Food Choices of Young Adults in the United States of America: A Scoping Review

ABSTRACT

Understanding food choice is critical to developing effective health promotion efforts to counter the leading causes of morbidity and mortality in the United States. Although physiologic, environmental, and social factors influence the development of health conditions, routine decisions, such as food choice, also contribute substantially over time. Behavioral scientists believe that these routine decisions represent a key opportunity to improve population health. We conducted a scoping review of both health and business literature to identify themes in the food choices of young adults aged 19–24 y in the United States. Informed by the Joanna Briggs Institute processes for scoping reviews, we conducted a structured search of 8 health and business databases on 18 April 2017. The databases were PubMed, Business Source Complete, PsycInfo, Cochrane Library, CINAHL, Web of Science, SCOPUS, and ABI/Inform Collection. Eligible literature captured real-world dietary choices of the general population of young adults between 1 January, 2007 and 31 December, 2017. Records were screened in Covidence. Data was extracted into Excel and key findings thematically analyzed. The search returned 9085 records. Ninety-nine records met the eligibility criteria. Themes identified in the foods chosen by young adults include inadequate fruit and vegetable consumption, choosing international flavors and food formats, convenience foods, frequent snacking, the selection of healthy foods based on perceptions of what is healthy rather than the nutrient or calorie content of foods, an interest in sustainable production methods, the desire to customize/tailor foods, foods young people find interesting, and regional foods. This research identified common food choices that can help inform the tailoring of health promotion efforts; however, more research is needed to understand the underlying mechanisms and principles shaping these choices.

Introduction

Food choices are often the result of routine, rapid decisions rather than carefully considered selections based on an evaluation of benefit against risk (1). These choices, however, have significant impact on long-term health outcomes (2). Food intake is associated with a range of health issues including obesity, diabetes, arthritis, musculoskeletal disorders, some cancers and mental illness, stroke, and heart disease (3, 4). Globally, cardiovascular disease is the leading cause of morbidity and mortality from noncommunicable disease (5). The WHO anticipates that key risk factors for these conditions will rise, including those related to food choice. For example, >1.4 billion people will be overweight and >300 million people obese by 2025 (6). By 2030, 23 million deaths are anticipated globally each year from cardiovascular diseases at an annual cost of US$1 trillion dollars (7).

In the United States heart disease is the primary cause of death, with 1 in 3 adults clinically obese and rates of overweight rising at younger ages (8). Approximately US$200 million is attributed to annual health care costs and job absenteeism related to largely preventable cardiovascular diseases (7, 9). Yet, there is a strong evidence base that higher consumption of fruits and vegetables accompanied by lower intake of energy-dense foods, processed meats, and sugar-sweetened beverages (SSBs) can reduce the risk of cardiovascular disease and other noncommunicable diseases (10). Understanding food choice, including what foods are chosen and in what context, is important for tailoring interventions to promote healthy eating and improve population health (11).

The period of young adulthood is an underexplored but ideal window in the lifespan for promoting healthy food choices. Although daily decisions about eating—what, when, and how much to consume—are influenced by a complex set of factors for all people, the transition to adulthood includes significant biological, social, economic, and environmental changes that affect food choice (12–15). During this time neurologic and psychologic development affect the processes of decision making (16, 17). Concurrently, young adults are growing in independence and exposed to associated new social groups and influence (13, 14). These changes can promote or hinder consumption of healthy foods. Large prospective studies have highlighted this vulnerability by tracking weight gain and showing how these behaviors often continue for many years (18). It is important, therefore, to reach young adults before these behaviors become entrenched to reduce the risk of negative health outcomes later in life and, instead, encourage positive eating trajectories.

Policy-makers and health professionals need to be empowered with current information on the food choices of young adults to address key areas of risk; however, little research has explored these choices for young adults in the United States (19, 20). Conversely, business targets this group as a key consumer market, spending >US$4 billion in 2012 marketing to America's 31 million young adults (21, 22), while actively seeking to establish life-long relationships around food choice (23). This disconnect between health research and business activities suggests an opportunity to better leverage existing business data to inform health efforts. A preliminary search for existing scoping reviews in PROSPERO, PubMed, Cochrane Library, and Business Source Complete indicated a lack of consolidated information both within and across disciplines.

This scoping review aims to help address this gap by asking, “What food choices do 19- to 24-y-old young adults in the United States of America make, and what are the associated physical and social contexts of those choices?” This paper presents findings and recommendations related to the food choices made by young adults.

