RESEARCH
Original Research
Multiple Sociodemographic and
Socioenvironmental Characteristics Are
Correlated with Major Patterns of Dietary Intake
in Adolescents
GRETCHEN J. CUTLER, PhD, MPH; ANDREW FLOOD, PhD; PETER HANNAN, MStat; DIANNE NEUMARK-SZTAINER, PhD, MPH, RD
ABSTRACT
Background Few studies have used dietary pattern analy-
sis, a useful method to summarize dietary intake, in
adolescents.
Objective Examine sociodemographic and socioenviron-
mental correlates of habitual dietary patterns.
Design Data for this cross-sectional/prospective analysis
were drawn from Project EAT (Eating Among Teens), a
population-based study.
Subjects/setting Project EAT-I (Time 1), collected data on
4,746 adolescents in 1998-1999. Project EAT-II (Time 2)
resurveyed 53% (n⫽2,516) of the original cohort 5 years
later in 2003-2004. Dietary intake was assessed using the
Youth/Adolescent Food Frequency Questionnaire.
Main outcome measures/statistical analysis performed Factor
analysis identified four dietary patterns at Time 1 (veg-
etable, fruit, starchy food, and snack food) and Time 2
(vegetable and fruit, fast food, starchy food, and snack
food). Linear regression was used to examine the rela-
tionship of Time 1 socioeconomic status and race (mutu-
ally adjusted) on factor scores for each dietary pattern,
and then of Time 1 socioenvironmental characteristics
(adjusted for socioeconomic status and race) on these
factor scores.
Results In prospective analyses, socioeconomic status,
family meal frequency, and home availability of healthy
food were positively associated with the vegetable and
fruit and starchy food patterns and inversely associated
with the fast food pattern. Home availability of unhealthy
G. J. Cutler is a senior epidemiologist, Minnesota De-
partment of Health, St Paul; at the time of the study,
she was a predoctoral fellow, Division of Epidemiology
and Community Health, University of Minnesota, Min-
neapolis. A. Flood is an associate professor, P. Hannan
is a senior research fellow, and D. Neumark-Sztainer is
a professor, Division of Epidemiology and Community
Health, University of Minnesota, Minneapolis.
Address correspondence to: Gretchen J. Cutler, PhD,
MPH, PO Box 64975, St Paul, MN 55164. E-mail:
cutle007@umn.edu
Manuscript accepted: August 24, 2010.
Copyright © 2011 by the American Dietetic
Association.
0002-8223/$36.00
doi: 10.1016/j.jada.2010.10.052
230 Journal of the AMERICAN DIETETIC ASSOCIATION
food was inversely associated with the vegetable and fruit
and starchy food patterns and positively associated with
the fast food and snack food patterns. Maternal, paternal,
and peer support for healthy eating were positively asso-
ciated with the vegetable and fruit pattern and inversely
associated with the fast food pattern. Similar associations
were seen in cross-sectional analyses.
Conclusions Multiple correlates of dietary patterns were
identified. Health professionals should target these fac-
tors to improve the dietary quality of habitual eating
practices in adolescents by encouraging parents to de-
crease home availability of unhealthy food while increas-
ing availability of healthy food, family meal frequency,
and parental support for healthy eating.
J Am Diet Assoc. 2011;111:230-240.
F
ew youth consume a diet that aligns with current
dietary guidelines, especially with respect to fruit
and vegetable intake (1). The poor dietary intake
exhibited by many adolescents is of concern given the
high prevalence of obesity and other health-related out-
comes associated with diet (2). The development of
healthy eating habits is critical in this age group to de-
crease disease risk in adulthood (3). Understanding char-
acteristics of adolescents with less-than-optimal diets is
crucial for developing more targeted and effective inter-
ventions focused on improving dietary intake.
Adolescent eating behavior is a function of multiple
levels of influence, and Social Cognitive Theory and eco-
logic models can be helpful in understanding the different
levels of influence (4). One important level of influence is
an adolescent’s social environment (4). Peers can have a
significant influence on an adolescent’s eating behavior
(4). Adolescents spend a substantial amount of time with
their peers and eating is often an important part of this
socializing (4). In addition, adolescents eat the majority of
their meals and snacks at home, and families influence
eating behavior by being the provider of food while also
influencing attitudes, preferences, and values surround-
ing food (4). Sociodemographic factors such as income,
education level, and race can influence all of the above.
Adolescent dietary intake has customarily been exam-
ined in terms of single foods or nutrients, but dietary
pattern analysis has recently emerged as an important
alternative to these traditional methods (5-7). The di-
etary pattern approach has intuitive appeal because the
human diet does not consist of a single nutrient or food,
© 2011 by the American Dietetic Association
 Table 1. Study characteristics of the Time 1 Project EAT (Eating Among Teens) cohort by age
and sex subgroup
High School Middle School
Girls Boys Girls Boys
Characteristic (nⴝ1,154) (nⴝ1,168) (nⴝ465) (nⴝ453)

4™™™™™™™™™™™™™™ mean⫾standard deviation ™™™™™™™™™™™3

Age (y) 15.8⫾0.8 15.9⫾0.8 12.8⫾0.8 12.9⫾0.8
Body mass index 23.7⫾4.8 23.6⫾4.5 22.2⫾4.8 21.8⫾5.0
Energy intake (kcal/d) 1,871⫾829 2,251⫾1,071 2,199⫾1,153 2,302⫾1,151
4™™™™™™™™™™™™™™™™™™™™™™ % ™™™™™™™™™™™™™™™™™™™™™3
Weight statusa
Underweight 4.4 5.3 4.0 5.1
Average weight 65.4 64.6 60.6 63.3
Overweight 19.7 14.8 20.5 15.0
Obese 10.4 15.2 14.9 16.7
Race/ethnicity
White 60.1 65.2 40.7 41.0
Black 12.0 11.4 15.1 17.7
Hispanic 3.2 4.7 6.7 8.7
Asian 19.8 15.0 23.5 24.2
Hawaiian/Pacific Islander 0.4 0.5 0.0 0.4
Native American 2.0 1.5 7.3 4.4
Mixed 2.5 1.7 6.7 3.6
Socioeconomic status
Low 16.0 11.6 20.8 17.4
Middle low 19.8 17.4 18.1 17.7
Middle 25.2 22.8 24.3 30.7
Middle high 24.9 32.3 20.8 19.0
High 14.1 15.9 16.1 15.1
a
Weight status classified using sex- and age-specific cutoff points based on reference data from the Centers for Disease
Control and Prevention growth chart tables (41-43).

