more seasonings to improve the flavor.

• Moms are more likely to believe the Easy to Switch statement when coupled with

lean proteins than they are to believe the statement when talking about whole grains. Some are already serving skinless chicken, lower fat hamburger, and fish to their families, while others serve a lot of beans, eggs, and yogurt. Learning that such items fall into the lean protein category, makes this seem more doable to many moms. Some see the ‘switch’ as simply a ‘switch’ in how these things are prepared.


And, as suggested previously, those who didn’t care for this statement, believe switching to lean proteins would require a period of time to adjust to the different taste, or that switching to lean proteins will be more expensive.

Implications . . .

� A campaign on lean proteins also needs to include an education component. Though moms are a little more familiar with some sources of lean protein (e.g., skinless chicken, lean hamburger, and fish), most are not aware of other sources such as eggs, beans, low fat dairy, etc., that they often include in their regular eating habits. Some are also unfamiliar with how to cook these items so they still taste flavorful.

� ‘Lean protein’ is not how moms usually think of low fat items such as chicken,

fish, and eggs. They are much more used to thinking of these as low fat or having less fat. This is particularly true among Spanish-speaking moms.

� Moms believe one of the major benefits of lean protein (or any other protein) is

that it gives you energy. This is something a campaign might address, as all moms (and their kids) want more energy! In addition, moms love the idea of something that tastes great and has less fat. This might also be an effective way to encourage consumption of lean proteins.

� ‘Switching,’ ‘substituting,’ and ‘changing’ are not always things people want to do,

especially if they’re ‘switching,’ ‘substituting,’ or ‘changing,’ from something they know they like to something they don’t like or are afraid to try. Encouraging moms to take small steps toward incorporating whole grains and lean proteins into their eating habits may be more effective.


III. Summary of Findings – Whole Grains A. Perceptions of Whole Grains

1. What is Whole Grain? Bread and cereals, particularly Cheerios, were the foods that came to mind most often when thinking of whole grains. When describing whole grain products, moms said they have more nutrients, are darker in color, are more natural, and are not so processed. A few said they have a different, grainier texture. Most agreed they are more expensive than similar products that are not whole grain. There was some confusion about the difference between whole grain, multigrain, stone-ground, 100% whole wheat, and 100% wheat. Products made with any of these ingredients were thought to be healthier than products made with white flour, but many moms were not sure why.

I eat whole grain stuff sometimes, but not every day. I don't understand it really well since I don't purchase it a lot. My children noticed the taste. They told me that (whole wheat pasta) tasted different. The truth is that it does have a different taste; it is lighter. I liked it but not my husband. (S) I guess it seems a little more gritty because of the different ingredients and the grains that are in it. As far as taste though, most of them, you don't really notice the taste. It has more flavor. I like whole grain better. I think it's confusing. The wording is confusing. I always look at the fiber in it. They diagnosed my husband with diabetes and they recommended we eat wheat products. I began to buy wheat tortillas and the truth is that they taste the same. We did not notice a difference in the flavor. (S) I think they’re confusing, ‘cause there are so many different kinds of wheat bread and you don’t know. There’s the 5-grain, or whole wheat or whatever. There’s just so many; it’s so confusing. If you're buying just white bread then it's $1.00 or so, but if you're buying 9-grain, then it's $3.00 to $4.00 a loaf.


2. Benefits of Whole Grains

The majority of moms have a general sense that whole grain foods are healthier than foods not made from whole grains. However, many do not have a clear understanding of why whole grains are better for you. The most frequently cited reason for being healthier than non-whole grains is because they have fiber. Interestingly, even though most did not have a clear understanding of exactly what makes whole grains healthy, moms were able to list a number of benefits to eating whole grain foods, including the following:

• Helps your digestive system. • Good for heart health. • Provides more energy. • Good for people with diabetes. • Lowers cholesterol. • Fills you up faster/helps control weight.

A few moms were very educated about the health-related benefits of whole grain foods as well as why certain food products should be consumed. These moms were frequently those who had family members with a health condition that forced the family into changing their eating behaviors and learning about the reasons for the changes. In addition, the “new” WIC Food Package includes 100% whole wheat or whole grain bread, as well as other whole wheat/grain products, which may have increased the understanding of some participants.

Helps the digestion. There are some that have zero cholesterol and that helps the heart, so they don’t have fat that accumulates in the heart. (S)

It helps you to be healthier and more energized and to feel better. When you eat healthy, your body feels extremely different than when you eat junk food.

