Determining attitudinal and behavioral factors concerning milk and dairy intake and their association with calcium intake in college students

  • Rose, Angela M. (Department of Human Sciences, Ohio State University, Human Nutrition Program) ;
  • Williams, Rachel A. (Department of Human Sciences, Ohio State University, Human Nutrition Program) ;
  • Rengers, Brooke (Department of Human Sciences, Ohio State University, Human Nutrition Program) ;
  • Kennel, Julie A. (Department of Human Sciences, Ohio State University, Human Nutrition Program) ;
  • Gunther, Carolyn (Department of Human Sciences, Ohio State University, Human Nutrition Program)
  • Received : 2017.12.16
  • Accepted : 2018.03.02
  • Published : 2018.04.01


BACKGROUND/OBJECTIVES: Average intake of calcium among college students is below the recommended intake, and knowledge surrounding the attitudinal and behavioral factors that influence milk and dairy intake, a primary food source of calcium, is limited. The purpose of this study was to evaluate college students' attitudes and behaviors concerning milk and dairy consumption and their association with calcium intake. SUBJECTS/METHODS: Participants were 1,730 undergraduate students who completed an online survey (SurveyMonkey) as part of baseline data collection for a social marketing dairy campaign. The online survey assessed attitudes and behaviors concerning milk and dairy intake, and calcium intake. Questions about milk- and dairy-related attitudes and behaviors were grouped into 14 factors using factor analysis. Predictors of calcium intake were then evaluated. RESULTS: Median calcium intake across all participants was 928.6 mg/day, with males consuming higher calcium intakes than females (P < 0.001). Adjusted for gender, calcium intakes were most strongly (and positively) correlated with associating milk with specific eating occasions and availability (i.e., storing calcium-rich foods in one's dorm or apartment) (both P < 0.001). Other correlates of calcium intake included: positive-viewing milk as healthy (P = 0.039), having family members who drink milk) (P = 0.039), and taking calcium supplements (P = 0.056); and negative-parent rules concerning milk (P = 0.031) and viewing milk in dining halls negatively (P = 0.05). CONCLUSIONS: Calcium intakes among college students enrolled in the current study was below the recommended dietary allowance of 1,000 mg/day, reinforcing the need for dietary interventions in this target population, especially females. Practitioners and researchers should consider the factors found here to impact calcium intake, particularly associating milk with specific eating occasions (e.g., milk with breakfast) and having calcium-rich foods available in the dorm room or apartment, as intervention strategies in future efforts aimed at promoting milk and dairy foods and beverages for improved calcium intake in college students.