but instead represents a complex set of highly correlated
dietary exposures (8,9). Statistical methods such as factor
analysis are often used to derive empirical dietary pat-
terns, and can be a useful technique to summarize di-
etary intake and relate that intake to specific character-
istics of a research population (3,10). Few studies have
examined dietary patterns in adolescents, especially in
the United States. This approach has been used success-
fully in multiple adult populations and additional re-
search in adolescent populations is warranted (3).
To our knowledge, only four other studies have exam-
ined characteristics associated with dietary patterns in
adolescent populations, and all took place outside of the
United States (10-13). These studies examined sociode-
mographic (10-13) and lifestyle characteristics (12,13),
but none examined the association between socioenviron-
mental characteristics and dietary patterns. Our study
contributes to the literature by examining both sociode-
mographic and modifiable socioenvironmental character-
istics associated with specific habitual dietary patterns of
adolescents. It is one of only a handful of studies to
identify dietary patterns in adolescents in the United
States, and has the benefit of a large and ethnically and
socioeconomically diverse cohort.
The primary aim of this study was to investigate the
cross-sectional and prospective relationship between
baseline sociodemographic and socioenvironmental char-
acteristics and habitual dietary patterns identified at
baseline and 5 years later. Understanding the character-
istics of adolescents consuming specific dietary patterns
is crucial. This knowledge will help determine what sub-
groups and specific modifiable characteristics should be
targeted in dietary interventions, ultimately increasing
the influence and efficiency of these interventions.
METHODS
Study Design and Population
Project EAT (Eating Among Teens) is an observational
study of the socioenvironmental, personal, and behav-
ioral determinants of dietary intake and weight status
among a large and ethnically diverse adolescent popula-
tion. In Project EAT-I (Time 1), 4,746 middle school and
high school students in 31 Minnesota schools completed
in-class surveys and anthropometric measures during the
1998-1999 academic year. Trained Project EAT staff ad-
ministered surveys and measurements. Project EAT-II
(Time 2) aimed to resurvey all original participants 5
years later, in 2003-2004. During this follow-up, 2,516
participants completed mailed surveys, representing 69%
of those who could be contacted, and 53% of the original
cohort. Study characteristics of the Project EAT cohort
can be found in Table 1. The University of Minnesota’s
Institutional Review Board Human Subjects Committee

February 2011 ● Journal of the AMERICAN DIETETIC ASSOCIATION 231

 Measure Description of Time 1 survey measure

Socioenvironmental
Family meal frequency
Parental support for
healthy eating
Peer support for
healthy eating
Healthy home food
availability
Unhealthy home food
availability
Sociodemographic
Socioeconomic status
Race/ethnicity
During the past 7 days, how many times did all, or most, of your family living in your house eat a meal
together: Never, 1-2 times, 3-4 times, 5-6 times, 7 times, or More than 7 times (44).
Based on four items assessing perceptions of how strongly one’s mother and father care about and
encourage healthy eating. These questions included: My mother/father cares about eating healthy food, and
My mother/father encourages me to eat healthy food. Response options included: Not at all, A little bit,
Somewhat, or Very much (44). Cronbach’s .79.
Based on agreement with the statement: Many of my friends care about healthy eating. Response options
included: Not at all, A little bit, Somewhat, Very much, or I don’t know.
Created by combining the following scale variables: Fruits and vegetables are available in my home,
Vegetables are served at dinner in my home, We have fruit juice in my home, Milk is served at meals in
my home. Response options included: Strongly disagree, Disagree, Agree, and Strongly agree (44,45).
Cronbach’s .63.
Created by combining the following scale variables: We have “junk food” in my home, Potato chips or other
salty snack foods are available in my home, Chocolate or other candy is available in my home, and soda
pop is available in my home. Response options included: Strongly disagree, Disagree, Agree, and Strongly
agree (45). Cronbach’s .80.
Based on adolescent self-report. The prime determinant was parental education level, defined by the higher
level of educational attainment of either parent. An algorithm was developed that also took into account
family eligibility for public assistance, eligibility for free or reduced-cost school meals, and employment
status of the mother or father. Five categories were created (Low, Low Middle, Middle, Upper Middle, and
High). Validity was supported by parental assessment in a substudy (46). Spearman correlation 0.67,
weighted .79.
Based on the question: Do you think of yourself as: white; black or African American; Hispanic or Latino;
Asian American; Hawaiian or Pacific Islander; or American Indian or Native American. Adolescents were
given the option to choose more than one category, and those with multiple responses were coded as
Mixed/Other for analyses.

Figure. Description of measures used at Time 1 of Project EAT (Eating Among Teens) to assess socioenvironmental and sociodemographic
characteristics of participants. NOTE: Information from this figure is available online at www.adajournal.org as part of a PowerPoint presentation.

approved all study protocols. Passive or active consent
procedures were followed in Project EAT based on the
requirements of the participating schools’ research
boards. All participants signed an assent form before
survey completion.
Participant Survey
The Project EAT Time 1 survey assessed a range of so-
cioenvironmental, personal, and behavioral factors of po-
tential relevance to weight status, weight control, dietary
intake, and physical activity in adolescents. Development
of the Project EAT survey was guided by 21 focus groups
with 141 adolescents, Social Cognitive Theory (14), and a
literature review. The survey was pilot-tested with 252
multi-ethnic 7th- and 10th-grade students.
be within acceptable ranges for dietary assessment tools
(16,17). The average correlation coefficient from the val-
idation study comparing the YAQ to three 24-hour di-
etary recalls was 0.54 (15,16). Some studies have sug-
gested that there may be higher levels of measurement
error in low socioeconomic status (SES) minority popula-
tions (18,19). Before using the YAQ for Project EAT, the
questionnaire was pretested among a group of very low-
income, ethnically diverse middle school students and
was found to be acceptable in terms of the students over-
all comprehension and ability to complete the question-
naire within one class period (20). In another study, Xie
and colleagues (21) addressed the use of the YAQ in a
multi-ethnic, multi-income, and multi-educated popula-
tion of adolescents and found it to be acceptable.