It seems like it gives you more energy, energy to move, to keep you going. That’s just how I see it. We’ve changed our habits in the last couple of months of eating. It seems like it’s enough, with the wheat bread, instead of eating a whole lot. Just a slice of wheat bread and cheese with it, and it’s filling. It keeps you going.

My kids eat (whole grains) because they can't eat things like pasta or they will get bad stomachaches, so the wheat helps digest your stomach better.

I say that multigrain is healthier. They told my husband at the hospital that multigrain products are healthier. The wheat products help the pancreas; they do not have sugar. (S)

When you are eating lots of flour you are damaging your heart and when you don’t you are more active. (S) It lowers the cholesterol or at least that's what they say on the Cheerios box.


3. Vitamins and Minerals in Whole Grains

When asked which vitamins and minerals are in whole grains, most respondents were unable to name any, although one or two mentioned iron.

I've read about it before, but I couldn't sit here and tell you everything about it. I think it is low in sodium (S) And low in carbohydrates. (S) It’s fiber. I've heard that whole grain is very good for women because it has all the iron and vitamins.


B. At-Home Usage 1. Questionnaire Results Participants were asked to complete a brief questionnaire indicating which whole grains they have in their households and which they eat. This information was gathered to provide insight into their current purchase behaviors of whole grains and to give perspective to their feedback on the positioning statements.

Do you have any whole grains in your kitchen now? What kinds of whole grains do you have in your kitchen now?

Almost all respondents indicated they have whole grains in their kitchen. Whole grain/whole wheat bread and oatmeal were the products most often named, followed by other cereal and popcorn. Mentioned less frequently were whole wheat crackers, whole wheat tortillas, and whole wheat/multigrain pasta.

What whole grains have you eaten in the past 24 hours? The majority of focus group participants said they had eaten whole grain/whole wheat bread in the past day. A smaller group of women, about one-fourth of them, said they had eaten oatmeal, other cereal, popcorn or whole wheat crackers in the past day.

What whole grains do your children eat? According to these moms, whole grain/whole wheat bread and oatmeal are the whole grain foods their children are most likely to eat. These items were followed by popcorn, whole wheat crackers, and other cereal. While a large number of the moms said their kids eat whole grains, in later discussions it became apparent that this may have been overstated. There were some moms who let their children eat whatever they want, and if their kids don’t like whole wheat bread, for example, they buy white bread for them.

I try to give my children the best and I try to keep informed. I am reading magazines, the Internet . . . but I do not give my children whole grain products because they don’t like them. (S)

2. Whole Grains Users

a. Why Prefer Whole Grains? Moms who currently eat whole grains, or whose children eat whole grains, were asked why they prefer them over non-whole grains. Health-related reasons, which dominated the discussion, included the following: less sugar, healthier, fiber, helps lower


cholesterol, and it’s more filling (eat less, lose weight). Additional reasons were that some prefer the taste of whole grains and others say they like the texture.

They have less sugar so it is good for my daughter. I notice that when her grandmother gives her white bread or tortillas she tires easily, she feels lethargic. She is tired and doesn’t want to do anything. When I see that she eats a lot of protein she gets a lot of good energy, she is fine and it helps her to go to the bathroom. (S) Because it tastes better and you don't have to eat as much to feel good and to feel full. I use both. I eat whole wheat because I feel like it's better for me. It does have a different taste though, and it's a different texture. I actually like the different textures inside the bread, the little pieces. I love that. Less risk of having cholesterol because it cleans your organs due to the fibers and grains. (S)

b. Reasons for Serving Whole Grains to Children In addition to the immediate health benefits, moms want to encourage their children to eat whole grain products so they develop healthy eating habits. Some of the moms mentioned that when they were growing up, their eating habits were unhealthy. They ate white bread, flour tortillas, and a lot of fat. By serving whole grains, as well as fruits and vegetables, they are attempting to chart a different path for their children by getting them used to eating foods that are good for them.

I have noticed that we all grew up in a different time. Our parents were not so focused on not eating so much sugar, so much bread, tortillas. We are Latino so we like tortillas. Now we see obesity, cholesterol, heart problems, all of that. We are trying to teach our children to eat better than we did. (S) Give them nutrition at an early age (so they are) forming good habits. (S) It’s good for your kids to start teaching them to eat vegetables and good foods.

