WWI!"(“HIIWUILHLIJMENWWI 5-5 LIBRARYL! 91:?“ Michigan State Universi H; r This is to certify that the thesis entitled 7%40‘4 End \C/eans; Jig/17w“ {:2an 6.01ch c! 961 M flw‘aflm MMQ/Mbl/(A QM K110 wai/tgl €33,31th by [gm 540442 @1111 has been accepted towards fulfillment of the requirements for ”745745 Jegreein MUWLI ILflUZU >461L Salami E ; éjox professor i men 5 Dt [/2 l/Z/ OVERDUE FINES: 25¢ per W per item RETURNING LIBRARY MATERIALS: Place in book return to rem charge from circulation reco: HEALTH FOOD STORES: INDEPENDENT RETAILERS' SOURCES OF FOOD AND NUTRITION INFORMATION AND KNOWLEDGE BASE BY Krista Shellie Dessert A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE Department of Food Science and Human Nutrition 1980 ABSTRACT HEALTH FOOD STORES: INDEPENDENT RETAILERS' SOURCES OF FOOD AND NUTRITION INFORMATION AND KNOWLEDGE BASE BY Krista Shellie Dessert Independent health food store retailers provide food and nutrition information to the public, yet their infor- mation sources and knowledge base have not been identified. A self-administered questionnaire and Nutrition Knowledge Test (NKT) were mailed to 499 independent health food store retailers in the United States. The most popular food and nutrition information sources reported were: the book, flow to Get Well by Pavlo Airola (49%); Let's Live Magazine (60%); individuals with no conventional training (62%); the National Nutritional Foods Association (35%); and programs or classes (41%). Retailers' test performance (60% correct) was more similar to Michigan Education Association teachers (54%) than Society for Nutrition Education members (94%). The only information source which significantly influenced retailers' NKT scores was contact with conventional educa- tors. Since retailers' information sources and NKT scores differed from conventional nutrition educators, distribution of accurate information through the sources identified in this research should be explored. DEDICATION This thesis is dedicated to the future when all foods are healthy, not health foods. ii ACKNOWLEDGEMENTS My sincere gratitude is extended to the following people: To my parents, Joanne and Gene Shellie, whose prior guidance and support made this thesis possible. To my major professor, Dr. Carolyn Lackey for her support, assistance, and guidance throughout this research project, and her hours spent making editorial revisions. To Dr. Kolasa for all her tactless comments and use- ful suggestions. A special thanks to Dr. Kolasa for granting a novice the opportunity to gain a lot of computer experience at her expense. This is a skill I plan on utilizing in the future. To Drs. Wanda Chenoweth and Michael Branson for their suggestions and advice. To other fellow graduate students that befriended me in times of need. To the study participants who took the time to com— plete and return the questionnaire and test. To my husband, J. Michael, whose technical assistance and emotional support in stressful times made this end pro— duct a little bit better, and my life a lot better. iii TABLE OF CONTENTS List of Tables. . . . . . . . . . . . . . . . . . . List of Figures . . . . . . . . . . . . . . . . . . INTRODUCTION . . . . . . . . . . . . . . . . . . . OPERATIONAL DEFINITIONS . . . . . . . . . . . . . . REVIEW OF LITERATURE. . . . . . . . . . . . . . . . The Health Food Movement . . . . . . . . . . . . The Retail Health Food Industry. . . . . . . . . Independent Health/Natural Food Stores . . Independent Health/Natural Food Store Retailers. Independent Health/Natural Food Store Customers. Summary. . . . . . . . . . . . . . . . . . . . . METHODS AND PROCEDURES. . . . . . . . . . . . . . . Development of the Data Collection Instrument. . Sample Selection . . . . . . . . . . . . . . . . Analysis of Data . . . . . . . . . . . . . . . . RESULTS AND DISCUSSION. . . . . . . . . . . . . . . Response and Participation Rates . . . . . . . . Representativeness of Sample . . . . . . . . . . Sample Characteristics . . . . . . . . . . . . . Nutrition Knowledge Test . . . . . . . . . . . . Nutrition Information Sources. . . . . . . . . . Customer Contact . . . . . . . . . . . . . . . . Employee Characteristics . . . . . . . . . . . . SUMMARY AND CONCLUSIONS . . . . . . . . . . . . . General Summary . . . . . . . . . . . . . . . . Conclusions And Implications . . . . . . . . . . APPENDICES A. Data Collection Instruments. . . . . . . . . Cover Letter . . . . . . . . . . . . . . . Self-Administered Questionnaire. . - . - - Nutrition Knowledge Test . . . - . . - . . iv vi ix 11 18 23 25 25 28 29 39 43 46 46 48 50 60 72 88 95 98 98 .104 .109 .109 .110 .114 Appendix B. A Review of Information Sources. . . . . . . . 118 C. Recoded Categories For Open-Ended,.. Multiple Response Questions. . . . . . . . . . 122 LIST OF REFERENCES . . . . . . . . . . . . . . . . . 128 LIST OF TABLES TABLE PAGE 1. Geographic Distribution of Independent Health FOOd Stores. 0 I O O O O O O O O O O O O O O O O 0 l7 2. Comparison of the Potential Research Sample's Geographic Distribution to Prevention and Whole Foods Magazines' Geographic Distribution Estié mate of the Independent Retail Health Food Industry 0 O O O O O O O O O O O O O O O O O O O O 49 3. Research Participants' Relationship tO Their Health Food Store. . . . . . . . . . . . . . . . . SO 4. Research Participants' Geographic Distribution Compared to Prevention Magazine's 1978 Geographic Distribution Estimate of the Independent Retail Health Food Industry . . . . . . . . . . . . . . . 52 5. Research Participation Rates per Area of Research Sample. . . . . . . . . . . . . . . . . . 54 6. Research Sample's Independent Retail Health Food Store‘s Annual Dollar Sales Compared to Health Food Business's Survey Results. . . . . . . SS 7. A Description Of the Research Sample's Sex and Age Distribution . . . . . . . . . . . . . . . S6 8. Research Sample's Length of Time in Retail Health Food Business . . . . . . . . . . . . . . . 58 9. The Research Sample's Educational Level, Degree Specialization Area and Granting Institution . . . 59 10. Research Sample's Nutrition Knowledge Test Performance. . . . . . . . . . . . . . . . . . . . 61 ll. NKT Test Questions With Extreme Indices of Discrimination and or Difficulty of the Research sample 0 O O O O O O I O C O O O O O O O O I O O O 63 12. Comparison Between SNE, MBA and Retailers Indices of Discrimination and Difficulty Of Selected Questions. . . . . . . . . . . . . . . . . . . . . 68 vi TABLE 13. A Description Of How the Research Sample Characteristics Influence NKT Score Performance. . . . . . . . . . . . . . . . . 14. The Number of Research Participants Who Indicated They Had Knowledge About Food And Nutrition Before Working in Any Aspect of the Health Food Business. . . . . . . . . 15. The Types of Information Sources Used Most Often By The Research Sample Who Possessed Knowledge About Food and Nutrition Prior to Working in any Aspect of the Health Food Business . . . . . . . . . . . . . . . . . . . 16. A Comparison of the Type of Information Source Used Currently in Business Activities Most Often by Research Participants' Length of Time in the Health Food Business . . . . . . 17. Specific Food and Nutrition Information Sources Used by Retailers. . . . . . . . . . 18. Subject and Sponsor of Food and Nutrition Training Programs or Classes Taken Through a School Association or Organization by the Research Sample. . . . . . . . . . . . . . . . 19. A Comparison of the Specific Food and Nutrition Information Used by Research Participants in Business 6 years or Less to Research Parti- cipants in Business Longer than 6 Years. . . 20. A Comparison Between the Types Of Food and Nutrition Information Currently Used Most Often by the Research Sample and the Specific Books, Magazines, People and Associations Used as Information Sources. . . . . . . . . . 21. The Number of Hours Per Week Research Parti- cipants Spent on the Sales Floor in Their Health Food Store. . . . . . . . . . . . . . . 22. A Description Of the Research Sample's Nutrition/Dietary Advice and or Counseling serVices O O O O O O O O O O I O O O O O O O O 23. A Comparison of Educational Level and Geo- graphic Location of Research Participants Whose Stores Offer Nutrition Services to Those Whose Stores DO Not Offer Nutrition Services vii PAGE 73 74 75 77 79 82 84 87 89 90 91 TABLE PAGE 24. A Comparison of Test Scores Between Research Participants Whose Stores Offer Nutrition Services and Research Participants Whose Stores DO Not Offer Nutrition Services. . . . . . 91 25. Specific Food and Nutrition Information Sources Used by Retailers Who Provided Nutrition/Dietary Advice and or Counseling Services . . . . . . . . 92 26. The Research Sample's Health Food Store Employee Training Requirements. . . . . . . . . . 97 27. A Comparison of the Research Sample's NKT Scores of Those Who Provided Employee Training Based Upon Their Knowledge Base to Other Research Participants . . . . . . . . . . . . . . 97 viii LIST OF FIGURES FIGURE PAGE 1. The Retail Health Food Industry Distri- bution System. . . . . . . . . . . . . . . . l9 2. Sampling Stages for Research Sample. . . . . . 42 3. Research Study Response Rate . . . . . . . . . 