Sociodemographic and Socioenvironmental Measures

Dietary Intake
Dietary intake was assessed at Time 1 and Time 2 using
the Youth/Adolescent Questionnaire (YAQ). The YAQ is a
semiquantitative food frequency questionnaire that was
designed to improve the assessment of adolescents’ diets
in large epidemiologic studies (15). The validity and re-
producibility of the YAQ has been examined in children
and adolescents ages 9 to 18 years and has been found to
Sociodemographic and socioenvironmental characteris-
tics were assessed in the Time 1 Project EAT survey.
Sociodemographic characteristics included SES and race/
ethnicity. Socioenvironmental characteristics included
family meal frequency, home availability of healthy and
unhealthy food, and parental and peer support for
healthy eating. A description of these measures is in-
cluded in the Figure.

232 February 2011 Volume 111 Number 2

Statistical Analysis
Participants reporting usual energy intakes ⬎7,000 kcal/
day or ⬍400 kcal/day were excluded from the analysis
since these values are considered to be biologically im-
plausible as usual intake. Dietary patterns were first
identified separately by age and sex subgroup (middle
school girls, middle school boys, high school girls, high
school boys). We identified similar dietary patterns in
each subgroup, and thus we combined the four age and
sex subgroups into a single population for the remaining
analyses. As the results from the combined population
were similar to those of the subgroups, we have presented
only the combined results here.
Dietary patterns were identified using principal com-
ponents factor analysis based on dietary data from re-
sponses to the YAQ at Time 1 and Time 2. The YAQ
provided frequency of consumption information on 152
separate line items, and we chose not to further group
these items to reduce the number of subjective decisions
made in determining the dietary patterns. Using an en-
ergy density approach, we divided each individual’s daily
frequency of consumption for each of the 152 line items by
his or her total daily energy consumption to adjust for
energy. We then standardized the energy-adjusted fre-
quency values to a mean of 0 and standard deviation of
1.0. Each of the standardized, energy-adjusted, frequency
variables entered the principal components factor analy-
sis (using PROC FACTOR in SAS statistical software,
version 8.2, 2001, SAS Institute Inc, Cary, NC). The fac-
tors were orthogonally rotated using the varimax proce-
dure to facilitate interpretation. Four factors (ie, dietary
patterns) were retained at Time 1 and Time 2 based on
Eigenvalues ⬎1, an inspection of where the Scree plot
began to flatten out, and interpretability. For every sub-
ject we calculated factor scores for each of the retained
dietary patterns by summing frequency of consumption
multiplied by factor loadings across all food items.
The factor scores calculated for each dietary pattern
represent the level of adherence to that specific pattern,
with higher factor scores representing a higher consump-
tion of foods represented by that dietary pattern. Unlike
cluster analysis, where participants are assigned to only
one dietary pattern, in factor analysis, participants re-
ceive a factor score for each of the dietary patterns iden-
tified. Thus, in our study, participants received a factor
score for each of the four dietary patterns identified at
Time 1 and for each of the four dietary patterns identified
at Time 2. In addition, the dietary patterns identified in
this study within time points were uncorrelated, and
participants could score high on multiple patterns or low
on multiple patterns.
Multivariable linear regression (Proc GLM, version 8.2,
2001, SAS Institute Inc, Cary, NC) was used to examine
the cross-sectional and prospective associations between
baseline sociodemographic and socioenvironmental fac-
tors and the multiple dietary patterns identified at base-
line and 5 years later at Time 2. Confidence intervals
(95%) and P values were used to interpret the statistical
significance of hypothesis tests. A linear regression model
was run for each sociodemographic and socioenvironmen-
tal variable without adjustment. A model was then run
adjusting both sociodemographic variables (SES and
race/ethnicity) for each other, along with age and sex. For
each socioenvironmental variable, models were run ad-
justing for SES, race/ethnicity, age, and sex. Factor scores
for each dietary pattern were modeled as separate con-
tinuous variables. Independent variables were run as
continuous variables with the exclusion of race/ethnicity,
which was run as a categorical variable with white ado-
lescents used as the reference group.
To examine the dietary profile of each dietary pattern
identified at Time 1 and Time 2 we first divided the factor
scores for each pattern into quintiles. We then calculated
the mean value and standard deviation for selected
dietary intake variables for participants in Quintile 1
(lowest factor scores) and Quintile 5 (highest factor
scores) of each dietary pattern. All mean values were
adjusted for energy using an energy density approach as
described above excluding daily percent energy from fat.
RESULTS
Time 1 Dietary Patterns: Description
Foods with the highest factor loadings for each of the four
factors retained at Time 1 are presented in Table 2.
Factor loadings for the foods can be interpreted the same
way as correlation coefficients, with the most positive
values contributing the most to a factor score (22). Prin-
cipal components factor analysis methods identified four
dietary patterns at Time 1 in the Project EAT sample. We
labeled these factors the vegetable pattern, fruit pattern,
snack food pattern, and starchy food pattern after exam-
ining the foods that loaded highly on each factor. Foods
loading highly on the vegetable pattern included zuc-
chini, squash and eggplant, kale and greens, spinach, and
peas and lima beans. Foods loading highly on the fruit
pattern included oranges and grapefruit, apples and ap-
ple sauce, pears, grapes, bananas, strawberries, canta-
loupe and melons, peaches, and plums and apricots.
Foods loading highly on the snack food pattern included
chocolate bars, other candy bars, candy with chocolate,
brownies, cake, potato chips, and nachos. Foods that
loaded heavily on the starchy food pattern included En-
glish muffins/bagels, grilled cheese, pancakes, and crack-
ers, mashed potatoes, lasagna, pretzels, macaroni and
cheese, and spaghetti with sauce. Participants received a
factor score for each of the four dietary patterns identified
at Time 1 (vegetable, fruit, snack food, starchy food). A
higher factor score for an indentified pattern corre-
sponded to a higher consumption of foods represented by
that dietary pattern. In addition, the identified dietary
patterns were uncorrelated, and a participant could score
high on the vegetable and fruit patterns while also scor-
ing high on the snack food pattern.
Time 1 Dietary Patterns: Cross-Sectional Associations
Multivariable regression coefficients linking Time 1 so-
ciodemographic and socioenvironmental characteristics
to factor scores for the Time 1 dietary patterns are shown
in Table 3. SES was positively associated with the fruit
vegetable and starchy food patterns, and negatively as-
sociated with the snack food pattern. When compared to
white adolescents, Asian-American and black adolescents
had higher scores on the fruit pattern, and Asian-Amer-
ican and Hispanic adolescents had higher scores on the
February 2011 ● Journal of the AMERICAN DIETETIC ASSOCIATION 233
 Table 2. Factor loadingsa for the dietary patterns identified at Time Table 2. Factor loadingsa for the dietary patterns identified at Time
1 of Project EAT (Eating Among Teens) 1 of Project EAT (Eating Among Teens) (continued)
Dietary Pattern Dietary Pattern
Factor 3: Factor 4: Factor 3: Factor 4:
Diet intake Factor 1: Factor 2: Snack Starchy Diet intake Factor 1: Factor 2: Snack Starchy
variables Fruit Vegetable Food Food variables Fruit Vegetable Food Food