3. Why Not Whole Grains Moms who don’t currently eat whole grains were asked what they don’t like about them. Not liking the taste (either themselves and/or other family members) of whole grains is one of the major obstacles. Other barriers include: confusion about what whole grains are, confusion about how to prepare them, and not liking to try new things. In some cases, particularly with bread, the higher price of whole wheat products compared to non-whole wheat products is also a barrier to purchase.


Sometimes white bread just tastes better with certain things, like on certain sandwiches, I like having white bread or potato bread better. The labels are confusing and that gives you doubt in a product. A lot of times you stay with the product that you already know because you are too lazy to look for another that has a higher percentage of fiber or wheat. (S) Some children say that multigrain bread looks like it has rocks in it because of the grain. (S) I like white better because it tastes different. I tried wheat once and haven't tried it again. I don’t like trying stuff that’s new. I’m really picky and I like my food being the way I want. My mom’s obsessed with whole grains – tortillas, everything – and she thinks it’ll help you lose weight, so she tries to get me to try it and I won’t. I think as parents sometimes we think our kids aren't going to like certain things, so we just don't take the time to make it and that it would be a waste of money because they're not going to eat it, so it's kind of our fault for not introducing it to them and letting them try it. I like (whole wheat bread), but I do like it sweeter. I try to make my daughter eat it and she won’t, so I eat it. I am starting to acquire a taste for it. The taste is different like say a Multigrain Cheerios or Honey Nut Cheerios as compared to a Cocoa Crispy. (S)

The white bread is cheaper. (S)

Choosing whether or not to purchase certain whole grain products and serve them to their family hinges, to a certain extent, on acceptance by other family members. While many moms and their families like whole wheat bread, and many prefer it, the same is not true for pasta. Some moms do serve whole wheat pasta, but acceptance of it is not nearly as widespread as for whole wheat bread. Relatively speaking, there were more negative comments about whole grain pasta than other whole grain items.

It looks almost like it’s dirty. The pasta, when you cook it, looks like you dropped it on the ground and picked it up. I don’t like it as pasta. I don’t like the whole grain pastas because it doesn’t seem to cook down like regular pasta does. It stays al dente and I don’t like that. I’m scared to try whole grain pasta, because I like my pasta and I don’t want it to have any different taste to it. So I haven’t tried it. It just doesn’t look appealing. It’s discolored and it just doesn’t look right.


C. Packaging When buying whole grains, there are numerous elements moms look for on the package to identify the item as whole grain. Most often mentioned was looking for the words 100% whole grain or 100% whole wheat. Other words moms look for include: whole grain, multigrain, and lowers cholesterol. In addition, some look for a red checkmark, indicating the product is Heart Healthy, or a red heart, such as the one they find on Cheerios boxes. Several said they look for the wheat stalk on the package, while a very limited number look for the whole grain stamp when looking to purchase whole grain items. Similarly, a few read the ingredient label on the back of the package.

I must say that I'm horrible at that. I know some people like to read what is in it and how many calories it has, but I just look at the box and if it says whole grain then I'm going to trust it. I don't flip it around and check how many calories are in it and stuff like that. If it says whole grain and it is appealing to the eye, then I'm going to get it.

Multigrain or 100% wheat. I will take it just the same. (S)

I would look at the front of the box is all. There are several of them (Cheerios), but one of them says that it lowers your cholesterol, and then they have the multigrain that says multigrain on it, so I just go by what it says. 100% whole wheat. (S)

Some of them also have a heart on them, like the Cheerios box, and that tells you that it is better for your heart. I look for the grain stalks, the picture, when I see that I know that it is wheat. (S) Not in the bread because it is always wheat but in other products I do notice and look for the wheat stalk. (S)

Following are examples of the logos or symbols mentioned in the groups:


D. Assessment of Positioning Statements Focus group participants were presented with four alternative positioning statements, and for each statement, asked which they think would be most effective in encouraging moms to eat more whole grains. In reviewing the statements, participants were asked to circle the words or phrases they liked and to cross out those they didn’t like. Following is a summary of the findings for each of the statements. a. Healthy/Good for All

• Eating whole grains is an important part of eating healthy.

• Moms today are eating more whole grains than non-whole grains, and making healthy changes for their families.

• Eating whole grains is a healthy choice for everyone in your family.

Overall, moms like the Healthy/Good for All messaging for the following reasons:

• The focus on healthy is viewed very favorably, and eating healthy is an issue that’s important to everyone. In addition, moms like the linkage between eating healthy and being healthy. There were many comments about family members with health issues who had to change their diets. This Healthy concept encourages families to change.