47 ix INTRODUCTION The total dollar sales and number of retail stores in the health food industry has grown at an average rate Of 25% in the last 10 years, and growth is expected to continue into the 1990's (1). The retail health food industry is composed Of in- dependent health/natural food stores and health food store chains. Spaeth (2) and members of the American Council on Science and Health (3) stated that a large percentage of the industry is composed of independently owned retail stores rather than chain operated retail outlets. According to a Bank of America study (4), distin- guishing factors between independently owned health food stores and conventional food stores is that health food stores provide the public with food and nutrition informa~ tion, and successful independent store retailers need a working knowledge of food and nutrition. Some independent store retailers provide nutrition counseling services to their customers. Wagner (5), Sebrell (6), King and Sipple (7), Leveille (See note 1), and Stephenson (8) identified possible physical, psychological, and economic harm to the public resulting from non-factual food and nutrition infor- mation distributed in some health food stores. No 2 standardized educational requirements have been established for retailers to meet before providing food and nutrition counseling services or information to their customers. In- dependent health food store retailers' sources of food and nutrition information and food and nutrition knowledge has not been identified. The Objectives of this study were to characterize independent health/natural food store retailers': A. Methods of Obtaining the food and nutrition in- formation they use in daily business activities, both currently and prior to working in any aspect of the health/natural foods business. Use Of magazines, books, people, training pro- grams and classes, and associations and/or or- ganizations as an ongoing, current source Of the food and nutrition information used in their daily business activities. Food and Nutrition knowledge based by administer- ing a nutrition knowledge test. Customer contact according to the number of hours/ week spent on the sales floor and the store's involvement with customer nutrition counseling. OPERATIONAL DEFINITIONS Organic. Organic describes a cultivation process as well as a final product (4, see note 2). Organically grown food is produced without the use of nitrogen ferti- lizers and pesticides. Organic animal products are fed organically grown feed and raised without hormones or anti- biotic treatments. Natural. NO legal definition for natural food exists (4, see note 2). Food in its unprocessed state is natural. In common usage, natural foods do not contain intentional additives and closely resemble the original form in which they were grown or raised. Health Food. Health food is a generic term which encompasses organic and natural foods (4, see note 2). A health food has implied health claims (potential medicament). Independent Natural Food Store. In natural food stores, organic foods are emphasized (4). Most food is purchased directly from farmers and specialty wholesalers. Mass-produced cosmetics and synthetic vitamins are generally not stocked. The store literature may have a philosophical or religious connotation. Independent Health Food Store. A wide range Of nu— tritional interests and dietary needs are catered to by 4 health food stores (4, see note 3). Typical stores stock a complete assortment Of natural, organic, and health foods. These stores emphasize natural and synthetic health and vitamin supplements. The store literature may emphasize healthful living. These stores have a cozy atmosphere. The stock is purchased through a manufacturer, distributor and/or wholesaler system. Health Food Chains. Chain health food stores are similar to independent stores except: chains manufacture some of their own stock; 90% of the product sold on the retail level are packaged under their own labels; and less emphasis is placed on nutrition (4, see note 3). There is a mass market atmosphere. Store literature, if stocked, con- sists of free manufacturer's leaflets. Health food chains promote their own brand name products. Food Cooperatives. Food cooperatives are community based stores(4). Their purpose is to provide members with food at a lower cost. Nutrition and nutrition literature are usually not emphasized. REVIEW OF LITERATURE The Health Food Movement Popularity of Health Foods Stillings (see note 4) identified a survey conducted by Yankelovich, Skelly, and White in 1978 which revealed a 77% increase in the public's interest in nutrition during the 1970s. Popular books on diet and nutrition were identified by 8% of the general public as a reason for increased in- terest in nutrition and 22% of the public obtained nutri- tional information from books on health. Other events which contributed to the general public's increased interest in food and nutrition are: major food industries marketing practices, consumer advocates, and government programs. (See note 2). Hueneman (9) stated that lay nutrition literature and food quackery became popular because the scientific community did not adequately meet the public's nutrition interests. Anderson and Standal (10), and others (11) agreed with Hueneman. Contrasting this viewpoint, McBean and Speckman (12), and Beeuwkes (l3) believed lay literature popularity was attributed to persuasive, unscientific tactics of the promoters. 6 According to Anderson and Standal (lO), preference Of health foods over regular supermarket foods has been in- fluenced by popular literature's promotion. -Both McBean and Speckman, (12) and Anderson and Standal (10) feel popu- lar literature emphasizes distrust of the regulation and safety Of the food supply and nutritional inadequacy of pro- cessed foods. ’Since much of the nutrition information in popular articles is "inaccurate, misleading and confusing", a nutrition knowledge gap has developed between the heightened public awareness of nutrition and the public level of under- standing of nutrition (See note 4). Several social concerns in the last decade have co- alesced to produce an increased interest in health foods (14). Interest in ecology and the environment was stimu— lated in 1962 by Rachel Carson's book entitled, ”The Silent Spring". The safety and nutritional quality Of processed foods and or foods grown with chemical pesticides became a social issue. A consumer rights movement, made up of such organizations as the Center for Science in the Public Interest, have created a growing consumer consciousness. Another factor is the legacy of the "hippie movement and anti—Vietnam war protests" which created an interest in far eastern cultures (14). The national economic recession was also a motive to deviate from the standard "meat and potatoes” American meal pattern. Health Foods' Validity It is usually suggested, in scientific papers dealing with natural/organic health foods, that these products are a food fraud and consumers of such products are classified as food faddists (See Note 5, 15). This opinion may stem from the lack Of research about the health food movement as a whole (14). The research which has been conducted has dealt mainly with isolated segments of the health food move- ment and lacked a theoretical orientation (14). Another source of frustration is that health food users' dietary patterns cannot be adequately classified or assessed (14). No evidence has been found for major compositional differ- ences between conventional foods and health foods (See note 2). Also, it is believed that many health food leaders are misinformed, motivated by profit, or committed to rigid ideological systems (14). Schaller and Carroll (16) and Deutsch (17) identified food fads and fake food cures as the most serious quackery problem facing society today. The Health Food Movement As A Social Revitalization Movement As an alternative to the isolated research approach used in the past, Kandel and Pelto (14) studied the health food movement in New England with a theoretical, network approach. Based upon thorough examination of all health food associated establishments and consumers, it is Kandel 8 and Pelto's (14) Opinion that the present health food move- ment can be viewed as a type of social revitalization move— ment. Revitalization movements are "attempts by people to radically restructure their cultural beliefs and practices in order to construct a more satisfying way of life" (14). The characteristics inherent in a revitalization movement have been identified in the health food movement of the southern New England states (14). This examination Of the health food movement in New England developed a conceptual framework for examining and understanding the national health food movement. The essential components of a social revitalization movement include the following: (a) a basic ideology with theme variations, (b) commitment, (c) opposition, (d) formal organizations, and (e) polycephalous leadership among in- dependent groups (14). The basic ideology of the southern New England Health food movement is to eat less animal flesh, fewer processed and convience foods, and often to consume concentrated doses of vitamins (14). The dietary patterns in this health food movement's ideology are considered to be physically, psychologically, spiritually, environmentally and ecologically superior to the traditional American meal pattern. Variations exist to this basic ideology. Members Of a social revitalization movement recognize one another by a bond of "subjectively perceived commitment" (l4). Commitment is first stimulated by some type of trans- forming experience which initiates a person into the movement. This transforming experience may be a change in food habits. Opposition to the movement, real or perceived, is a major factor in the commitment process. The opposition serves to motivate and energize the movement. Movement leaders may exaggerate the antagonism of the opposition for their own purposes (14) . The current major Opposition to the health food move- ment in southern New England is the established food indus- try and nutrition professionals (14). If large health food industries join the large established food producing cor- porations, like the Kellogg Company did, social support needed for commitment may decrease and perceived opposition may change. An example of perceived opposition involving nutrition professionals is the libel suit filed against Dr. Frederick Stare and Dr. Elizabeth M. Whelan by the National Nutritional Foods Association in 1978. Drs. Stare and Whelan were accused.Of "conspiracy to defame, disparage, damage and destroy reputation and business" (18). Other nutrition professionals were named as co-conspirators. The Manhatten Federal Court dismissed the complaint on June 21, 1980. For an individual to remain a member of the movement, a formal organization must exist to both reinforce the new behavior and disprove of old behavior patterns. Independent retail health food stores function as communication distri- bution centers in the health food movement (14). These stores serve multiple functions. They are sources of food 10 to support new dietary patterns as well as meeting places for health food users. They are also sources Of nutrition information