Methods

We followed the Joanna Briggs Institute (24, 25) guidelines for conducting scoping reviews. First, we developed an a priori protocol detailing the research question, objectives, inclusion criteria, and methods. To frame the review, we used several definitions from authoritative global and national sources (see Table 1).

TABLE 1.

Definitions of key terms

Term	Definition used
Health	Although acknowledging that health embraces concepts of wellness (26), for pragmatic reasons this review defines healthy as the absence of diagnosed illness
Young adults	Individuals aged 19–24 y inclusive, consistent with the lower ages of the US Census Bureau of Statistics definition of young adults as 19–34 y of age (27), and with the higher ages included in the WHO (28) definition of young people as 10–24 y of age. Beginning at 19 y of age eliminates data grouping young adults with adolescents and ensures emphasis on those who are no longer at high school. Ending at 24 y reflects the prolonged developmental transition from adolescence to adulthood. The target population of the United States includes all people living in the country regardless of citizenship status
Food choice	The entire food product rather than nutrient and calorie composition
Context	The physical environment and social circumstances of the food choice. Physical environments are the locations where the food choices are made. Examples include, but are not limited to, the home, educational facility, employment location, sporting venue, religious facility, cultural event, fine dining, family restaurant, fast food, or grocery outlet. Social circumstances include eating alone, with friends, with family, with work colleagues or other stated social groups, and address different group sizes if reported
Food behaviors	Food purchasing and consumption experiences including grocery shopping, snacking, dining, and meal preparation

We identified 8 comprehensive health and business databases for search: PubMed, Business Source Complete, PsycINFO, Cochrane Library, CINAHL, Web of Science, SCOPUS, and ABI/Inform Collection. These databases were selected for their wide range of formats and originating sources including government reports, peer-reviewed journal articles, newspaper articles, industry briefs, and expert publications.

A University of Queensland librarian helped develop a 3-step search strategy. The strategy comprised an initial search of 2 databases followed by an analysis of relevant returns, a refined search across all databases, and a manual search of reference lists. The strategy included data collected and published in English or Spanish between 1 January, 2007 and 31 December, 2017.

We trialed an initial search strategy in PubMed. Intentionally broad, it included keywords identified from the research question, MeSH terms, variations in spelling, and the Boolean operators AND and OR. We reviewed relevant records for additional key words and index terms. We then refined the search terms, which reduced the number of irrelevant returns, particularly related to food safety, food insecurity, illness states, and overseas research. The refined strategy was then piloted in both PubMed and Business Source Complete to test the relevance of the search terms across databases addressing different disciplines. Germane returns were analyzed, and search terms further refined. We then compared the strategy to the available search fields of the 8 databases. In keeping with the ethos of scoping reviews, every effort was made to standardize the search with adjustments made only to accommodate differences in search parameters. Each strategy was reviewed by the University of Queensland librarian as an additional consistency check. Supplemental Table 1 provides the final PubMed search strategy from which all searches were based.

The final search, conducted on 18 April, 2017, returned 9085 records. The records were imported into EndNote 7 and stored in individual folders within 1 library before being imported into Covidence for screening. This removed 513 duplications.

We conducted a 2-stage screening process. First, we screened each title and abstract against the protocol's eligibility criteria. The process of conducting scoping reviews involves careful, iterative refinement of the eligibility criteria to ensure focus on the research question. Therefore, the original eligibility criteria were intentionally inclusive to avoid excluding relevant content in the early stages. The first stage of screening excluded 7122 records.

Next, we reviewed the full text of the remaining 1450 records. Throughout the process, we refined the eligibility criteria to ensure the included records focused on real-world choices in a post-secondary school environment. This process of review, reference to the research question and objectives, and team discussion was central to establishing relevant and coherent parameters for the review. The final eligibility criteria are provided at Table 2.

TABLE 2.