Oranges/grapefruit 0.65 — — — Toaster pastries — — 0.30 —

Apples/apple sauce 0.60 — — — Milk — — ⫺0.37 —
Pears 0.59 — — — English muffin/
Grapes 0.58 — — — bagels — — — 0.38
Peaches/plums/ Crackers — — — 0.37
apricots 0.56 — — — Grilled cheese
Strawberries 0.54 — — — sandwich — — — 0.36
Bananas 0.53 — — — Lasagna — — — 0.36
Cantaloupe/melon 0.50 — — — Pretzels — — — 0.35
Orange juice 0.47 — — — Macaroni and cheese — — — 0.33
Apple juice/other Pancakes — — — 0.31
juice 0.43 — — — Tomato/spaghetti
Raw carrots 0.32 — — — sauce — — — 0.30
Zucchini/squash/ Mashed potatoes — — — 0.30
eggplant — 0.60 — — Fried food not at
Kale/greens — 0.56 — — home — — — ⫺0.38
Spinach — 0.54 — — Fried food at home — — — ⫺0.50
Beets — 0.51 — — White rice 0.33 — — ⫺0.55
Mixed vegetables 0.30 0.50 — —
Yams/sweet potatoes — 0.48 — —
a
Factor loading ⬍0.30 omitted for simplicity.
Broccoli 0.32 0.47 — —
Cooked carrots — 0.46 — —
Tofu — 0.46 — — vegetable pattern. In contrast, Asian-American, black,
Peas/lima beans — 0.45 — — and Hispanic adolescents had lower scores on the starchy
Green/red peppers — 0.44 — — food pattern when compared to white adolescents.
Celery — 0.43 — — Multiple socioenvironmental characteristics were sta-
Grains (kasha, tistically significantly associated with factors scores for
couscous) — 0.40 — — the Time 1 dietary patterns. Frequency of family meals
String beans — 0.40 — — was positively associated with scores for the fruit, vege-
Tomatoes — 0.33 — — table, and starchy food patterns, and negatively associ-
Iceberg lettuce — 0.32 — — ated with scores for the snack food pattern. High avail-
Brownies — — 0.52 — ability of healthy foods in the home was positively
Other candy bars — — 0.51 — associated with factor scores for the fruit, vegetable, and
Cake — — 0.47 — starchy food patterns, and negatively associated with fac-
Chocolate bars — — 0.44 — tor scores for the snack food pattern. In contrast, high
Sweet rolls — — 0.44 — availability of unhealthy foods in the home was nega-
Snack cakes — — 0.44 — tively associated with scores for the fruit, vegetable, and
Donuts — — 0.43 — starchy food patterns, and positively associated with
Candy with chocolate — — 0.42 — scores for the snack food pattern. Maternal, paternal and
Pie — — 0.42 — peer support for healthy eating were positively associated
Ice cream — — 0.40 — with scores for the fruit, vegetable, and starchy food pat-
Gelatin dessert — — 0.39 — terns. In addition, maternal support for healthy eating
Pudding — — 0.39 — was negatively associated with scores for the snack food
Fruit snacks — — 0.38 — pattern.
Nachos — — 0.38 —
Corn chips — — 0.38 —
Potato chips — — 0.37 — Time 2 Dietary Patterns: Description
Milk shake — — 0.36 — Foods with the highest factor loadings for each of the four
Cookies — — 0.36 — factors retained at Time 2 are presented in Table 4. The
Popsicles — — 0.34 — same four dietary patterns found at Time 1 were no
Nuts — — 0.34 — longer found at Time 2, although the patterns still re-
Popcorn — — 0.30 — mained fairly similar. The snack food pattern and the
(continued) starchy food pattern were identified again at Time 2. The
two separate vegetable and fruit patterns combined to
create one vegetable and fruit pattern. Finally, a new

234 February 2011 Volume 111 Number 2

 Table 3. Cross-sectional results from multivariable linear regression analysis evaluating the association between Project EAT (Eating Among
Teens) Time 1 sociodemographic and socioenvironmental characteristics and factor scores for identified dietary patterns at Time 1
Dietary Pattern
Sweet and Salty
Fruit Vegetable Snack Food Starchy Food
Independent variable ␤ a
P value ␤ P value ␤ P value ␤ P value