which is conveyed through books,_pamphlets, and periodicals; other health food shoppers, and store propriet- ors (14). In a social revitalization movement there is poly- _cephalous leadership, and a combination of face-tO—face and impersonal recruitment through books and mass media (14). Because the movement spreads through both face-to-face and indirect communication through many leaders, cultural and social participation may exist separately. In southern New England, leadership in the movement may be divided into 2 types: social and asocial leaders (14). Social leaders influence the beliefs of their fol- lowers utilizing face-tO-face recruitment techniques. Soc- ial leaders include the guru's of revitalization cults and proprietors Of "small enterprises" (14). Many of the re- vitalization cult leaders are from India or the Far East, and all are foreign born. Asocial leaders influence health food users through books, articles, and public appearances, but do not act as leaders for an organized following. A- social leaders, such as Adelle Davis and Gaylord Hauser, have distributed their written materials through such com— munication distribution centers as retail health food stores. There are positive and negative aspects of the health food movement. The health food movement has raised the nu— tritional consciousness Of North Americans (14). It has also 11 provided a group Of successful innovators of behavioral change in relation to diet for health professionals to study. This raised nutrition consciousness may be at the expense of economic psychological, and physical harm to the public. (5, 6, 7, 8 see note 1). For example, Wagner (5) stated that money is wasted on false cures or on products with un- usually high mark-up prices. The Food and Drug Administra- tion estimated that ten million Americans spend approximately one half billion dollars annually on items of this nature (5). Sebrell (6) stated that health food stores destroy people's confidence in the food supply. King and Sipple (7) also stated that psychological damage results from de- stroying the public'sconfidence in what is actually true. Leveille (See Note 1) suggested people may delay medical treatment while trying health food cures. Physical harm has occurred to health food store frequenters who practice lay nutritionist's advice. In 1978, an infant death was reportedly caused by a mother who followed Adelle Davis's potassium chloride remedy for colic in her book entitled Let's Have Healthy Children (8). The Retail Health Food Industry The retail health food industry is comprised of in- dependently owned health/natural food stores, and health food chains. A large percentage Of the retail industry is composed of individual entrepreneurs (2, 3, see note 3). 12 In 1978, there were approximately 6500 independent retail health food stores in the United States (See Note 3). In 1978, the 2 major chains in the health fOOd industry were reported as General Nutrition Centers with 700 outlets and Nature Food Centers with 62 retail outlets (See note 3,1). Audits have not existed for the health food industry (See note 3, 1). Therefore, retail stores are difficult to iden- tify. The large number of independents in the industry have made data collection especially difficult (2, 19). Due tO this difficulty Of reaching the independent sector of the industry, data collection has been negligible. The health food industry and conventional food in- dustry have provided different services to customers. The main emphasis of grocery stores and supermarkets has been to sell food. In addition to food, health food stores stocked nutrition supplements, food and nutrition informa- tion, and non-food health products. Small independent stores also differ from health food chain operations. Independent stores feature a cozy atmo- sphere, and retailers may provide personal recommendations for products. .Chain Operators have a mass-market atmosphere and are usually located in shopping malls. Usually, chain stores recommend their own product lines (see note 3). The primary selling strengths Of health food stores have been product claims of safety and nutritional superiority and customer education about health and nutrition (4). l3 McBean and Speckman (12) believed the entire industry Of health foods has capitalized on the concept Of good nutri- tion and health versus poor nutrition and disease. Health food stores have been in existence for more than 70 years, with first reports of health food stores in California (2). When small, independently owned health food stores first appeared, they were considered an insignificant segment Of the grocery industry (4). However, the industry has grown nationally from an estimated $170,000,000 in con— sumer sales in 1970 to almost $1.1 billion in 1978 (1). In the Wall Street Journal, health foods were reported as a $1.5 billion dollar business in September of 1979 (20). In 1978, the health food industry comprised 0.7% of the total United States food store sales of $148.1 billion (1). Total annual sales in the retail health food industry grew from 1968 to 1978 at an average rate of 25%. Future Growth Of the Industry Future growth of the retail food industry will be influenced by positive and negative factors. According to Prevention magazine's survey (1), future growth will be positively influenced by the following factors: An increase in the number of potential health food store customers due to growth in the population age groups of 25-44 year olds and 65 year olds and older by 1990, a heightened national awareness Of additives, pesticides, animal drugs, and 14 environmental problems; a greater public awareness Of health foods due to increased national advertising by large health food industry suppliers and manufacturers; more investment in the industry as the health food business is recognized as stable; professionaly trained sales and market people joining the health food industry, and the application Of the government released Dietary Goals for the United States. Market distribution, government intervention, com- petitive sales, and inflation may have a negative impact on the future growth Of the health food industry. In order for future growth to continue, the market distribution must fit manufacturer's and retailer's needs, and consumer demands (See Note 3). In the last 10 years, distribution networks have greatly improved (1). However, according to a Bank of America study (4), distribution handi- caps and meeting current demand may have a negative influ— ence on future growth. Government intervention may also have a negative in- fluence on industry growth, both with respect to the Food and Drug Administration and the Federal Trade Commission's terminology and labeling regulations, and restriction of retailers product recommendations (1, 4). The retailers conversationvuxjicustomers,and recommendation of products has been a key success factor in health food marketing (See note 3). Traditional retail grocery store sales of health foods may reduce the number of retail health food stores. If 15 traditional supermarkets can successfully participate in the sale of health foods, the consumer image Of health food's "specialness" may change and result in decreased health food sales (1, see note 3). In the August, 1980 issue of Eggg Science Corner, (21) Jeanne M. Hoskin reported a Safeway supermarket in Texas is trial marketing a new, 600 square food health food section managed by a "full-time nutrition- ist”. Geographic Distribution The health food industry has an uneven national dis- tribution (1, 22). According to Whole Foods Magazine (22) 65% of the independent natural and health food stores are located in California, New York, Michigan, Pennsylvania, Texas, Ohio, Florida, Illinois, and New Jersey. The heavi- est concentration Of stores were located on the East and West Coasts (l). The west coast: Washington, Oregon, California, Hawaii, and Alaska, accounted for 21% of the 1978 estimated 18,031 health food store shoppers, 22% of the 1978 estimated 6,000 health food stores, and 27% Of the 1978 estimated $1 billion health food sales (1). One third of all the inde- pendent health food stores on the West coast are located in California (22). The West coast may be approaching a saturation point with respect to growth (1). The Atlantic coast: New England,New York, Pennsyl- vania, West Virgina, Virginia, South Carolina, North Carolina, 16 Georgia and Floria accounted for 29% of the 1978 estimated 18,031 shoppers, 32% of the 1978 estimated 6,000 health food stores, and 31% of the estimated $1.1 billion sales (1). The Mountain states: Montana, Idaho, Wyoming, Utah, Nevada, Colorado, New Mexico, and Arizona, had the lowest percent of shoppers (6%), the lowest percent of health food stores (8%), and the lowest percent of total health food store sales (6%) of all the geographical areas. East central states: Wisconsin, Michigan, Illinois, Indiana, Ohio, Kentucky, Tennessee,Alabama and Mississippi, and West central states: North Dakota, Minnesota, South Dakota, Nebraska, Iowa, Kansas, Missouri, Oklahoma, Arkansas, Louisiana, and Texas both accounted for 24% of the total health food store shoppers. West central states have fewer number of stores (890) than east central states (1350). Total dollar sales also were lower in the west central ($135 million) than the east central states ($238 million). This may indi- cate that the west central state's health food store shoppers spend less money in health food stores. Market Distribution System The health food industry has a unique type of distri- bution system (See note 3). There are four levels of acti— vity involved with manufacturing and marketing health food. These levels are the manufacturer, distributor, wholesalers and retailer. There were approximately 750 manufacturers TABLE 1. Geographic distribution of independent health food stores (1). Total Shoppers Total Stores Total 1978 Sales(M) Area Number Percent % # % S S Atlantic Coast 5,177 29 945 32 324 31 East Central 4,366 24 1,350 23 238 23 West Central 4,366 24 890 15 135 13 Mountain 1,028 6 480 8 67 6 Pacific 3,743 21 1,335 22 285 27 Total 18,031 100% 6,000 100% $1,050 100% 1Prevention (1) 18 in 1976 (19). A large number were small, independently owned producers, (19, See