Supported by : American Dairy Association-Mideast


  1. Rizzoli R, Bianchi ML, Garabedian M, McKay HA, Moreno LA. Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly. Bone 2010;46:294-305.
  2. Weaver CM. Nutrition and bone health. Oral Dis 2017;23:412-5.
  3. Nicklas TA. Calcium intake trends and health consequences from childhood through adulthood. J Am Coll Nutr 2003;22:340-56.
  4. Gunther CW, Legowski PA, Lyle RM, McCabe GP, Eagan MS, Peacock M, Teegarden D. Dairy products do not lead to alterations in body weight or fat mass in young women in a 1-y intervention. Am J Clin Nutr 2005;81:751-6.
  5. Novotny R, Daida YG, Acharya S, Grove JS, Vogt TM. Dairy intake is associated with lower body fat and soda intake with greater weight in adolescent girls. J Nutr 2004;134:1905-9.
  6. Ma J, Johns RA, Stafford RS. Americans are not meeting current calcium recommendations. Am J Clin Nutr 2007;85:1361-6.
  7. Larson NI, Neumark-Sztainer D, Harnack L, Wall M, Story M, Eisenberg ME. Calcium and dairy intake: longitudinal trends during the transition to young adulthood and correlates of calcium intake. J Nutr Educ Behav 2009;41:254-60.
  8. Nelson MC, Story M. Food environments in university dorms: 20,000 calories per dorm room and counting. Am J Prev Med 2009;36:523-6.
  9. Bowman SA. Beverage choices of young females. J Am Diet Assoc 2002;102:1234-9.
  10. Koszewski WM, Kuo M. Factors that influence the food consumption behavior and nutritional adequacy of college women. J Am Diet Assoc 1996;96:1286-8.
  11. Morrell JS, Logren IE, Burke JD, Reilly RA. Metabolic syndrome, obesity, and related risk factors among college men and women. J Am Coll Health 2012;60:82-9.
  12. Harris KM, Gordon-Larsen P, Chantala K, Udry JR. Longitudinal trends in race/ethnic disparities in leading health indicators from adolescence to young adulthood. Arch Pediatr Adolesc Med 2006;160:74-81.
  13. Strong KA, Parks SL, Anderson E, Winett R, Davy BM. Weight gain prevention: identifying theory-based targets for health behavior change in young adults. J Am Diet Assoc 2008;108:1708-15.
  14. Cluskey M, Grobe D. College weight gain and behavior transitions: male and female differences. J Am Diet Assoc 2009;109:325-9.
  15. Nikolaou CK, Hankey CR, Lean ME. Weight changes in young adults: a mixed-methods study. Int J Obes (Lond) 2015;39:508-13.
  16. Bandura A. Social Foundations of Thought and Action: a Social Cognitive Theory. Englewood Cliffs (NJ): Prentice-Hall; 1986.
  17. Auld G, Boushey CJ, Bock MA, Bruhn C, Gabel K, Gustafson D, Holmes B, Misner S, Novotny R, Peck L, Pelican S, Pond-Smith D, Read M. Perspectives on intake of calcium rich foods among Asian, Hispanic, and White preadolescent and adolescent females. J Nutr Educ Behav 2002;34:242-51.
  18. Reicks M, Ballejos ME, Goodell LS, Gunther C, Richards R, Wong SS, Auld G, Boushey CJ, Bruhn C, Cluskey M, Misner S, Olson B, Zaghloul S. Individual and family correlates of calcium-rich food intake among parents of early adolescent children. J Am Diet Assoc 2011;111:376-84.
  19. Larson NI, Story M, Wall M, Neumark-Sztainer D. Calcium and dairy intakes of adolescents are associated with their home environment, taste preferences, personal health beliefs, and meal patterns. J Am Diet Assoc 2006;106:1816-24.
  20. Arcan C, Neumark-Sztainer D, Hannan P, van den Berg P, Story M, Larson N. Parental eating behaviours, home food environment and adolescent intakes of fruits, vegetables and dairy foods: longitudinal findings from Project EAT. Public Health Nutr 2007;10:1257-65.
  21. Neumark-Sztainer D, Story M, Dixon LB, Resnick MD, Blum RW. Correlates of inadequate consumption of dairy products among adolescents. J Nutr Educ Behav 1997;29:12-20.
  22. Kim MJ, Kim KW. Nutrition knowledge, outcome expectations, self-efficacy, and eating behaviors by calcium intake level in Korean female college students. Nutr Res Pract 2015;9:530-8.
  23. Poddar KH, Hosig KW, Anderson ES, Nickols-Richardson SM, Duncan SE. Web-based nutrition education intervention improves selfefficacy and self-regulation related to increased dairy intake in college students. J Am Diet Assoc 2010;110:1723-7.
  24. Sebring NG, Denkinger BI, Menzie CM, Yanoff LB, Parikh SJ, Yanovski JA. Validation of three food frequency questionnaires to assess dietary calcium intake in adults. J Am Diet Assoc 2007;107:752-9.
  25. Matlik L, Savaiano D, McCabe G, VanLoan M, Blue CL, Boushey CJ. Perceived milk intolerance is related to bone mineral content in 10- to 13-year-old adolescent females. Pediatrics 2007;120:e669-77.
  26. Ross AC, Taylor CL, Yaktine AL, Del Valle HB; Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Washington, D.C.: National Academies Press; 2011.
  27. Horwath CC. Dietary intake and nutritional status among university undergraduates. Nutr Res 1991;11:395-404.
  28. Balk EM, Adam GP, Langberg VN, Earley A, Clark P, Ebeling PR, Mithal A, Rizzoli R, Zerbini CA, Pierroz DD, Dawson-Hughes B; International Osteoporosis Foundation Calcium Steering Committee. Global dietary calcium intake among adults: a systematic review. Osteoporos Int 2017;28:3314-24.
  29. Lin YC, Lyle RM, Weaver CM, McCabe LD, McCabe GP, Johnston CC, Teegarden D. Peak spine and femoral neck bone mass in young women. Bone 2003;32:546-53.
  30. Lieberman HR, Marriott BP, Williams C, Judelson DA, Glickman EL, Geiselman PJ, Dotson L, Mahoney CR. Patterns of dietary supplement use among college students. Clin Nutr 2015;34:976-85.
  31. Marquis M. Exploring convenience orientation as a food motivation for college students living in residence halls. Int J Consum Stud 2005;29:55-63.
  32. Caruso ML, Klein EG, Kaye G. Campus-based snack food vending consumption. J Nutr Educ Behav 2014;46:401-5.
  33. Loth KA, Friend S, Horning ML, Neumark-Sztainer D, Fulkerson JA. Directive and non-directive food-related parenting practices: associations between an expanded conceptualization of food-related parenting practices and child dietary intake and weight outcomes. Appetite 2016;107:188-95.
  34. Reicks M, Degeneffe D, Ghosh K, Bruhn C, Goodell LS, Gunther C, Auld G, Ballejos M, Boushey C, Cluskey M, Misner S, Olson B, Wong S, Zaghloul S. Parent calcium-rich-food practices/perceptions are associated with calcium intake among parents and their early adolescent children. Public Health Nutr 2012;15:331-40.
  35. Matthews JI, Zok AV, Quenneville EP, Dworatzek PD. Development and implementation of FRESH--a post-secondary nutrition education program incorporating population strategies, experiential learning and intersectoral partnerships. Can J Public Health 2014;105:e306-11.