Sociodemographic
Socioeconomic statusb .06 ⬍0.0001 .06 ⬍0.0001 ⫺.03 NS .14 ⬍0.0001
Race/ethnicity
Other ⫺.01 NSc .18 0.008 .05 NS ⫺.30 ⬍0.0001
Asian .71 ⬍0.0001 .67 ⬍0.0001 ⫺.03 NS ⫺1.33 ⬍0.0001
Black .24 0.0009 .04 NS .01 NS ⫺.42 ⬍0.0001
Hispanic ⫺.23 ⬍0.0001 .29 ⬍0.0001 .34 ⬍0.0001 ⫺.52 ⬍0.0001
White (reference group)
Socioenvironmental
Frequency of family meals .05 ⬍0.0001 .05 ⬍0.0001 ⫺.03 0.02 .05 ⬍0.0001
Healthy food availability .07 ⬍0.0001 .02 0.003 ⫺.04 ⬍0.0001 .07 ⬍0.0001
Unhealthy food availability ⫺.07 ⬍0.0001 ⫺.07 ⬍0.0001 .07 ⬍0.0001 ⫺.02 0.0002
Maternal support .14 ⬍0.0001 .08 ⬍0.0001 ⫺.04 0.01 .10 ⬍0.0001
Paternal support .12 ⬍0.0001 .06 0.0002 ⫺.03 NS .08 ⬍0.0001
Peer support .15 ⬍0.0001 .09 ⬍0.0001 ⫺.02 NS .07 ⬍0.0001
a
The change in factor score for a 1-unit change in variable (values for race/ethnicity⫽difference in score in comparison to white adolescents).
b
All models adjusted for socioeconomic status, race/ethnicity (socioeconomic status was adjusted for race/ethnicity and vice versa), age, and sex.
c
NS⫽not significant.

dietary pattern was identified that we labeled fast food,
characterized by foods one would likely eat at a fast-food
restaurant such as hamburgers, french fries, fried food,
and non-diet soda. Participants received a factor score for
each of the four dietary patterns identified at Time 2
(vegetable and fruit, snack food, starchy food, fast food)
and a higher factor score for an indentified pattern cor-
responded to a higher consumption of foods represented
by that dietary pattern. In addition, the identified dietary
patterns were uncorrelated, and a participant could score
high on the vegetable and fruit patterns while also scor-
ing high on the fast food pattern.
Time 2 Dietary Patterns: Prospective Associations
In general, prospective findings were similar to associa-
tions found in cross-sectional analyses. Multivariable re-
gression coefficients linking Time 1 sociodemographic
and socioenvironmental characteristics to factor scores
for the Time 2 dietary patterns are shown in Table 5.
When looking prospectively, SES was positively associ-
ated with the vegetable and fruit and starchy food pat-
terns, and negatively associated with the fast food
pattern. When compared to white adolescents, Asian-
American and black adolescents had higher scores on the
vegetable and fruit pattern. In addition, Asian-American
and Hispanic adolescents had higher scores on the fast
food pattern, and lower scores on the starchy food pattern
when compared to white adolescents.
Multiple Time 1 socioenvironmental characteristics
were also statistically significantly associated with fac-
tors scores for the Time 2 dietary patterns. Frequency of
family meals was positively associated with scores for the
vegetable and fruit pattern and negatively associated
with scores for the fast food pattern. High availability of
healthy foods in the home was positively associated with
factor scores for the vegetable and fruit pattern and the
starchy food pattern, and negatively associated with fac-
tor scores for the fast food pattern. In contrast, high
availability of unhealthy foods in the home was nega-
tively associated with scores for the vegetable and fruit
and starchy food patterns, and positively associated with
scores for the fast food and snack food patterns. Maternal,
paternal, and peer support for healthy eating was posi-
tively associated with scores for the vegetable and fruit
pattern and negatively associated with scores for the fast
food pattern.
Diet Profile of Identified Dietary Patterns
The mean intake of multiple dietary variables is shown by
highest vs lowest quintile of factor score in Table 6 for each
of the four dietary patterns identified at Time 1 and Time 2.
As expected, high scorers for the vegetable, fruit, and veg-
etable and fruit pattern had higher mean servings per day
of fruits and vegetables. High scorers for the starchy food
pattern had higher mean servings per day of grains at Time
1 and Time 2. High scorers for the snack food pattern at
Time 1 and Time 2 and for the fast food patterns at Time 2
had the lowest mean daily servings of fruits and vegetables.
High scorers for the fast food pattern at Time 2 had the
overall highest daily percentage of energy from fat.
DISCUSSION
The goal of this study was to investigate the cross-sec-
tional and prospective relationships between sociodemo-

February 2011 ● Journal of the AMERICAN DIETETIC ASSOCIATION 235

 Table 4. Factor loadingsa for the dietary patterns identified at Time Table 4. Factor loadingsa for the dietary patterns identified at Time
2 of Project EAT (Eating Among Teens) 2 of Project EAT (Eating Among Teens) (continued)
Dietary Pattern Dietary Pattern
Factor 1: Factor 2: Factor 3: Factor 4: Factor 1: Factor 2: Factor 3: Factor 4:
Diet intake Vegetable Fast Snack Starchy Diet intake Vegetable Fast Snack Starchy
variables and Fruit Food Food Food variables and Fruit Food Food Food