note 3). Eighty percent Of re- tail health food products flow through a-distributor/whole- saler. In 1978 there were approximately 100 health food distributors (1). Most distributors only handled one line or a few products, In 1978, 30-40wholesalers existed in the United States (1, see note 3). Wholesalers handled a full line of products and incurred a 15-25% mark up (1, see note 3). Retailers usually used an average Of 7 wholesalers (23). Retailers may sell a product under a manufacturer, distri— butor, wholesaler, or retailer label. The non—food segment of health food products had over 40% of the total dollar sales in 1978 (see note 3). Vitam- ins and nutritional supplements were the largest product category in the health food business (1). In 1978, the health food industry accounted for 26% of the $1.4 billion United States vitamin and nutritional supplement market (1). Independent Health/Natural Food Stores Inventory The typical independent health/natural food store caters to a wide range of consumers' nutritional interests and dietary needs (4). According to the Bank of America survey (4), the average store carries an assortment of na- tural, organic, and health foods. Inventory items include: 19 Manufacturer 80% of products 20% of products Distributor Wholesaler 15-25% mark-up J/ Retailer 29% markup FIGURE 1: The retail food industry distribution system1 1See note 3 20 health and nutrition literature, grains, flours,nuts, seeds, teas and herbs, dietetic food, organic produce, dairy foods, beverages, and baked goods. Product categories with the largest mark-up in 1980 were vitamins and supplements (52%), Herbs (49%) and body care items (41%) (4, 23). Items in each of these categories also comprised the largest percent of sales: Vitamins and supplements, 32.1%; herbs, 5%; body care items, 5.3%. Books comprised 3.6% of the store sales and had an average markup of 36%. Store Services Independent health/natural food stores may function as resources for consumer education materials and contacts. Some independent health food stores Offer special services to their customers and participate in community events (4, 23). Some stores distribute leaflets on nutrition to their customers and provide nutrition education centers (4). In Health Food Business's annual report on the industry (23), 40% of the respondents held in-store events. Nutrition lecturers were the most popular type of in—store event (31%) (23). Thirty-four percent of the respondents participated in community events, particularly shows and fairs (33%). The types of shows were not specified. It was difficult to accurately assess what percentage Of the general public used independent health/natural food stores as a food and nutrition information source. Studies 21 which investigated public food and nutrition information sources did not include health food stores in their study design (13, 10, 24). However, food and nutrition informa- tion is stocked in health food stores. According to Small Business Reporter (4), food and nutrition books and magazines comprised six percent Of a health food store's initial in- ventory investment. Inventory Statistics In 1978 there were approximately 6,400 independent retail health food stores in the United States (22, 1, 4, see note 3). This estimated 6,400 health food stores ac- counted for 3.1% of the 189,300 grocery stores nationwide (1). Whole Food Magazine (22) estimated average annual sales per store in the United States to be $189,000 in 1978. In Health Food Business's 1980 annual survey, the median annual store income was $125,000 (23). According to Prevention magazine (1), average sales per store have been growing at an average rate of 11% between 1970 and 1978. Average health food stores retail sales were about $167,000 in 1977 as compared to the average grocery store's sales of $782,000 or average supermarket chains sales of $3.5 million (1). 22 According to Whole Foods Magazine, 400 new independent stores opened in 1978 (22). Little (See note 3), cited 600 stores opening in 1978. In either case, the retail base has not been stable,for both sources cited 400 and 200 store closings per year (See note 3, 22). The total number of independent health and natural food stores has increased 53% in the last 8 years (1, 4, 22). The number of health food stores has more than doubled from approximately 3,000 to 6,400 between 1972 and 1978 (4, 22). According to Preventionlnagazine's survey of the health food industry (1), the number of stores has increased from less than 1,000 in 1969, to more than 6,000 in 1979 (1). Store Management A store's purchasing decisions are usually made by the owner/manager (22). In 1978, 50% of the health food store owner/managers were women, 33% were men, and 17% were husband/wife teams (22). In 1980, the average length of time in business for independent store owners was 7 years. The median length of time in business was 4 years (23). Independent health food stores spend $3,020 on an average per year for store advertising. Weekly and daily newspapers, and "other print" were the most commonly used media sources (23). In 1980, the average independent health food store employed two full time employees, and 2 part-time employees (23). It is suggested that employees have a background in 23 food retailing, but it is not necessary that they do (4). Employees should, however, be honest and willing to learn (4). Eighty percent of all independent health food store owners in 1980 only owned one health food store (23). Health food store owners' average annual salary in 1980 was $17,242 (23). Independent Health/Natural Food Store Retailers Retailers Food and Nutrition Information Sources Bank of America (4) identified three essential char- acteristics of a successful independent health food store owner. In order to be successful, store owners needed food retailing experience, business acumen, and a working know- ledge Of nutrition. The need for a successful store oper- ator to possess a working knowledge of nutrition distinguished independent stores from health food chains (10). How and where store owners acquired their nutrition knowledge could not be identified in the literature. Popu— lar publications may be one source of nutrition information. Prevention magazine (1), with a circulation Of 2,267,428, is the most widely distributed health magazine. Other popular health magazines include: Let's Live with a circulation of 135,544, and Bestways, with a circulation Of 130,000. Off campus degree programs in nonaccredited schools that offer graduate and undergraduate programs in nutrition may be another source of nutrition information. Dr. Donsbach 24 University in Huntington Beach, California is an example of one such program. Graduates of this program receive a plaque bearing a degree from Donsbach University.. Health food store owners' involvement in these type of nutrition schools, or other food and nutrition information sources, was not de- scribed in any literature reports. Retailers' Involvement in Nutrition Services Some independent store owners have Offered nutrition counseling services to their customers and referred to them— selves as "nutrition consultants". There are no standardized requirements for acquiring this title. Business cards con- taining the owner's name and phone number with the title "nutrition consultant" have been distributed at independent health food store's check-out counters. No information de- scribing how widespread this practice is could be Obtained. Claims have been made that health food store owners and clerks practice medicine without a license. Margolius (25) cited incidences in which health food clerks have come close to giving medical advice and prescribing specific foods and vitamins for various symptoms. Reva Frankle, nutrition coordinator at the City University of New York School of Medicine, described her two week work experience in a health food store. She stated: The retailer and his clerks were trained to act as pseudomedicine men, prescribing various foods, herbs, and teas plus vitamin and mineral supplements tO meet the health needs of the customer. (25). 25 Independent Health/Natural Food Store Customers In 1978 there were 18,031,000 health food store shop- pers in the United States (1). This represented 12.2% of the total U.S. population over 18 years Old (1). Health food store shoppers are young, educated, fairly wealthy people. Two-thirds Of all health food store shoppers are women (1). Bank of America (4) and Cavanaugh (3) identified 20 to 40 year olds as the most active health food customers. 53% Of the health food store shoppers have average annual household incomes of $15,000 or more (1). Young families and middle to upper income residents usually spent more money at health food stores (4, 3). The buying style Of health food store shoppers who shop 6 or more times in an average 3 months reflects highly ecology-oriented consumers (1). Summary The popularity of health foods has been influenced by an increased public interest in nutrition, popular nu- trition literature, and certain social concerns. During the 1970's there was a 77% increase in the public interest in nutrition (see note 4). Twenty-two percent of the gen- eral public obtained nutrition information from books on health. Preference of health foods over regular supermarket foods has been promoted by popular literature (10). Social concerns, such as ecology, food safety, and consumer's rights have also promoted the use of health foods (l4). 