• This concept communicated something they can do that is good for their family,

not just for them.

• Some moms liked the reference to Moms today are eating more whole grains, since moms do most of the shopping and are the ones making the food choices for their families.

I like that eating whole grains is an important part of eating healthy and also eating whole grains is a healthy choice for everyone in your family. I like it because it says it is ‘healthy.’ I think that we get sick less when we eat healthy, such as cancer. (S)

It's letting the families know that eating whole grain is very healthy. I like how they use moms because there are a lot of moms, and that kind of makes us pay more attention because when you hear the word ‘mom,’ you're thinking about your children and what they should and shouldn't be eating, so I think using the word ‘mom’ in there is good.


I liked the word ‘moms’ because we are the ones that go to the store and make the healthy choices. (S) It is a healthy choice because in eating these products you know you are giving something good to your family. (S) I liked the last part about making healthy changes for their families. I would think that most mothers would want the best for their kids. If I wasn't doing the right thing, it would kind of make me look at things and realize maybe I'm not doing what I need to do to keep everybody healthy. ‘Everyone in the family’ pops out. They’re my family. I want to do what’s good for my family. We don’t have a lot of health concerns in my family, so that pops out for me. I want to do what’s good for my family. The mom part really doesn't bother me that much because it's really the moms who make the decisions mostly in the household of what their family eats. Dads don't really care because they just want food.

Very few moms said they didn’t like this messaging, however there were some words or concepts that were bothersome:

• The majority of moms disliked the reference to moms in the statement. Some felt it was too limiting because there are others involved in making decisions on whether or not to eat healthy such as fathers, grandparents, or even the children.

• Some also disliked the reference to moms today are eating more . . , because it

sends a guilt-inducing message. If moms today are doing something, and as a mom you’re not doing it, it makes the mom feel like she is doing something wrong, that she is not being a good mom. Others said that just because moms today are doing something, it doesn’t mean they are going to do it too. In other words, that is not motivation enough – they are going to do what they think is best for their family.

• The reference to non-whole grains was confusing to a few.

I like these, but I don't like the mom part either because dads and grandmas and other family members are doing it too. The part about eating more grains I do like though.

It’s not always going to be a mother. It can be a father; it can be a child who decides to start it. It’s not going to be just the mother. It’s families in general. I did not like it because there are single fathers with children; in some families there is not a mother. (S)


I didn’t like the ‘moms today are eating more whole grains than non-whole grains.’ I don’t care what other people are doing. It doesn’t bother me. I’m not trying to follow them. I mean, if I’m going to do something it’s going to be for me and my family, not because somebody else is doing it. I don’t care what moms today are doing – I want to know what I’m doing.

The third one that says ‘eating whole grains is a healthy choice for everyone in your family’ stirs up guilt like as if I had not given them any before. (S) I think the words ‘non-whole grains’ are kind of confusing. I didn’t necessarily know when I walked in here what whole grain was. I know I’ve been eating whole grain bread since I was itty-bitty, and that’s what I feed my kids. But I couldn’t describe what it is, so that was kind of confusing to me.

b. Good Taste

• Whole grains taste great and have more vitamins and minerals.

Those moms who liked this positioning said they like knowing they’re getting more vitamins and minerals when eating whole grains. They know whole grains are supposed to be better for you, but they were not sure why. This statement addresses the need for moms to understand more about why whole grains are better than non-whole grains. The emphasis on taste is helpful for those who have not had much experience with whole grain foods or are afraid to try them. This statement was thought to be especially meaningful to kids, who are, for the most part, much more interested in how food tastes than whether or not it is healthy.

I actually like the fact that it says it has vitamins and minerals. I like to know what’s in (whole grains). If you just say it is healthy then that might not be as appealing as the word taste. They might think it doesn't taste good if it just says ‘healthy.’ Kids see the word ‘healthy’ and they think no sugar and no salt. I like this statement for kids because it was just about a week ago that my kids were asking me how our bodies work, so I told them when you eat you get vitamins and minerals from your food, so then they started getting curious about where they got their vitamins and minerals and stuff, so I really like this one because it doesn't say healthy or anything like that because that's for old people.

Those who did not care for this statement feel there is a disconnect between tasting good and having lots of vitamins and minerals.


• Taste and vitamins and minerals should not be talked about together. Knowing there are more vitamins and minerals in whole grains is beneficial, but vitamins and minerals don’t taste good, so, for some, it doesn’t sound believable.