Mixed vegetables 0.60 — — — Tomato/spaghetti

Broccoli 0.58 — — — sauce — — — 0.44
Zucchini/squash/ Other cheese — — — 0.39
eggplant 0.57 — — — Spaghetti with sauce — — — 0.37
Green/red peppers 0.54 — — — Grilled cheese
Cooked carrots 0.53 — — — sandwich — — — 0.35
Spinach 0.53 — — — Crackers — — — 0.34
Kale/greens 0.51 — — — Macaroni and cheese — — — 0.33
Celery 0.48 — — — Mashed potatoes — — — 0.32
Tomatoes 0.45 — — — Popcorn — — — 0.31
String beans 0.45 — — — Fried food at home — — — ⫺0.50
Tofu 0.43 — — — White rice 0.41 — — ⫺0.61
Raw carrots 0.43 — — —
Iceberg lettuce 0.42 — — 0.32
a
Factor loading ⬍0.30 omitted for simplicity.
Cantaloupe/melon 0.40 — — —
Peas/lima beans 0.38 — — —
Oranges/grapefruit 0.37 — — — graphic and socioenvironmental factors and habitual di-
Yams/sweet potatoes 0.36 — — — etary patterns identified in a cohort of ethnically and
Peaches/plums/ socioeconomically diverse adolescents. To our knowledge,
apricots 0.35 — — — this is the first study to examine the relationship between
Strawberries 0.33 — — — sociodemographic and socioenvironmental characteris-
Pears 0.32 ⫺0.35 — — tics and habitual dietary patterns identified in an adoles-
Apples/apple sauce 0.31 ⫺0.39 — — cent population in the United States. Multiple sociode-
Grapes 0.30 — — — mographic and socioenvironmental characteristics were
French fries — 0.53 — — statistically significantly associated with factor scores for
Fried food not at the identified dietary patterns cross-sectionally, and sim-
home — 0.52 — — ilar results were found in prospective analyses. Availabil-
Cheeseburgers — 0.47 — — ity of unhealthy food in the home was significantly asso-
Potato chips — 0.41 — — ciated with intake of all dietary patterns, suggesting the
Soda, not diet — 0.39 — — influence of this variable on the diet of adolescents in this
Corn chips — 0.35 — — study. Significant associations were also found for other
Hamburgers — 0.31 — — socioenvironmental characteristics including availability
Dark bread — ⫺0.30 — — of healthy food in the home, frequency of family meals,
Milk — ⫺0.39 — — and parental and peer support for healthy eating.
Yogurt — ⫺0.39 — — Using principal components factor analysis we identi-
Bananas — ⫺0.42 — — fied four dietary patterns in the Project EAT adolescent
Cold breakfast cereal — ⫺0.42 — — population at Time 1 (vegetable, fruit, snack food, starchy
Brownies — — 0.50 — food). An interesting finding was the identification of a
Pie — — 0.44 — fast food dietary pattern in this adolescent population 5
Cake — — 0.43 — years later at Time 2. A possible explanation is that as
Snack cakes — — 0.41 — adolescents age they have more autonomy, and they
Sweet rolls — — 0.41 — may choose to eat more fast foods due to taste prefer-
Donuts — — 0.39 — ence or limited experience cooking for themselves. Also,
Other candy bars — — 0.38 — whereas separate vegetable and fruit patterns were
Candy with chocolate — — 0.37 — identified at Time 1, these separate patterns merged
Chocolate bars — — 0.35 — into a single vegetable and fruit pattern at Time 2. This
Cookies — — 0.35 — new vegetable and fruit pattern may also be due to the
Pudding — — 0.32 — maturing of this population, as most studies in adult
Milk shakes — — 0.32 — populations identify vegetables and fruits in a single
Fruit snacks — — 0.31 — dietary pattern.
Muffins — — 0.30 — Our results included the finding that high scores for the
(continued) fruit and vegetable patterns were associated with Asian-
American, black, and Hispanic ethnicity at the same time
that they were associated with higher SES. Given that
these ethnic groups were associated with low SES, we

236 February 2011 Volume 111 Number 2

 Table 5. Prospective results from multivariable linear regression analysis evaluating the association between Project EAT (Eating Among Teens)
participants’ Time 1 sociodemographic and socioenvironmental characteristics and factor scores for dietary patterns identified 5 y later, at Time 2
Dietary Pattern
Vegetable and Fruit Fast Food Snack Food Starchy Food
Independent variable ␤ a
P value ␤ P value ␤ P value ␤ P value

Sociodemographic
Socioeconomic statusb .05 0.001 ⫺.13 ⬍0.0001 ⫺.01 NS .10 ⬍0.0001
Race/ethnicity
Other .05 NSc .27 0.005 .19 0.05 ⫺.40 ⬍0.0001
Asian .96 ⬍0.0001 .21 0.0003 ⫺.09 NS ⫺1.50 ⬍0.0001
Black .22 0.02 .18 NS .14 NS ⫺.15 NS
Hispanic .05 NS .28 ⬍0.0001 .55 ⬍0.0001 ⫺.61 ⬍0.0001
White
Socioenvironmental
Frequency of family meals .06 ⬍0.0001 ⫺.07 ⬍0.0001 .01 NS ⫺.004 NS
Healthy food availability .03 0.003 ⫺.06 ⬍0.0001 ⫺.01 NS .02 0.007
Unhealthy food availability ⫺.06 ⬍0.0001 .04 ⬍0.0001 .04 ⬍0.0001 .02 0.02
Maternal support .07 0.0002 ⫺.08 ⬍0.0001 ⫺.03 NS .02 NS
Paternal support .06 0.0009 ⫺.07 0.0002 ⫺.003 NS ⫺.03 0.02
Peer support .05 0.03 ⫺.14 ⬍0.0001 .004 NS ⫺.03 NS
a
The change in factor score for a 1-unit change in variable (values for race/ethnicity⫽difference in score in comparison to white adolescents).
b
All models adjusted for socioeconomic status, race/ethnicity (socioeconomic status was adjusted for race/ethnicity and vice versa), age, and sex.
c
NS⫽not significant.