26 The health food movement can be viewed as a type Of social revitalization movement (14). A basic ideology, com- mitment, opposition, formal organizations, and leadership types have been identified. Retail health food stores func- tion in the movement as a type of formal organization to support new dietary patterns. Health food store owners sup- port new dietary patterns by providing a meeting place for health food store users, and distributing asocial leader's written materials. Independent health food stores are an established source of public food and nutrition information (10, 4). An accurate percentage of the public that Obtains informa- tion from independent health food stores has not been ob- tained (8, 10, 24). From the increase of 53% in the number Of independent stores between 1970 and 1978, and the 25% increase in average total dollar sales in the industry dur- ing the last 10 years (1), it may be assumed that indepen- dent health food stores provide food and nutrition informa- tion to a steadily increasing percentage Of the public. As indicated by the Nutrition Education and Training Act passed by Congress, credentialed public nutritionists and government agencies are seeking methods to educate the public about food and nutrition. It is more effective to improve or modify an existing, popular, public food and nu- trition information source than to develop a new program whose acceptance must be established. Accurate public food and nutrition information may be effectively distributed through independent health food stores. 27 Before modifying the existing food and nutrition in- formation distributed in health/natural food stores, an assessment of the food and nutrition information currently distributed is needed. Independent store owners' sources of food and nutrition information and food and nutrition know- ledge base is the first place tO begin an assessment for two basic reasons. A large percentage of the retail health food industry is composed of independent owners (3, 2), and the success of an independent health food store is dependent on the owner's working knowledge of nutrition (4). In a review of literature, a description Of indepen- denthealth food store owners' food and nutrition background could not be found. Therefore, this researcher will identify independent health food store owners' prior and current sources of food and nutrition information, and their level of food and nutrition knowledge. This researcher will also describe the number Of hours/week store owners spend on their sales floor, independent health food stores' involve- ment in nutrition/dietary advice and/or counseling services, and independent health food store employees' food and nu- trition training. METHODS AND PROCEDURES A self-administered questionnaire and nutrition know- ledge test were mailed to a sample of health food retailers in the U.S. to obtain information about their food and nutri- tion information sources and knowledge. The sample in this study consisted Of independent health/natural food store re- tailers throughout the United States who subscribed to Whole Foods magazine. Data were collected with a mailed, self- administered questionnaire and self-administered Nutrition Knowledge Test. The self-administered questionnaire devel- oped for this study was pretested and critiqued by members of Michigan State University faculty and graduate students in the Department of Food Science and Nutrition. The Nutri— tion Knowledge Test was previously developed and validated for use with the general public by Lackey et a1. (26). The specific factors analyzed in this study were health food retailers' food and nutrition information sources prior to working in any aspect of the health food business, the food and nutrition information sources currently used in daily business activities, retailers participation in food and nutrition classes or training programs, nutrition/ dietary advice and or counseling services, health food store 28 29 employee training, and a description Of store and retailers demographic characteristics. DEVELOPMENT OF THE DATA COLLECTION INSTRUMENT Description of Data Collection Instrument The self-administered questionnaire contained 17 open and close-ended questions and contingency questions (Appendix A). The questionnaire was composed of 3 major parts: prior food and nutrition training; current sources Of food and nutrition information; retailers demographics, and a de- scription of stores. Retailers' sources of food and nutrition information used in their daily business activities were investigated in the questionnaire because this assessed the information available to the public in the health food store. Prior and current sources Of information were identified to pre- sent credentialed nutrition educators with two identified places to modify the food and nutrition information health food store retailers Obtain for use in their daily business activities. Questions pertaining to the type of food and nutri— tion information sources used before working in any aspect of the retail health food business were included in the first section of the questionnaire. Questions pertaining to the type of food and nutrition sources used most Often in daily business activities were included in the second 30 section of the questionnaire. Questions about retailers' use of books, magazines, people, associations and organiza- tions, and classes or training programs as an ongoing food and nutrition information source were also included in the second section. These five resources were chosen because they were estimated to be the most heavily used type of food and nu- trition information source for the general public. Questions pertaining to health food store retailers and their stores were included in the third section of the questionnaire. Information about retailers' customer con- tact was Obtained by asking questions about the number of hours/week retailers spend on the sales floor, and retailers' involvement in customer nutrition counseling/dietary advice and or counseling services. Customer contact was identified so retailers who had minimal customer contact could be dis- tinguished in the study from those who had a substantial amount of customer contact. Questions about the provider of and type Of customer nutrition/dietary advice and or coun— seling services were asked to determine whether the respon- dents to this questionnaire were the providers of these ser- vices, and whether the services provided originated exter- nally or internally within the store. The origin Of the nutrition services was important tO determine because a respondent providing nutrition/dietary advice and or counseling services to their customers consisting of computerized dietary or hair analysis may not reflect the 31 information sources these retailers use. If, however, a respondent provided general nutrition/dietary advice and or counseling services to their customers based upon their own food and nutrition knowledge base, the type of food and nutrition information sources used may be reflected in the services provided to customers. Questions pertaining to store and retailer demographics were based on other studies of the health food industry. Store demograhics included: average annual dollar sales, and geographic location. Average annual dollar sales are a reflection of store size. Information about the store's geographic location were solicited to reflect how store char- acteristics vary nationally. Questions about retailers' demographics pertained to: sex, age, education level, and years working in any aspect of the retail health food industry. In addition to solici- ting completed educational level, questions pertained to the degree specialization and school granting the degree. Ques- tions addressing the degree specialization and granting in- stitution were included to determine whether health food retailers participated in Off campus degree programs of un- determined credibility. The length Of time in the retail health food business was included in the questionnaire to determine whether the type of food and nutrition information sources used were associated with the length of time in the health food business. 32 Rationale for Selection of Data Collection Instrument Method Kerlinger (27) stated that personal interviews are the most powerful type of survey research methodology. The mailed, self-administered questionnaire is not as powerful Of a survey research method, according to Kanuk and Kerlinger (28, 27), because of response and nonresponse bias, and low response rates. For this study, the advantages Kanuk (28) identified: geographic flexibility, freedom from interviewer bias, anonymity, and a non—threatening response environment, outweight the disadvantages inherent in mailed questionnaires. The retail health food industry does not have an even geographical distribution (22, 1). Store characteristics vary according to store location (22, l). A mailed ques— tionnaire will reflect the geographical characteristics Of the industry (28). Methods Used to Reduce Error in Data Collection Instrument Kanuk (28) suggested measuring non-response bias against the known sampling frame to control for response and non-response bias in mailed, self-administered ques- tionnaires. In the retail health food industry, the samp- ling frame was difficult tO accurately describe due to the large number of independents in the industry and lack of traditional audits. The store and retailer demographic in- formation was compared to other studies in an effort to identify response and nonresponse bias. The cover letter 33 in this study requested subjects to return the question- naire and Nutrition Knowledge Test whether they chose to participate in the study or not. Questionnaire construction and design may affect re- sponse bias and response rates. Babbie (28) believed ques— tions should be constructed so items are clear, unambiguous, relevant, and concise. Closed and open-ended questions are both used in questionnaires, and problems are inherent with both types (29, 30). An advantage Of open-ended questions is that they are more exploratory. Campbell (30) stated that respondent evasiveness and varying frames of reference are two problems associated with open-ended questions. Babbie (29) felt that a researcher could structure responses to a close-ended question which overlook certain issues im- portant to the respondent. Health food store retailers' food and nutrition in- formation sources have not been described or investigated in prior research studies. Therefore, more exploratory, open-ended questions were constructed in this self-adminis- tered questionnaire to reduce response structuring bias. Responses from contingency questions are dependent or contingent upon the answer to a previous question. A contingency question should appear in a questionnaire so that it is read only by respondents to whom the question pertains. Contingency questions in this self-administered questionnaire were identified by capitalizing a phrase 34 beginning with the word "IF" in the left hand margin. For example, "IF YES: please describe...these services”. The way questions are ordered in a questionnaire may affect responses. Babbie (29) felt the questionnaire should begin with the most interesting questions. Contrasting that view, Levine (31) felt the first few questions should be simple and impersonal because they elicit the most "don't know" reSponses. Both Levine and Babbie (31, 29) stated that questions should be grouped according to subject matter. Levine (31) warned that the last few questions should not contain important information because they are most frequently omitted. In this questionnaire, questions were grouped ac- cording to subject categories. The first questions were relatively Simplepinteresting and impersonal. The last few questions required minimal thought and could be answered quickly, thus reducing ommissions. Questionnaire appearance has been known to affect re- sponse rates. Babbie and Levine (29, 31) both stated that the questionnaire should appear uncluttered and brief with maximum white space. Babbie (29) suggested using sub- headings for organization and respondent readability. Subheadings were used in this questionnaire for or- ganization and respondent readability. One inch right and left hand margins, subheadings, and triple spacing between question responses gave this questionnaire an uncluttered appearance. 