• Those who don’t think whole grain foods taste good also find this statement

unbelievable. • Some liked learning that there are more vitamins and minerals in whole grains,

but didn’t think the statement went far enough. The claim that whole grains have more vitamins and minerals is something they see a lot, so it has little impact. For some, it would be more meaningful if the statement included information specifically stating what vitamins and minerals they’re getting with whole grains.

I think people would have trouble trying to convince people that it has a great taste and it has a lot of vitamins because if you taste something that has a lot of vitamins, it doesn't have a great taste, so it would be hard to convince people of this. If I’m going to talk about the taste, I’m definitely not going to say there’s vitamins and minerals, because vitamins and minerals don’t taste good. I’m definitely not going to say that. If you eat a bar with vitamins and minerals, you can tell they’re in there; that wouldn’t be good taste, I don’t think. I don't think everyone would agree with the taste, but having more vitamins and minerals in it, you can't go wrong with that. Well, it lies to me because it says whole grains taste great, and I don’t think they taste great. They’re tolerable, but I don’t think they taste great.

Nobody’s bothered to ask about the vitamins and minerals. What vitamins and what minerals? Why am I going to eat it? What’s it really going to do for me and my family? What difference is it going to make? What vitamins am I going to get out of it? It’s like people who overuse ‘healthy for you’. Lots of people are overusing the ‘made with vitamins and minerals’ – it’s overused, too. If there’s more specifics to it, it’s more eye-catching. I like simple and easy things, but if it’s something that’s stated in a simple way, that it’s giving you half your daily value of vitamin B or whatever, then that’s eye-catching.


c. Vitamins and Minerals

• Whole grains have more necessary vitamins and minerals for eating healthy.

• Whole grains offer more fiber, vitamins, and minerals - which are important to eating healthy.

Similar to the reasons for liking the Taste statement, some moms liked this one because it told them why whole grains are healthy. This one had the added benefit of communicating that whole grains contain fiber. This was important information for many moms to hear.

The main thing is fiber because everybody is looking for fiber. And it also tells you what it's offering and what nutrients you get with eating the whole grains. I would buy something if it had fiber listed on the front of it because where else do you get that besides your cereal or your bread maybe? I like the second one that says whole grains offer more fiber, vitamins, and minerals, which are important to eating healthy. I like that one better than the first one because it points out the fiber and the vitamins and minerals.

Also similar to the Taste statement, there were some who were concerned about whole grains containing more vitamins and minerals, and wondered what it would do to the taste. In addition, some participants objected to the phrase whole grains have more necessary vitamins and minerals, since they believe that the vitamins and minerals people need are different from person to person.

There are some people out there that don’t want a lot of minerals. They think they might get sick if they eat too much minerals. The vitamin part’s good because everybody wants the vitamins, but the minerals – some people might be a little cautious. When you think of vitamins and minerals, you think of the taste of a smoothie that has a vitamin booster in it and it doesn't taste all that great. Someone who’s breastfeeding needs completely different things than what I do. So, who’s to say what’s necessary, and what vitamins and minerals are you feeding me that are necessary?


d. Easy to Switch

• Substituting more whole grains is a healthy step anyone can take.

• Making half of your grains whole is a healthy step anyone can take.

• Substituting more whole grains is easy and healthy for your family.

More than the other positioning statements, opinions towards the easy to switch messaging were split. The reasons why some moms liked it were the same reasons others disliked it.

• This statement tells people it’s not as hard to eat whole grains as they may think.

• Households that are already eating whole grains liked this statement because it reflected what they had experienced. Some of them had initial concerns that other family members would balk at eating whole wheat bread, for example, but if there was resistance from others, it didn’t last long.

• The phrase making half your grains whole was viewed favorably, because even if

a household doesn’t switch entirely to whole grains, a partial switch is better than none.

I think I like the first statement the best because it's letting everybody know that it's not as hard as most people think it is to substitute a little bit at a time, and then gradually they will like it. As long as you can get them to try it, most of the time they will like it just as much as the regular stuff. For people that do not eat whole grain, half is fine. It is better than nothing. It is better to take half a step forward than half a step backwards. (S) I liked the one that says ‘making half of your grains whole is a healthy step anyone can take’ because it's pretty much saying you're going to cut what you're eating to eat whole grains, and this is something you choose to do. It’s letting you know if you make even a little bit of a step, it’s better than not doing all of it.

Those who didn’t care for this statement were most likely to object to the word substitute. For these moms, substitute means something (that they probably like very much) is being eliminated from their diet and being replaced with something else (that doesn’t taste as good to them).