Eligibility criteria

Criteria	Inclusion	Exclusion
Population	Content addresses the general population aged 19–24 y inclusive in the United States not diagnosed with an illness	Content falls outside of the target population age or country specifications. The population is diagnosed with an illness
	Population may be college or university students with no age specified.	Population is in a high school setting
Behavior	Food choices occur in a real-world setting	Content reports laboratory conditions
	Content reports demonstrable behaviour	Content is opinion or predictive rather than documenting a current food choice
Reporting	The mean age of a studied population falls in the target age range of 19–24 y and the SD does not place participants at ≥30 y.	Data for the target population cannot be disaggregated (data are included as part of a larger group with unknown mean age or mean age ≥30 y or with adolescents). Content does not clearly describe the age of the population—provides only general information
	Business records that do not state an age range but provide multiple points of reference indicating target population such as “millennial” and “young adults”	Records describe “young” customers without indicating if target population are children, adolescents, or young adults
	Data collection is clearly reported as occurring between 1 January, 2007 and 31 December, 2017	Content falls outside of the timeframe, or the date of data collection cannot be confirmed with the authors
	For interventions, baseline data is included when all other criteria are met	Content does not report eligible baseline data
Food choice	Content includes selection of a food or nonalcoholic beverage product	Content provides no whole product choice or focuses on nutrient or calorie components of food
Other	Full text is published in English or Spanish, 1 January, 2007–31 December, 2017	No full text available

Full text not available online was requested from the University of Queensland library (4 records). Text in Spanish was translated into English using Google Translate (1 record). Authors were contacted when the date of data collection was unclear (12 out of 18 records excluded). One author was contacted to confirm a typographic error regarding the location of data collection (record eligible). Any remaining ambiguity in eligibility status was resolved via team consultation, usually resulting in further refinement of the eligibility criteria.

Although the protocol included a targeted search of grey literature, Scopus, PubMed, and Business Source Complete databases returned some grey literature. The database search also returned >9000 records, indicating a good breadth of material was already located. For pragmatic reasons, we did not conduct a further search of grey literature.

After the initial screening, 77 records met eligibility criteria. A manual search of the reference lists identified 22 additional eligible records (see Figure 1). We extracted narrative data from each eligible record into Excel 2016 using the 17 categories listed in Table 3. Data were thematically analyzed.

FIGURE 1.

Flow diagram of literature search and study selection process for scoping review.

TABLE 3.

Data extraction categories

General	Approach and Results	Methods	Sample	Choice
Citation	Objective(s)	Relevant definitions	Number	Food or beverage selection
Business/health record	Program theories	Data collection method	Population	Consumption behavior
Public full-text link	Argument or main finding	Data collection location	Age bracket	Microenvironment
—	—	—	Majority characteristics	Social context

Results

The section below summarizes the prominent themes in the literature in narrative form with the corresponding citations provided in Supplemental Table 2. The titles for each theme reflect the nomenclature used in the records. These titles are SSBs, fruits and vegetables, international foods, convenience foods, snack foods, healthy foods, customizable foods, foods from sustainable production methods, interesting foods, and regional foods. Themes are organized by frequency determined by counting the appearance of the theme in the data. Themes counted most often are listed first. Each summary of the theme presents data from both health and business records.

SSBs

The literature suggests many young adults consumed substantial amounts of SSBs, including energy drinks and coffee beverages. Soda consumption slightly declined over the time period of the review; however, recent national data still reported prevalence of at least once daily SSB consumption as higher for 18- to 24-y-olds (at 43%) than any other age group (29). Energy drink consumption was reported to have increased over the 10 y, with young males consuming more than young females (30). Coffee beverages increased in popularity over the timeframe of this review, with 1 business article referring to coffee as being perceived as a snack that can be consumed at any time of day (31). The business literature noted that following the success of coffee chains such as Starbucks, fast-food restaurants created their own popular designer, and often high-calorie, offerings (32), and universities sold as many as 12 types of coffee on campus (33).

A common topic of examination in the health literature was SSB consumption (13 out of 52). Both soda (29, 34–37) and energy drink consumption (38–42) received targeted research attention; however, coffee drinks were included only as a subset of broader consumption habits.

Fruits and vegetables

Many of the health-related studies focused on fruit and vegetable consumption (FVC) (20 out of 52). Consistent across these studies was that, at ∼2 servings/d, the majority of sampled young adults consumed less than the recommended amounts of fruit and vegetables (10).

The largest samples and most frequent reporting of FVC were in the annual research survey, the American College Health Association National College Health Assessment (ACHA-NCHA). The records showed that FVC intake was relatively stable over time for the college population. Between 2010 and 2014, 58.7%–61.1% of responding students self-reported consumption of 1–2 servings of fruits and vegetables daily, 27.1–28.9% consumed 3–4 servings daily, 5.3–6.3% consumed ≥5 servings daily, and 6.1–6.6% consumed no servings daily (25, 33, 43, 44).