35 Berdie (32) conducted a study designed to identify the relationship between questionnaire length and response rate. Response rates were recorded for l, 2 and 4 page questionnaires each with 10 questions/page. From the study results, Berdie revealed no significant correlation between questionnaire length and response rate. The questionnaire used in this study was 4 pages long with l to 8 questions per page. Since both the front and back of each page were used, the questionnaire appeared to be 2 pages long. Methods Used to Maximize Response Rates Kanuk, Norman and Levine (28, 33, 31) have identified certain questionnaire techniques that maximize response rates. Providing a stamped, pre-addressed return envelope and some type of reward to the participants increases response. Send- ing a personalized cover letter which emphasizes past cooper- ation extended by others in the profession and importance of the project also encourages participation. In this study, a stamped, pre-addressed manilla en— velope was sent along with the questionnaire, cover letter and Nutrition Knowledge Test to the selected sample addresses. Various potential gifts to participants were considered in this study. The researcher reviewed current United States Department of Agriculture (USDA) and Cooperative Extension publications as possible rewards for the sample population. 36 "Nutrition and Your Health", published jointly by USDA, and Department Of Health, Education and Welfare (DHEW), in February, 1980, was selected as a desirable reward for par- ticipants in this study. However, due to cost limitations in mailing and problems acquiring numbers of the pamphlets, no gift was sent to participants in this study. The cover letter in this study (Appendix A) emphasized past coopera- tion of others in the profession by identifying Whole Foods magazine in the cover letter. Reference was also made to a speaker at the annual National Nutritional Foods Association (NNFA) convention in June 1980 who discussed the importance Of health food retailers as nutrition educators. The im- portance of this study was projected from Betty Kamen's statement that health food retailers had an important role as nutrition educators. The cover letter stated that good nutrition educators must have access to reliable nutrition information sources. Personal importance was conveyed by stressing that subjects in this sample were representing all independent health food store retailers in the country. Individual subject's per- sonal addresses were typed on each cover letter using the Wang word processor at University Printing Office, Michigan State University. Each cover letter was individually signed by the researcher. The cover letter was typed on the De- partment of Community Health Science letterhead. 37 Data Collection Instrument Revisions The questionnaire and cover letter underwent several revisions. The researcher initially explOred the use of mark-sense cards which precluded coding. The use of these cards were estimated to be too expensive, time consuming, and costly for this study. The first draft of the ques- tionnaire was too lengthy, lacked focus, and contained poorly written questions. Several revisions were made following suggestions from the major professor and other committee members. The first draft Of the cover letter was impersonal, bland, and contained questionnaire directions. Peer and faculty suggestions, and greater familiarity with the health food industry assisted in preparation of the final draft. Pretesting and Critiquing A final draft Of the questionnaire and cover letter was presented to Michigan State University, Department Of Food Science and Human Nutrition community nutrition graduate students on June 19, 1980 for clarification and critiquing. A description of the project was also presented. The ques- tionnaire, cover letter and Nutrition Knowledge Test also were pretested for ambiguity, readability and validity with 5 local independent health/natural food store owners during the week Of June 24, 1980. As a result Of the meeting and 38 pretesting, several revisions were made to further increase clarity and validity of the final questionnaire. Participant Observation and Interview Training A disadvantage of mailed, self-administered ques- tionnaires is respondent structured responses and questions. To minimize this possibility, the researcher visited local health food stores and attended the National Nutritional Foods Association's annual convention in Chicago. Interview training sessions were conducted by Dr. Carolyn Lackey and Kathryn Kolasa (Assistant and Associate Professors at Michigan State University), to enhance participant observation and interviewing skills. A 24 hour dietary recall using food models was videotaped in the Dietetic Instructional Resource Center (DIRC) at Michigan State University. The videotape was reviewed and critique by Drs. Lackey and Kolasa. The taping and reviewing assisted in development and refinement Of interaction techniques with interviewees. Nutrition Knowledge Test (NKT) Independent health/natural food store owners nutrition knowledge was measured with the Nutrition Knowledge Test (NKT) developed at Michigan State University (26). Michigan State's Nutrition Knowledge Test was selected because it is a reliable and valid instrument to measure general nutrition knowledge. A review of literature revealed 39 no other standardized method to assess nutrition knowledge (10, 34 see notes 6). The development of the Nutrition Knowledge Test included the use of test specifications and review items, the use of item analysis and reliability testing. The test ' is a 40-item, true-false and mulitple choice test of general nutrition knowledge (Appendix A). Sample Selection Rationale for Sample Selection Method Independent health food store owners were selected as the target population because these retailers comprise a majority of the industry. Since independent health food store owners do not all belong to a trade organization, sub- scription to health food oriented publications was investi- gated as a source of identifying independent retailers. Whole Foods magazine's subscription list was selected because it identified itself as a trade journal written for food retailers and wholesalers Of natural and health foods (22). Also, Whgle Fggds magazine had the ability to dis- tinguish independent health food stores from other types of subscribers. The total circulation number of Whole,FOOds magazine in.1980 was 12,000. Of this 12,000, 9,000 con- sisted of independent store owners and 3,000 consist of managers of health food chains or wholesalers. This 9,000 40 exceeded the 1979 estimate of 6,400 stores existing in the United States (1). Other magazines contacted by the researcher include: Family Health, Better Nutrition, Let's Live, Health Foods Retailing, Prevention, Health Ways, and Life and Health. These magazines either would not distribute their subscrip- ‘tion list or could not distinguish independent health/ natural food store owners from other subscribers. Subject Population The names and addresses of 1,000 independent health food store owners subscribing to Whole_flggd§ magazine was purchased. The researcher requested every ninth name to be systematically selected by a computer from the 9,000 inde- pendent store owners subscribing to Eh91£_£29d& magazine The mailing list of independent health food store owners subscribing tO Whole Fggds magazine was available from the magazine subscription service. For practical purposes, sys- tematic sampling yields similar results to those achieved with random sampling (29). The mailing list obtained from Whole Foods magazine contained 1,000 independent health/natural food store re— tailers' addresses. The mailing list clearly indicated that individuals other than independent owners' addresses were included. Thirty addresses were removed from the mail- ing list by the researcher because the addressed included the word restaurant, cafe, or farm. Fifteen duplicate store 41 addresses also were removed. Names and addresses were sys- tematically selected from the remaining 955 name mailing list to obtain 499 subjects. The sampling stages are re- viewed in Figure 2. This 499 member sample represented ap- proximately 12% Of the estimated 6,400 health food store owner population. Questionnaires were mailed to 49 states and Nova Scotia and British Columbia, Canada. By chance, 2 states were excluded: Delaware and Wyoming. Data Collection Administration Manilla envelopes, 9% x 12%, were mailed to potential participants on August 25, 1980. Each envelope contained a questionnaire, nutrition knowledge test, cover letter, and return envelope. Return was requested by September 12, 1980. This allowed 18 days for return from the date mailed. Research Study Costs The direct costs in this study included the following: zeroxing $50; postage, $10; envelopes $40; keypunching, $80; subsidized computer time $70; item analysis, $10; and word processing, $140. Indirect costs include the researcher's labor, faculty assistance and typing. Direct costs total approximately to $800. Based upon the direct costs, cost per questionnaire was $1.69, and cost per return was $10. 