Easy to switch wasn’t believable to some, because they don’t think it would be easy to switch. The main problem mentioned was that other family members wouldn’t like the taste, so they wouldn’t accept a change to whole grains. The other thing that makes this difficult (not easy) is the cost, since whole grains foods are (or are perceived to be) much more expensive than non-whole grains. There was also some resistance to the phrase making half your grains whole. Instead of viewing it as intended, some interpreted this as serving two types of a food item at a meal, one whole grains and the other non-whole grains. Obviously, this means more work for mom.

I crossed out the word ‘substituting.’ It makes you feel like you're cutting out the white bread or the white pasta completely, and some people aren't so quick to cut that out and switch to the whole grains. Why is it that you have to substitute it? Why can’t you just add it? If I have family come over, I’m going to serve regular crackers and wheat crackers, and then people can decide what they want. I’m not going to substitute. I think it’s a detriment to whole grains when you say ‘substitute’ because that’s saying, in my mind, that I’ve got to replace with something that’s new and I don’t know if I care for it or not.

I think saying to ‘make half of your grains whole’ is kind of a big step. You have to get used to the whole grain, and I don't think it's easy to get your kids to switch. It sounds like if you set the table with half wheat bread and half white bread, everyone is going to go for the white bread because that is the one they know and are used to eating. (S) What about fixed income? When I think ‘easy to switch’, I’m thinking how much more it’s going to cost me.

Whole grain is always way more. Whole grain pasta is, like, $4 a box compared to the regular stuff that’s $2.


IV. Summary of Findings – Lean Proteins A. Perceptions of Lean proteins

1. What is Lean Protein? When asked what lean protein means, responses were typically examples of food items moms consider to be lean protein. Chicken, ground beef, and fish were the most frequently mentioned items. Some mentioned that chicken needs to have the skin removed to be considered lean. Upon further discussion, lean proteins were defined as being low fat/having less fat. Many moms suggested that food preparation is also a factor in whether something is a lean protein or not. For example, chicken and fish are no longer lean proteins if they are deep-fried. Knowledge was mixed about whether or not some products are lean proteins. There wasn’t a consensus on whether beans, nuts, eggs, and pork are lean proteins, and only a few mentioned milk or other dairy products such as yogurt, cheese, or cottage cheese as lean protein. Spanish-speaking moms were unfamiliar with the Spanish word for lean, magra. They either used the English word lean, which is how lean meat they purchase is labeled, or they use the translation for low fat.

Chicken or meats without the fat. If you’re making regular pinto beans with your dinner you can get that good part of the protein. But if you’re refrying them, you get all the oil, the grease. It depends on how you cook it (chicken). Baked is fine, but if you fry it in oil it is not fat free. (S)

Participants were also asked about non-lean protein and asked to give examples. Some products were consistently identified as being non-lean protein, such as sausage, bacon, bologna, and fried chicken. 2. Benefits of Lean Protein

Comments regarding the benefits of lean proteins were mostly health-related. Some were general health comments, but other moms made more specific comments about being good for your heart, not clogging your arteries, building muscle and having more energy. Another benefit of lean protein is weight control.

It’s healthy for you, and it gives you energy, which you need for your body.


It’s good for your blood because it’s not putting a lot of fat and grease in your arteries. It’s better for your cholesterol, too. Helps you in the future against diabetes. (S) Does not have so much fat that clogs arteries. (S) I think of protein as energy. If it’s lean, you’re not getting a lot of fat, so it’s energy without the fat. When you choose a leaner product, you're more likely to have higher energy levels. It is healthier for your heart and better for your cholesterol or clogging of arteries or hardening of arteries. It's just more beneficial to your body, and it will digest better in your body. Because they are low in fat and it helps lower your weight. (S) I just know that lean protein is healthier. When I buy meats, I look for the leanest looking product. I know hamburger has the percentage on it, so I look at that, and then when I go to fry it up, I rinse it with water in a strainer to get the grease off of it just because I know it's not healthy. Heart disease runs in our family, too. Keeps your lean muscle mass; keeps your hair in your head; helps all your muscles.


B. At-Home Usage 1. Questionnaire Results Participants were asked to complete a brief questionnaire indicating which lean proteins they have in their household and which ones they and their children eat. This information was gathered to provide insight into their current purchase behaviors of lean proteins to give perspective to their feedback on the positioning statements.