Although included health studies focused primarily on the FVC quantity, the business literature focused on the type of dish purchased. The most commonly reported FVC were primarily salad and vegetarian main meals, vegetable side dishes, and fruit consumed as a snack.

International foods

International, ethnic, and global foods were terms used interchangeably across the business literature to describe foods with flavors, and formats (such as tapas or tacos) of overseas origin. Grocery stores, fast casual restaurants, full-service restaurants, and university dining sold a wide range of globally inspired meals and snacks. Popular cuisines included Mediterranean, Asian, Oriental, Latin, and South American. The business literature reported that globally inspired foods appealed to perceptions of health and freshness, and provided opportunities for variety, creativity, large portion size, and local sourcing (45–47). First- and second-generation immigrants and exchange students favored authentic flavors and meals, whereas other young adults selected Americanized versions of foreign cuisine or smaller side dishes of authentic cuisine (46, 48–52). Calorie and nutrient components were not provided; however, authentic options were reported in the business literature as using lighter preparation methods and more fresh ingredients (53) than fast food (FF) and American-influenced versions (54). No health records specifically investigated the rise of international foods.

Convenience foods

Convenience appeared to be a key driver of sales. Health records associated the popularity of convenience foods with perceived value for money, as well as young adults’ lack of time, desire, and skills related to grocery shopping and cooking (55). Young adults chose foods they associated with convenient access to food providers and to foods that were ready for consumption in the desired context. Mess-free and portable foods (56) were popular for eating immediately on-the-go. (57, 58). Preprepared entrees (54, 55) were purchased for reheating or mixing at home (45, 54).

Young adults consumed FF throughout the time included in this review; however, FF preferences appeared to change over time. The business literature reported a general decline in popularity for traditional favorites including beef hamburgers and pizza (23, 31). In their place, sales of chicken products increased, passing beef items as early as 2009 (59). Also, FF versions of global dishes became popular at franchises including Wolfgang Puck Express, Wahoo's Fish Taco, Baja Fresh Express, Zao Noodle Bar, and Red Mango (51). Generally, business data suggest that industry responded to a consumer shift away from flavors and ingredients reflecting US traditions based on red meats and towards more varied and international dishes.

Convenience foods were not a focus of included health research. One study targeted FF consumption habits (60). It noted that university students appeared to augment meal plans ∼2 times per week with inexpensive FF, particularly dinners.

Snack foods

The evidence suggests many young adults favor snacking over eating 3 traditional meals per day. As early as 2007, the business literature observed a shift to frequent snacking, attributed partly to the belief that snacking is healthier and quoting nutritionist recommendations “to eat not just three square meals but up to six mini-meals throughout the day” (31), although this recommendation was not reflected in the health literature.

References to snacking continued, mostly in the business literature, throughout the 10 y, with young adults described as eating small portions (46, 61) more frequently than previous generations (56). The business literature suggested the purpose of snacking shifted over time to an affordable and convenient meal substitute (31, 62). The breadth of evidence discussing extended operating hours, small portion sizes, increased frequency of consumption, and eating outside the home, along with reduced cooking skills and cooking occasions, support the concept that a significant proportion of young adults snacked frequently and often while on-the-go.

Popular snack foods included convenient, individual-sized, and hand-held items, particularly breakfast foods, wraps and sandwiches, cookies and candies, fruit, and coffee. For some, perceptions of snack foods were broad. For example, qualitative health research by Reyes et al.(63) reported quotes of “(A snack is) like a burger, some fries. I just don't consider it lunch yet. It don't really fill me up.” and “(A snack is) something simple; it isn't a whole plate that I have to eat with a fork.”

Healthy foods

Healthy food was a recurring theme across the business and health literature. Twelve records specifically noted that some young adults have an interest in health as a driver of food choice; however, the perceptions of what is healthy (50, 64–68) were reported as influential more often than nutrient or calorie values displayed on menus, labels, or health promotion notices (26, 69, 70).

The way young adults used the term “healthy foods” often excluded health attributes and appeared to vary between social groups and across individuals. Business records reported that “healthy” was interpreted as adding “better-for-you” foods into the diet rather than reducing calories or intake of potentially harmful substances such as cholesterol or sodium (70). This included choosing vegetarian, organic, grass-fed, and hormone-free options (23, 46, 58, 71).