42 9,000 Subscribers 1,000 S’mple 45 Deleted Names 955 Sample J 499 Study Sample FIGURE 2: Sampling Stages for Research Sample 43 Approval of Research Involving Human Subjects The questionnaire, cover letter, Nutrition Knowledge Test, and study design were approved by the Michigan State University Committee on Research Involving Human Subjects on June 30, 1980. Analysis Of Data Information collected on the self-administered ques- tionnaire was coded by the researcher, keypunched by Michigan State University's data preparation service, and analyzed on Michigan State University's Cyber 750 computer using Statis- tical Package for the Social Sciences (35). Initial fre— quencies were run on all variables utilizing subprogram fre- quencies. Frequencies were run on all multiple response var- iables utilizing SPSS subprogram Mult Response. Mean, var— iance, Standard deviation, median, range, skewness, and kurtosis were calculated for the four interval level varia- bles utilizing SPSS subprogram Condescriptive. Once the initial descriptive procedures were done, the values for specific variables were recoded into discrete categories and contingency table analysis was performed utilizing SPSS subprogram Crosstabs. Analysis of variance and Students t- test were used to determine whether Nutrition Knowledge Test scores varied significantly between various nominal level characteristics.Pearson pmoduct-moment correlation 44 coefficients were calculated between the two interval level variables to measure association using SPSS subprogram Scattergram. A Z test for proportions were hand calculated and used to measure independence between multiple response variables. Once these initial procedures were done, multi- ple response items were transformed into mutually exclusive, dichotomous variables utilizing variable transformation pro— cedures Compute and If statements. These transformed, dicho- tomous variables were used to further subgroup the data. Again, Students t-test's were calculated to detect differ- ences between 2 subgroup's Nutrition Knowledge Test scores using subprogram T-test. The food and nutrition information sources Of re- tailers whose store offered nutrition/dietary advice and or counseling services were compared to the food and nutri- tion sources of retailers whose store did not Offer these services. Appropriate difference testing was performed. The food and nutrition information sources of retailers who had been in business longer than 6 years were compared to the food and nutrition information sources of retailers in business 6 years or less. Again, appropriate difference testing was performed. The Nutrition Knowledge Test underwent item analysis at Michigan State University Scoring Office. The item analy- sis included an index of difficulty, and an index Of dis- crimination for each of the 40 items in the test. A mean index of difficulty and index of discrimination was also 45 calculated. Kuder-Richardson formula number 20 reliability coefficient was calculated to determine the likelihood that this particular group would score similarly if the test were readministered. Specific test items which had an index of discrimination greater than or equal to 73, or less than or equal to 13; or an index of difficulty greater than or equal to 84; or less than or equal to 17 were identified. These 16 questions were chosen because they had the most extreme indices. These questions' indices were compared to other groups' indices who had previously taken the Nutrition Know- ledge Test. RESULTS AND DISCUSSION Response and Participation Rates On August 25, 1980, 499 questionnaires were mailed with return requested by September 12, 1980. This allowed an 18 day response period. The response rate in this study was 18% or 83 subjects. 16 questionnaires were returned to the researcher due to incorrect address, and 27 question- naires were returned indicating the contacted subjects were not presently a health food store retailer. These 43 sub- jects were not included in the research sample, leaving a net sample size of 456. Twenty respondents chose not to participate in the study. Six of these non-participants indicated they were health food retailers who chose not to participate. These 6 subjects accounted for 30% of the non- useable responses. Fourteen potential participants (70%) returned their questionnaires uncompleted with no reason specified. Of the total 456 potential participants, 58 (13%) returned their questionnaires and Nutrition Knowledge Test completed. Five respondents returned a completed ques— tionnaire without a corresponding Nutrition Knowledge Test. The research sample response rate is diagrammed in Figure 3. 46 / 27 not store owners 47 (499 sample) 16 incorrect address 456 net sample 63 Useable Responses completed question- naires \ (l 83 (18%) respondentil / 20 not useable Responses :T'-““=afi 58 completed NKT )6 14 Store Respondents Owners Unidentifie FIGURE 3: Research study response rate 48 Representativeness Of Sample TO determine the representativeness of the net re- search sample, the national distribution Of the 499 addresses were compared to health food industry studies conducted by Whole Foods Magazine (22) and Prevention magazine (1) in 1978. A chi—square test for goodness of fit was calculated using SPSS subprogram NONPAR tests. Two tests were run with the expected distribution being Whole Foods and EEE' vention magazines' national distribution estimates of the industry. The observed distribution in both tests was the national distribution of this research sample's health food retailers per geographic area. In both tests, the study sample distribution and the population distribution esti— mates were significantly different (pr.01)(Table 2). Prevention and Whole Foods magazines' independent retail health food industry distribution estimates were compared to one another. The discrepancies between the two health food industry distribution estimates based on 9 geographical areas are visible in Table 2. The largest discrepancy was between the Pacific and Mountain states. 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N H on em as as om NA zemz ms ma mm mm A mm Amd50po mouse Boos sauna are no code: on season moon .Hm o mm m as me mm mums Owe Quote xans can scan mocfi>uom >cme 30: O>mn muommcmmu umcu coccoesooou we pa .Opfiou coon sauna may 0» ocaocooo< .mm om he m we on am mam>ma ucmflunsc mum .mmocmzoaae >umumao coocmseoommc m.E oco ucouunu uOfium .mmocfimsm Odom space: may no powdmc >c< ca ocwxuoz Ou uofind :oHufluyaz cam coom usonc oucoazocx cowmmmw0d on: madsmm noummmom mcu >3 coumo umoz com: mwousom coflumeuomcH wo mmm>e one .mH mdmfifi 76 information source (7%). Retailers were requested to iden— tify one type of current information source they use most often. The same regrouping system was used as above. Once again, independent readings were used most often (75%) and personal experiences used least Often (6%). A Z—test for proportions was used to compare the prior and current types Of food and nutrition information. There was no significant difference between the type of prior and current food and nutrition information sources used. Per— sonal health problems were identified by 18% of the sample's responses as a type of prior food and nutrition information source. However, personal health problems were not listed by any respondent as a type of current food and nutrition infor- mation source. Personal experiences were listed less frequent- ly as a current food and nutrition information source than a prior source. The one type of current information source used most often had a response pattern similar to the list Of current information sources. Independent readings appear to be the type of food and nutrition information source used most often by this sample of health food retailers both prior to and after working in the health food business. Although there was no significant difference between the years retailers had been involved in the health food busi- ness and the type of information source used, retailers who were in the business the longest relied more on personal ex— periences (Table 16) than novice retailers. Newcomers to the business appear to rely more on independent readings for their 77 information source. If popular authors are asocial leaders in the health food movement (14), independent readings may provide the necessary indoctrination into the movement for newcomers . TABLE 16. A Comparison of the Type of Information Source Used Currently in Business Activities Most Often by Research Participants Length of Time in the Health Food Business. Type Of Currently Mean Deviation Used Information Years in From Group Source Number Business Mean Independent Readings 39 6.46 —.60 Classes/Training Programs 6 8.00 1.94 People 4 7.25 .19 Personal Experiences 2 12.50 5.44 Total 51 7.06 Type of Information Source and Nutrition Knowledge Test Scores A retailers performance on the Nutrition Knowledge Test was not influenced by the type Of current food and nutrition information source used most often. Since this information source was not significantly different from the types of prior and current information sources identified, it can be extra- polated that the type of food and nutrition information source 78 used did not influence retailers nutrition knowledge test scores. There also was no significant difference in test scores between retailers who identified personal health problems as a prior food and nutrition information source and retailers who did not. Specific Information Sources Respondents were asked to list three books, magazines, people, associations/Organizations, and classes or training programs from which they had acquired food and nutrition information. The information sources identified most fre- quently are listed in Table 17. How To Get Well, by Pavlo Airola, and Nutrition Almanac, by Nutrition Search, Inc.,were