What kinds of lean protein do you have in your kitchen now?

With a few exceptions (primarily those who were not sure what lean proteins are), all of the moms had lean proteins at home. The top three, chicken, eggs, and beans, were in almost all of the homes. Half to one-fourth have lean beef, fish, turkey, nuts, or lean pork in their kitchen, while very few have tofu. Some moms, while they have been serving lean proteins, were not making a conscious effort to serve lean proteins. Some of the moms didn’t know the difference between lean proteins and non-lean proteins. They said they were interested in learning more, and after the knowledge they gained from the focus group discussion, said it would influence how they shop.

Not everyone knows the difference. One buys what they are used to eating since childhood that is the way we were brought up. (S) You still need to define what lean proteins are. I don’t know that everyone realizes what a lean protein is. Is every nut a lean protein? Because you can buy a can of nuts and there’s grease all over them. I think there are a lot of people that do not know what lean protein is, because I did not know. (S) In my family they don’t even know what lean means. (S) Knowing what I know today and the list here that you gave us, those are the items that I would look for or something like that in the same category. I would also look at the labels. Because when I go to the store now I know what I am going to read because before I did not know what lean was. Now I know. (S) (Understanding labels) would be helpful because you look at that stuff sometimes and there’s so much stuff on there and you don’t even know what half of it is.


What lean proteins have you eaten in the past 24 hours? Eggs were the lean protein eaten by the most moms in the past 24 hours, followed by beans, chicken, and lean beef. Fewer had eaten fish, nuts, or lean pork, while very few had eaten turkey or tofu.

What lean proteins do your children eat?

The vast majority of the moms reported that their children eat chicken, eggs, and beans. Half or more said their children eat lean beef, fish, turkey, and nuts. Lean pork followed, with only a couple of moms saying their children eat tofu. 2. Why Prefer Lean Protein? Moms who prefer to eat lean protein say it is healthy, nutritious, and tastes good.

It is healthier; it does not have fat. All of the fats accumulate in the arteries, the heart. With time it will affect us. (S) If you eat more lean protein, it doesn’t make you gain as much weight as eating carbs.

3. Why not Lean Protein? There wasn’t a lot of resistance to eating lean proteins, but there were some negative comments about lean proteins being dry, or just not liking the taste. A few found it necessary to adjust the seasonings when cooking with lean proteins to improve the taste. Others said they would serve lean protein more often if the price weren’t so high.

Family doesn’t like taste. (S) I think it is okay, but I have to add extra stuff on it if it doesn't have skin, like I will add extra seasonings to make it taste good for my taste buds. I think that if the prices were more accessible more people would buy. Not all of us have the option of buying it. (S) I think that if it weren’t so expensive we would be encouraged in making a choice to change. (S)

4. Reasons for Serving Lean Proteins to Children Some moms said they serve their children lean proteins because they are healthier and to give them energy.

Because it is healthy for them, they don’t get constipated. (S)


C. Packaging There are several things moms look for when purchasing lean meat or poultry:

• Sticker that says lean. • % of fat (e.g., 80%/20%). • The words lean or low fat somewhere on the packaging. • The appearance of the meat or poultry, e.g., not a lot of fat on the outside of

the meat, limited marbling, skinless chicken. In general, they do not look for the grams of protein per serving.

That it says the percentage of fat. (S) And they have a number on there, like 80% and 20%, which means it's 80% lean and 20% fat.

Check the fat on it. If you're buying steaks, if they have a lot of fat on them then they're not lean. Usually the package will say lean if it is lean, but sometimes I will choose something just by looking at it. The sticker with ‘lean’ on it. (S) The seal has to say the percentage (of fat). (S) On pork, you have to look at the cut. With chicken, it has to be boneless, skinless. You can also visibly look for cuts of meats that don't have fat on it. Some of the meat will have obvious marbling in it. On meats, they will say ‘extra lean’ or sometimes the signs will say ‘less fat.’ Nuts have their own fats and oils, so I don’t know. It (lean protein) has the sticker and is says there is has a percentage and also it is thin. (S)

It tells you on the label. It will say something like 80% lean or whatever.


D. Assessment of Positioning Statements Focus group participants were presented with three alternative positioning statements, and for each statement, asked which they think would be most effective in encouraging moms to switch to eat more lean protein. In reviewing the statements, participants were asked to circle the words or phrases they liked and to cross out those they didn’t like. Following is a summary of the findings for each of the statements. a. Healthy/Good for All

• Eating lean protein is an important part of eating healthy.