Business responded to concepts of “healthy foods” by offering vegetarian options and lower-priced meat proteins advertised as healthier alternatives to red meats. In 2013 Chick-fil-A became the highest-selling FF chain per store marketing “better-for-you” FF (32). Major national restaurant chains, such as Domino's, followed, adding chicken options (32). McDonald's blended concepts of healthier foods with demand for portable snacks; for example, creating the “McWrap” (23, 62). More recently, large FF and fast casual restaurant chains, led by Chipotle, removed genetically modified organisms from their menus, promoting healthy ingredients and concern for the environment as shared values of brand and consumer (72). These business decisions reflect a growing interest in transparency, particularly for simpler ingredient lists young adults say are easier to understand and therefore trust (23, 57, 58).

Customizable foods

Selecting individual components of a food, such as pizza toppings or salad ingredients, was a theme called “customization” in the business literature. Customizing food was thought to be popular because it increases variety in the diet and, therefore, reduces the repetitiveness of frequent snacking (57). Customization also provides a way to express individual preferences, whether cultural, health, or lifestyle choices (45, 46, 58, 70).

The business literature reported customizable food options in a variety of purchasing environments including grocery shopping (58), fast casual restaurants (70), FF restaurants (23, 73), and at university dining facilities and stores (46, 53, 54, 74). The popularity of customizing food at the point of purchase reflected general preferences seen across the literature to not plan food choice ahead of time (48, 75) but to decide in the moment from the options presented.

Foods from sustainable production methods

Some young adults chose sustainable and locally sourced options, believing them to be both socially responsible and healthier, higher-quality sources (46, 71). Concepts of “sustainable” production methods varied but generally included organic and non–genetically modified options. The popularity of sustainable foods was particularly evident in the business literature covering university dining. University students consumed a diverse range of sustainably produced foods sourced from their own farms or from formal farm-to-campus partnerships. Several records commented that some students liked the idea of these foods but did not always like the flavors (71). To bridge the gap between values and taste preferences, universities provided education on sustainability (76) or updated popular, familiar dishes with healthier ingredients (45, 49, 71, 77–79).

Interesting foods

Some young adults, especially men, looked for a sense of adventure in their food, underpinned by familiar flavors. This appeared to drive development of new products offering creative, cost-sensitive foods (11, 56). Berfield and Wong (80) reported that more adventurous menu items, including Taco Bell's Doritos locos tacos, crazy cheesy crust Pizza Hut pizza, and bacon cheddar–stuffed burger at Burger King, were designed specifically for young adult males. Given FF consumption was higher amongst young adult males (60, 81), the evidence suggests their FF choices may favor high-calorie, nutrient-poor products.

Interesting foods also appeared as special menu items. Limited-time menu options, discounts, and combination meals were cited across the business literature with movie theaters (82), FF restaurants (52), and university dining facilities (49, 61, 83) engaged in cross-promotion, daily specials, and free giveaways to leverage concepts of variety and exclusivity popular with young adults. Notably, items served for ≤60 d do not require disclosure of their calorie count under the nutrition-labeling provisions of the Patient Protection and Affordable Care Act of 2010 (80, 84). The appeal of limited-time food options combined with the lack of available health information make these food choices both a potential area of vulnerability for young adults and an opportunity for health promotion activities.

Regional foods

Regional food choices appeared primarily in the business literature but also in qualitative health research. These food choices reflected long-held regional traditions. Seafood was popular in the north-east (61, 85) and on the west coast (46, 53). Traditional southern foods, such as chitlins and chicken, appeared in the south (32, 86). Regional culture influenced preparation styles, such as barbeque in the south (87), but was also used around the country (49, 85) to provide variety, flavor, and globally inspired dishes. The literature discussed food themed to local social events and cultural interests, including hot dogs at sporting events and turkey legs at medieval fares (49, 61, 87, 88).

Discussion

This review reveals the dominant themes of food choice amongst young adults in the United States drawn from health and business data sources. Adding real-world business data to what is often self-report frequency questionnaires or controlled condition health studies provides a confirmation of actual choices in routine food environments. Overall, the business data provides insight into a wider range of food choices than the health literature and offers insight into important variables of interest to health researchers, such as geographic trends and potential barriers to consumption of healthy foods.

Of primary importance, the literature consistently reported that many young adults do not meet national recommendations for healthy eating. This may be partly explained by the frequent snacking and affinity for convenience products seen across the evidence. The reported food choices foreshadow potential health problems likely to manifest as these young adults age. It also indicates that current health promotion efforts could be improved. Many themes identified in this review, however, suggest immediate ways to encourage healthy food choices as well as opportunities for future research.