the most popular books listed. Retailers who read Back to Eden, by Jethro Kloss scored lower on the test than retailers who did not list Back to Eden as an information source (Table 17). This relationship ap- proached significance (p =0.06). There was no significant difference in test scores between other books listed. How To Get Well, by Pavlo Airola, Back to Eden by Jethro Kloss, and Let's Get Well, by Adelle Davis all have a therapeutic emphasis. While Airola identified 56 specific ailments and their proposed remedies, Kloss and Davis tend to be more general in their approach of the topic. Pavlo Airola is identified by his study in Europe and Mexico. This foreign identification has also been observed in social lead- ers of the health food movement (14). Appendix B contains a short review of each book. 79 TABLE 17. Specific Food and Nutrition Information Sources Used by Retailers. Food and Nutrition Information Source Number Mean NKT Score Books Nutrition Almanac Nutrition Search, Inc. 28 24.68 How to Get Well Pavlo Airola 31 22.77 Back to Eden jethro Kloss 13 21.15 Let's Get Well Adelle Davis 13 21.23 Know Your Nutrition Linda Clark 9 24.89 Magazines Let's Live 38 23.55 Prevention 32 23.13 Whole Foods 19 25.16 Bestways 18 24.94 Food and Nutrition Classes or Training Programs Yes 26 25.19 No 29 22.69 People Chiropractors 14 23.57 Industry Sales Reps. 17 24.47 Nutritionist 8 22.88 Alternative Healers 18 22.61 Conventional Educators 11 27.56** Conventional Health Spec. 14 23.07 No Conv. Nutrition Training 39 23.64 Association Membership Yes 35 24.77 No 22 22.27 Nat. Nutri. Foods Assoc. 22 24.06 Mid-America Health Organ. 3 26.33 National Health Federation 4 27.50 ,___Natura1_EOOds_Association. 5 24-20 **Significance Level = p_<_.01 80 One explanation for the low scores of retailers who read Kloss's book is that this book emphasized a more philo- sophical approach to natural healing than.the other books. It is not surprising that Airola's book and Nutrition Almanac are popular amongst retailers, since both these books list ailments and specific vitamin and or mineral remedies, and these types of remedies are lucrative in the health food industry (1). Prevention magazine and Let's Live were identified as food and nutrition information sources by 61% and 51% of the retailers, respectively. Retailers' Nutrition Knowledge Test scores were not significantly influenced by their choice of magazines used for food and nutrition information. Health food store retailers referred to people from many different professions for food and nutrition informa— tion. The research sample was asked to identify 3 people they referred to for information. Initially, 36 people were identified. These 36 responses were regrouped into 7 cate- gories. Industry sales representatives and alternative medical practioners were identified by 17% and 18% of the responses, respectively. Conventional health specialists were reported as 14% of the responses. These conventional specialists have not necessarily had conventional nutrition training. Individuals who referred to conventional educators for food and nutrition information scored significantly (PIE.01) better than other retailers on the NKT (Table 17). Since the test was developed by conventional educators, 81 this may be a factor in the significantly different scores. Sixty—five percent of the research sample were mem- bers Of an association or organization which provided them with food and nutrition information. The National Nutri- tional Foods Association (NNFA) was identified as an infor- mation source for 66% of the research sample. Appendix B contains a description of the association and organizations identified by the research sample. Of the retailers who were members of an association or organization, only 13% belonged to Mid-America Health Organization, National Health Federation, or the Natural Foods Association. NNFA was, by far, the most popular association or organization in this research sample. Food and nutrition classes and or training programs through a school, association or organization, had been at- tended by 41% of the research sample. The research parti- cipants who had attended a class or training program were asked to identify the subject matter and sponsor. The 18 initial class or trainng program subjects listed were re— grouped into 5 categories. Table 18 contains these regrouped categories and their corresponding figures. Nutrition was the subject of 54% of all classes taken. Classes with a therapeutic emphasis were listed as 20% of all the classes attended. Personal health, food sources, and nutritional assessment were listed as the subjects of 26% of all classes attended. 82 TABLE 18. Subject and Sponsor of Food and Nutrition Training Programs or Classes Taken Through a School Associa- tion or Organization by the Research Sample. Number of Training Program or Class Responses Percent Subject Therapeutic emphasis ' 10 20 Personal health 6 12 Nutrition 27 54 Food Sources 4 8 Nutritional Assessment 3 6 Sponsor Accredited Colleges 14 32 Credibility questionable 16 36 Associations or institutions 8 18 Health Food industries 6 14 83 Initially, 37 different class or training program sponsors were listed. These 37 responses were regrouped into 4 categories. Sponsors were considered accredited or not based upon their listing in the College Catalog Library (36). Sources of questionable credibility were the most popular sponsors of this research sample's classes or train- ing programs. The second most popular sponsor was accredited colleges. Therefore, although most retailers indicated they received degrees from accredited colleges, it appears some retailers attended non-degree classes or training programs sponsored by non-established food and nutrition information sources. The NKT scores of the research sample who participated in food and nutrition classes or training programs sponsored by accredited colleges were compared to the NKT scores of other research participants using a student's t-test. There was no significant difference between these 2 groups' NKT score. College sponsored participants had scores slightly higher (25.20) than other retailers (23.33). Information Sources Of Retailers in Business 6 Years or Less In Table 19, the information sources of retailers in business less than 6 years was compared to retailers in busi- ness for a longer length Of time. All retailers, regardless of the length of time in business, used basicly the same information sources. Significantly (p5.05), more novice 84 TABLE 19. A Comparison of the Specific Food and Nutrition Information Used by Research Participants in Busi- ness 6 Years or Less to Research Participants in Business Longer Than 6 Years. Percent Percent Number of of total of total Novice retailers novice Source Retailers per source retailers Books How To Get Well 18 60 55 Nutrition Almanac 20 67 61 Know Your Nutrition 9 90 27* Back to Eden 6 43 18 Lets Get Well 5 39 15 Magazines Let's Live 22 60 67 Prevention 18 51 55 Whole Foods 10 50 30 Bestways 7 37 21 People NO conventional training 19 53 58 Chiropractors 10 67 30 Conventional health specialist ll 65 33 Nutritionist 6 60 18 Conventional educator 7 70 21 Industry Sales Representative 9 47 23 Alternative healers 10 56 30 Association Memberships National Nutritional Foods Association 15 63 46 Mid-America Health Organization 2 50 6 National Health Federation 1 25 3 Natural Foods Association 4 80 12 *Significance level = p5.05 85 retailers used Know Your Nutrition as a food and nutrition information source than retailers in business longer than 6 years. This book may be more popular than other books among beginning retailers because it is a type of vitamin and min- eral primer. More novice retailers relied on conventional educators for food and nutrition information. Retailers who received food and nutrition information from conventional educators scored significantly (pf. .01) better than others on the Nutrition Knowledge Test (Table 17, page 79). However, there were no significant difference between retailers scores based on length of time in the health food business (Table 13, page 73). Test scores were slightly higher for the research par- ticipants newest to the business. Perhaps this can be ex— plained by the heavy use of conventional educators by more novice retailers. The most popular association amongst retailers in business 6 years or less was the National Nutritional Foods Association (NNFA). Novice retailers accounted for 63% of all NNFA members in the research sample. Retailers in busi- ness less than 6 years may acquire more information from NNFA than other retailers. NNFA may function as a national net- work for the health food movement. Comparison Between the Type of Information Source Used Most Often and the Specific Sources Used Research participants were asked to list the type of information source they currently used most Often. They 86 were also asked to identify three books, magazines, people and associations or organization they obtained food and nutrition information from. Since independent readings were the type of information source used most often, books and magazines may be a more important information source than people or organizations. There was no specific source Of information specified significantly more than another within any category of in- formation sources used. The specific sources are listed within each type of information source currently used most often in Table 20. The respondents who relied most heavily on independent readings also were the heaviest users of every information source listed. All retailers belonging to Mid-America Health Organization and National Health Federation relied most on independent readings as a food and nutrition infor— mation source. Ninety—four percent of the retailers who ob- tained information from industry sales representatives re- lied most often on independent readings. Perhaps sales rep- resentatives provide written material for retailers. Health food industries have been identified as a social support sys— tem in the health food movement (14). Let's Live magazine was the most popular book or magazine among retailers who relied on independent readings. 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