• Moms today are eating more lean protein, and making healthy changes for their families.

• Eating lean protein is a healthy choice for everyone in your family.

Moms reacted similarly to this positioning when shown with lean proteins as they did when coupled with whole grains. That is, they like the healthy aspects of eating lean proteins, which, for some, reinforces many of their current eating habits. And, as stated previously, moms like to see the references to healthy eating for the entire family.

I liked the first one because eating lean protein is an important part of eating healthy, because it’s not a lot of fat. It is for the benefit of the entire family. Because it is for everyone. (S)

And I do think ‘healthy’ is good, because whole grains have been shoved down our throats; lean protein really isn’t. ‘Pork, the other white meat.’ That’s all they say. They don’t really say anything about lean protein. So this really hasn’t been shoved down your throat as health food goes. You hear about whole grains and everything like that, but nothing about proteins or any other. Fiber and all that, but not as much about protein.

Interestingly, while there were some negative comments about the moms phrase, there were fewer than with the whole grains Healthy statement.

Some people are like that. Some people want to follow what everybody else is doing. I’m just not that person. Again, I don’t like the whole moms thing like they had in the whole grains one, too.


b. Good Taste

• Lean proteins taste great, and have less fat.

There was agreement from most moms that lean proteins taste great, so this was a believable message . . . much more so than for whole grains.

And they do taste great. They taste a lot better than the fatty stuff. I like that one because there are a lot of lean proteins out there like pork chops and hamburger and steaks that taste great and have less fat. Sometimes I think they even taste better because there is less fat, and I don't like the taste of fat. Yes, because lean meat does taste better and has the benefits and it is true that it has less fat. (S) That sounds great to me. Something tastes great and it has less fat? What's not to like about that? You can't go wrong with that one. I think it sounds good because it is straight to the point. It has less fat, it tastes great, and it's good for your health.

Though far fewer than with whole grain foods, some moms feel lean proteins don’t taste as good as non-lean proteins. In addition, some think it would be necessary to cook lean proteins in a different way than if they were using non-lean proteins, e.g., additional seasoning might be needed, as well as needing to add oil. Finally, a few didn’t feel this message communicated clearly enough the benefits of eating more lean proteins.

I crossed out ‘tastes great’ because it took me a while to actually get used to lean protein, because my parents always bought whatever was on sale or the cheaper stuff when we were growing up. So, when I actually started supporting myself, I could afford it, so I bought it, and it was different. Yeah, like turkey bacon – you have to put oil in there. And, 97% hamburger gets stuck to the pan because it doesn’t have enough fat to keep it going. It’s less moist, depending on how you cook it. And, some people aren’t good cooks to begin with, and they don’t know how to cook regular food right, so you get lean meat and it’s really bad. I don’t think it tastes great; ground turkey – personally, I don’t like it. When you say ‘lean protein,’ that’s the first thing people say is ‘turkey.’ It’s not something that I eat, so it’s hard for me to wrap my mind around ‘tastes great’ when that’s the first thing I think of.


c. Easy to Switch

• Switching to lean proteins is a healthy step anyone can take.

• Switching to lean proteins is easy and healthy for your family.

The easy to switch message is also more believable for lean proteins than it is for whole grains. Because to some lean proteins taste better, some moms thought it would be easy to switch. Moms also liked the concept of a health step, even though it conflicts a little bit with switching.

It is easy to switch to leaner meat because, it might cost a little bit more, but it is healthier for you in the long run. And, it’s not that hard; it’s not that much more. It’s not expensive amounts like the grains. It can help you take the step in changing towards healthier meals. (S)

Some don’t think changing to lean proteins is easy, so this statement isn’t believable. According to these moms, switching to lean proteins would require a period of time to adjust to the different taste. And, similar to whole grains, the perceived cost of lean proteins compared to other proteins would be a barrier to switching for some.

I actually didn’t like that part so I scribbled it out. You have to try it and keep trying it. Some people don’t like things, and if they don’t like it they have to get used to it, and sometimes it’s not easy to change. You can, but it takes time to do it. The first try isn’t always going to work. I have a problem with the ‘easy’ thing, because it costs more money. I can only afford one package of lean versus two packages of regular. It makes a difference for me in my budget. Easy and anyone - not just anyone can make a decision in eating lean meat. (S) People are not easy with it, and it may take a while and it may be hard to get used to, but you already know you're going to have to make some changes and substitute fatty foods for less fatty foods.

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