Generally, young adults appear to have clear food preferences. Many of the identified themes were consistent over the 10-y timeframe of this review, suggesting these preferences are not fads and will continue to be desirable. Some of these preferences can be readily applied to the development and presentation of healthy food options. Specifically, the literature indicates that healthy foods should be made as convenient, practical, and interesting as possible. Healthy options should be presented as snack foods, customizable items, and in creative dishes, particularly featuring global or regional flavors. Popular formats are likely to be portable, nonmessy, and preprepared.

The evidence also highlighted concepts of spontaneity. Both the business literature and health research showed that many young adults do not pre-plan their food choices. A lack of planning may make young adults particularly susceptible to environmental cues. This vulnerability may partly explain why providing information on the health attributes of foods does not always prompt healthy choices, which is in line with previous research advocating for health information to be accompanied by appropriate environmental cues (89). Prominent placement and presentation of healthy foods in the microenvironment are examples of cues that may encourage healthy choices with this population; however, more research is needed to unpack the interplay between decision-maker and food choice environment.

The concept of adapting environmental cues aligns particularly well with theories of choice architecture, such as nudge. Nudge theory proposes that because people make hundreds of routine decisions every day, the process is simplified using heuristics, also known as general rules of thumb (90). These heuristics focus attention on key factors important to the individual, and disregard extraneous input. Interventions that leverage these heuristics to encourage a predetermined action are called nudges. Nudges can be “any aspect of choice architecture that alters people's behavior in predictable ways without restricting any options or significantly changing their economic incentives such as time or money” (90).

As nudges often target implicit processes (91) the ethics and efficacy of nudging is debated. Early systematic reviews, however, indicate that nudges may help to improve food choice. For example, a 2016 systematic review found the majority of nudge literature concerning nutritional research increased positive choices in individual studies (92). Nudges may be particularly effective at targeting beneficial biases already identified in the evidence, or to counter harmful perceptions.

Finally, this review reports on what foods were chosen. It is important for future research to build on this evidence by exploring why these foods were chosen. We noted that both business and health literature referred to perceptions of food attributes, the social context of food choice, and concepts of self, such as perceived health status, as influencing food choice. It would be useful to further explore the perceptions held by young adults towards foods and the context in which these choices are made. Schema theory may provide a helpful framework for such investigation. To date, little research has investigated the food schemas of young adults.

Schemas are the dynamic, organized collections of knowledge and experience on a topic stored in long-term memory (93). They are cognitive maps that help individuals navigate a topic by accessing stored information in relevant contexts (94). Identifying food schema would provide information on how young adults perceive popular foods. Understanding which parts of the schema are activated for young adults in different contexts could provide clues as to which environmental cues may be most effective.

Understanding food schema would also highlight opportunities to improve food-related messaging. In general, the literature indicates messaging should be highly visual, simple, and engender trust (23, 57, 58). For young adults unmoved by the health attributes of food, interventions that tap into intrinsic motivators may be particularly promising (66, 94). Food-related social issues, including sustainable production methods, supporting small economies, and tying to local cultural events, are themes that could be linked to specific food options. Notably, some young adults have an active interest in what they consider to be healthy foods and sustainable production methods, and this translates into healthy food choices. This represents an opportunity for schema research to investigate characteristics of this group that could be extrapolated to their less health-oriented peers.

Limitations

The search strategy may have omitted relevant evidence available in additional sources, such as other databases or grey material. To mitigate this issue, the strategy spanned the dominant sources of information published within the 10-y time span, including business reports sensitive to subtle shifts in the consumer market.

Conclusion

The literature indicates that many young adults choose foods that may have negative impacts on long-term health. Several themes identified in the evidence offer opportunities to improve the menu options, messaging, and presentation of healthy foods. This information may be useful to researchers and health professionals for the tailoring of health promotion efforts. Future research is, however, needed to understand the underlying mechanisms and principles that serve to promote or constrain healthy choices.

Notes

Funding disclosure: No financial support was received for this research. No financial arrangements exist between the authors and any company mentioned in the manuscript. No portion of this work is being concurrently published, reviewed, or posted on the internet.

Author disclosures: PP, JD, and SL, no conflicts of interest.

Supplemental Tables 1 and 2 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/advances/.

Abbreviations used: FF, fast food; FVC, fruit and vegetable consumption; SSB, sugar-sweetened beverage.