found this result somewhat counterintuitive. On closer
inspection, we found that the SES association was limited
to the white adolescents; in the other ethnic groups, SES
was not associated with scores on these two factors. The
relationship between SES and dietary patterns found in
our study may be driven by the large sample of white
adolescents in our cohort, and may not be as strong in
other racial/ethnic groups. In fact, Asian-American ado-
lescents consistently scored much higher on the fruit and
vegetable patterns when compared to white adolescents,
and may be an interesting population for future research
aimed at identifying factors that increase the likelihood
of meeting dietary recommendations for these foods. We
did find that Asian-American and Hispanic adolescents
scored higher on the unhealthy fast food pattern, indicat-
ing that SES should still be a consideration when plan-
ning dietary interventions. Our counterintuitive findings
may have also been related to the fact that a higher
number of students in non-white ethnic groups in our
adolescent population indicated that they were eligible
for free or reduced-cost lunch, which additional analyses
showed was positively associated with higher scores for
the vegetable pattern.
Four other studies have examined correlates of dietary
patterns in adolescent populations (10-13). These studies
focused on sociodemographic and/or lifestyle correlates,
and unlike our study, did not examine socioenvironmen-
tal characteristics. McNaughton and colleagues (11) ex-
amined an Australian cohort of adolescents, and observed
no association between dietary pattern scores and mea-
sures of SES based on economic resources, education,
occupation, family structure, and income level. Ambrosini
and colleagues (12) also examined correlates of dietary
patterns in an Australian cohort of adolescents and found
that a Western dietary pattern was inversely associated
with family income, whereas a healthy pattern was asso-
ciated with greater maternal education. Another study
examined correlates of dietary patterns identified in a
cohort of Spanish children, adolescents, and young adults
(10). Aranceta and colleagues (10) showed that low level
of maternal education was positively associated with
scores for a snacky pattern rich in sweets, high-fat baked
goods, and salty snacks, and inversely associated with
scores for a healthy pattern rich in fruits, vegetables, and
fish in children (aged 2 to 13 years) and young people
(aged 14 to 24 years). Finally, Kourlaba and colleagues
(13) examined correlates of dietary patterns in a popula-
tion of Greek adolescents and found no association be-
tween socioeconomic indicators (eg, number of cars in
family, existence of separate bedrooms for each child) and
dietary patterns they identified as representing healthy
and unhealthy food behaviors. We found that SES was
positively associated with the starchy food pattern in
each subgroup of our population, and that it was also
associated in expected directions (eg, higher SES associ-
ated with healthier patterns and vice versa) with the
other identified patterns in specific subgroups. The use of
different indicators of socioeconomic status may be a pos-
sible explanation for the differences in our study and
others in adolescent populations. In addition, as seen in
our results regarding race/ethnicity, it is possible that the
relationship between SES and dietary patterns may vary
in different cultures, or in rural vs urban regions of res-
idence.
Multiple studies have examined the relationship be-
tween sociodemographic characteristics and dietary pat-
terns in adult populations (23-34), and most found an
association between indicators of SES and dietary pat-

February 2011 ● Journal of the AMERICAN DIETETIC ASSOCIATION 237

 Table 6. Diet profile of identified dietary patterns of Project EAT (Eating Among Teens) participants at Time 1 and Time 2
Dietary Pattern
Fruit Vegetable Snack Food Starchy Food
a
Food/nutrient Q1 Q5 Q1 Q5 Q1 Q5 Q1 Q5

4™™™™™™™™™™™™™™™™™™™™™™™™™™™™™™™™™™™™ mean⫾standard deviation ™™™™™™™™™™™™™™™™™™™™™™™™™3

Time 1
Vegetables (servings/d) 0.7⫾0.5 1.2⫾0.7 0.5⫾0.3 1.6⫾0.8 1.1⫾0.9 0.8⫾0.4 0.9⫾0.8 1.1⫾0.6
Fruit (servings/d) 0.4⫾0.2 2.0⫾0.8 1.2⫾0.9 1.2⫾0.7 1.3⫾0.9 0.9⫾0.6 1.2⫾1.0 1.2⫾0.7
Grains (servings/d) 2.7⫾0.9 2.9⫾0.9 2.6⫾0.9 3.0⫾0.8 3.1⫾1.1 2.5⫾0.7 2.6⫾1.0 3.4⫾0.8
Regular soda (servings/d) 1.1⫾0.9 0.5⫾0.5 1.0⫾0.9 0.4⫾0.4 1.0⫾1.0 0.6⫾0.4 0.9⫾1.0 0.5⫾0.4
Calcium (mg/d) 563⫾288 498⫾203 592⫾283 483⫾179 656⫾312 421⫾129 462⫾291 607⫾195
Folate (␮g/d) 117⫾59 187⫾73 149⫾73 168⫾68 166⫾88 126⫾42 129⫾62 183⫾75
Fiber (g/d) 6⫾2 10⫾3 6⫾2 10⫾3 7⫾4 8⫾2 7⫾3 9⫾2
Carbohydrate (g/d) 132⫾20 155⫾16 146⫾18 143⫾17 141⫾24 141⫾14 142⫾23 144⫾15
Protein (g/d) 37⫾9 35⫾7 34⫾8 38⫾7 41⫾9 32⫾5 35⫾1.0 39⫾6
Energy from fat (%) 33⫾6 26⫾5 29⫾6 29⫾5 28⫾7 33⫾4 30⫾7 28⫾5

Vegetable and Fruit Fast Food Snack Food Starchy Food

Q1 Q5 Q1 Q5 Q1 Q5 Q1 Q5

Time 2
Vegetables (servings/d) 0.4⫾0.2 1.8⫾0.8 1.0⫾0.7 0.9⫾0.7 1.0⫾0.6 0.8⫾0.5 0.9⫾0.7 1.3⫾0.8
Fruit (servings/d) 0.6⫾0.5 1.3⫾0.8 1.4⫾0.7 0.5⫾0.4 0.9⫾0.6 0.8⫾0.5 1.2⫾0.9 0.8⫾0.5
Grains (servings/d) 3.0⫾0.9 3.1⫾0.8 3.2⫾0.8 2.8⫾0.8 3.0⫾0.8 2.8⫾0.7 2.7⫾0.8 3.5⫾0.8
Regular soda (servings/d) 0.9⫾0.6 0.5⫾0.4 0.4⫾0.4 0.9⫾0.6 0.7⫾0.5 0.6⫾0.4 0.7⫾0.6 0.6⫾0.5
Calcium (mg/d) 597⫾218 448⫾181 634⫾215 378⫾134 500⫾192 453⫾149 391⫾200 528⫾159
Folate (␮g/d) 89⫾25 144⫾45 132⫾39 87⫾30 108⫾37 98⫾29 106⫾40 119⫾39
Fiber (g/d) 6⫾2 11⫾3 9⫾3 6⫾2 8⫾3 8⫾2 7⫾3 9⫾3
Carbohydrate (g/d) 137⫾16 142⫾20 147⫾16 129⫾19 137⫾17 140⫾13 142⫾21 133⫾18
Protein (g/d) 37⫾7 41⫾9 41⫾8 36⫾7 38⫾8 34⫾5 37⫾9 41⫾8
Energy from fat (%) 31⫾5 28⫾6 26⫾5 34⫾6 30⫾6 31⫾4 29⫾6 30⫾6
a
Q1⫽Lowest quintile of factor score for defined pattern, Q5⫽highest quintile of factor score for defined pattern.

terns (23-32). Although the specific foods in the identified
dietary patterns varied across countries, similar to the
results of this study, higher SES, higher income level,
and/or higher education level was commonly associated
with the more healthy pattern, whereas low levels of
these socioeconomic indicators were usually associated
with the more unhealthy pattern (23-27,30-32). To the
best of our knowledge, no studies in adult populations
have examined socioenvironmental correlates of dietary
patterns.
Our results are similar to several studies that have
examined single foods or nutrients in children and ado-
lescents. For example, higher frequency of family meals
has been found to be positively associated with intake of
fruits, vegetables, grains, and calcium-rich foods, and
negatively associated with soft drink consumption (35).
Positive associations have also been found between home
availability of healthy food and parental encouragement,
and children’s fruit and vegetable intake (36-38). In ad-
dition, multiple studies have found a positive relationship
between SES and fruit and vegetable intake (36,39). Al-
though the above studies have found similar results re-
garding socioenvironmental characteristics as were found
in the current study, results from studies using dietary
pattern analysis provide a whole diet approach that may
be useful for informing dietary interventions (7,9,40).
Findings from our study in conjunction with findings
from studies examining single foods or nutrients suggest
that there are modifiable characteristics that we could
target in adolescent populations to encourage healthier
dietary patterns, while also decreasing unhealthy dietary
patterns. When the goal is to ensure that adolescents eat
a healthy diet, it is likely important to know how factors
such as family meal frequency, support for healthy eating
and home food availability influence the whole diet in
addition to how they influence intake of single foods or
nutrients.
Strengths of this study include a large, ethnically and
socioeconomically diverse population. Data were avail-
able on multiple sociodemographic and socioenviron-
mental characteristics that have not been studied previ-
ously in relation to dietary patterns in youth. Several
limitations of this study must be considered. Although
the Project EAT study population included adolescents
from multiple ethnic and socioeconomic groups, it may
not be representative of all adolescents. More than 70% of
the adolescents in the Asian-American group identified
themselves as Hmong, therefore, it is difficult to general-
ize the results found for these adolescents to other Asian-
American adolescents. A food frequency questionnaire

238 February 2011 Volume 111 Number 2

was used to assess usual diet, and as with any assess-
ment of dietary intake, underreporting of usual intake or
invalid reporting due to social desirability bias is possi-
ble. The principal strength of a food frequency question-
naire is in ranking the diets of individuals and looking at
long-term intake, which is of interest when examining
disease outcomes, weight change, and health (15). Al-
though we did a prospective analysis, it can be difficult to
infer causality in some relationships. This is a bigger
concern for socioenvironmental characteristics than for
sociodemographic variables. We cannot say, for example,
whether having high availability of healthy food in the
home leads to an increase in intake of these foods, or if
the high availability of healthy food in the home is the
result of a decision to purchase healthy foods among
individuals who have a pre-existing preference for these
foods. As mentioned previously, adolescent eating behav-
ior is a function of multiple levels of influence. We chose
to focus on sociodemographic and modifiable socioenvi-
ronmental characteristics, and results of this study must
be interpreted with that in mind. As with any analysis,
unmeasured or unexamined variables may partly explain
the outcome. In addition, we did not have data available
on school environment, and thus, the influence of school
environment on dietary patterns could not be explored in
this study. We did have baseline data on eligibility for
free or reduced-cost lunch and examined dietary patterns
for those eligible compared to those not eligible. Similar
dietary patterns were identified in both groups. Finally,
although an examination of dietary patters has certain
advantages over traditional methods of examining single
foods or nutrients, results can be more challenging to
interpret.
CONCLUSIONS
Few studies have used dietary pattern analysis in ado-
lescent populations, and this type of information may be
helpful in determining which subgroups of adolescents
are consuming the least healthy diet. Results of our study
highlight potential targets for interventions aimed at im-
proving adolescent dietary intake, including increasing
frequency of family meals, increasing parental and peer
support for healthy eating, and increasing home avail-
ability of healthy food while decreasing home availability
of unhealthy food. Important areas for future research
include examining the relationship between dietary pat-
terns and health outcomes such as obesity.
Our study results indicate the influence that environ-
mental factors can have on the overall quality of adoles-
cent dietary intake. Dietetics practitioners should assess
the environment surrounding adolescents, including the
availability of healthy and unhealthy food in the home,
frequency of family meals, and the level of support for
healthy eating that they receive from their parents and
peers. Dietetics practitioners should also assess the ha-
bitual eating patterns of children and should target en-
vironmental surroundings to improve the overall dietary
intake of adolescents by encouraging parents to make
improvements to the healthfulness of food available in
their home, to increase the frequency of family meals, and
to show adolescents their support and concern for healthy
eating. In addition, we must work toward ensuring that
families of all SES levels have access to healthy food
given the associations found in this study between SES
level and home availability of healthy food and healthy
and unhealthy dietary patterns. Future research should
further explore the nutrient profiles of habitual dietary
patterns of adolescents, and must also focus on develop-
ing interventions that will most effectively address the
environmental determinants of dietary risk in this impor-
tant age group.
STATEMENT OF POTENTIAL CONFLICT OF INTEREST:
No potential conflict of interest was reported by the au-
thors.
FUNDING/SUPPORT: This study was supported by
grant no. R40 MC 00319 from the Maternal and Child
Health Bureau (Title V Social Security Act), Health Re-
sources and Service Administration, Department of
Health and Human Services. The first author was sup-
ported in part by the Adolescent Health Protection Pro-
gram (School of Nursing, University of Minnesota) grant
no. T01-DP000112 from the Centers for Disease Control
and Prevention. The contents of this article are solely the
responsibility of the authors and do not necessarily rep-
resent the official views of the Centers for Disease Con-
trol and Prevention.
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