Values and Preferences Related to Cancer Risk among Red and Processed Meat Eaters: A Pilot Cross-Sectional Study with Semi-Structured Interviews
Abstract
:1. Introduction
2. Methods
2.1. Design
2.2. Protocol Development
2.3. Participant Selection
2.4. Procedures
2.4.1. Direct-Choice Exercise
2.4.2. Semi-Structured Interview
2.5. Data Synthesis and Analysis
2.5.1. Quantitative Analysis
2.5.2. Qualitative Analysis
3. Results
3.1. Participant Demographics
3.2. Willingness to Eliminate or Reduce Red Meat
3.3. Willingness to Eliminate or Reduce Processed Meat
3.4. Preferences and Factors Impacting Meat Consumption in the Face of Cancer Risk Reduction
4. Discussion
4.1. Main Findings
4.2. Comparison to Other Similar Studies
4.3. Strengths and Limitations
4.4. Implications
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. MAGIC Graphic Decision Aids for the Direct-Choice Exercise
References
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Study Participant No. | Age | Sex | Ethnicity | Level of Education | Employment Status | Marital Status | Family Characteristics | Exercise/Sport |
---|---|---|---|---|---|---|---|---|
1 | 24 | M | European origins | Master’s | Student | Married | No children | Regularly |
2 | 36 | M | European origins | Master’s | Student | Married | 1 child | With some regularity |
3 | 23 | F | European origins | Bachelor’s | Student | Single | No children | With some regularity |
4 | 23 | M | European origins | Bachelor’s | Student | Single | No children | Regularly |
5 | 23 | M | European origins | Bachelor’s | Student | Single | No children | Regularly |
6 | 30 | F | European origins | Bachelor’s | Student | Living common law | No children | Regularly |
7 | 23 | M | European origins | Bachelor’s | Student | Single | No children | Regularly |
8 | 27 | F | European origins | Master’s | Student | Living common law | No children | Regularly |
9 | 23 | F | Middle Eastern origins | Bachelor’s | Student | Single | No children | Never |
10 | 29 | M | European origins | Master’s | Student | Married | No children | Regularly |
11 | 32 | F | Middle Eastern origins | MD | Student | Married | 2 children | Seldom |
12 | 25 | M | European origins | Bachelor’s | Student | Single | No children | With some regularity |
13 | 48 | F | European origins | Bachelor’s | Employed for wages | Married | 1 child | Never |
14 | 49 | M | European origins | Bachelor’s | Employed for wages | Married | 1 child | Regularly |
15 | 47 | M | African origins | Master’s | Employed for wages | Single | No children | Seldom |
16 | 23 | F | European origins | Master’s | Employed for wages | Single | No children | Seldom |
17 | 51 | M | Middle Eastern origins | Bachelor’s | Employed for wages | Living common law | 3 or more children | With some regularity |
18 | 76 | M | Other North American | Secondary education | Retired | Married | No children | Regularly |
19 | 79 | F | European origins | Secondary education | Retired | Married | No children | Regularly |
20 | 72 | M | European origins/African origins | Secondary education | Retired | Married | No children | Seldom |
21 | 71 | F | European origins | Secondary education | Retired | Married | No children | regularly |
22 | 49 | M | European origins | Secondary education | Employed for wages | Married | 2 children | seldom |
23 | 33 | F | European origins | Secondary education | Employed for wages | Married | 2 children | seldom |
24 | 67 | F | European origins | Bachelor’s | Retired | Divorced | No children | Regularly |
25 | 23 | F | European origins | Bachelor’s | Employed for wages | Living common law | No children | With some regularity |
26 | 79 | M | European origins | Secondary education | Retired | Married | No children | regularly |
27 | 72 | F | European origins | Secondary education | Homemaker | Married | No children | With some regularity |
28 | 35 | M | Asian origins | Master’s | Employed for wages | Married | 1 child | Regularly |
29 | 21 | F | European origins | Bachelor’s | Out of work and looking for work | Single | No children | With some regularity |
30 | 27 | M | European origins | Master’s | Employed for wages | Single | No children | Regularly |
31 | 36 | M | European origins | Master’s | Employed for wages | Married | 1 child | With some regularity |
32 | 30 | M | European origins | Bachelor’s | Employed for wages | Single | No children | Regularly |
Unprocessed Red Meat | Processed Meat | |||
---|---|---|---|---|
Factors | Number of Mentions | Example Quotations | Number of Mentions | Example Quotations |
Taste | 24 | “Taste because it tastes good. If I had to compare that with other forms of protein like chicken and stuff like that, well cooked red meat really tastes better which gives me satisfaction from eating.” (M, Age 35, Employed) | 10 | “Especially charcuterie and salamis, I enjoy those a lot.” (F, Age 27, Student) |
“As a baseline I find that red meat tastes better than white meat in almost any circumstance.” (M, Age 29, Student) | “I think the both of us (referring to wife) like ham and we prefer that one over other types of processed meats. It is fairly lean to us.” (M, Age 76, Retired) | |||
Cost | 17 | “...that might be the most limiting factor for why I don’t eat maybe another serving of red meat a week. It is generally more expensive than both processed meat and poultry and fish.” (M, Age 27, Employed) | 8 | “I’m eating a lot of sandwich meats to make lunches for school being a student trying to find cheap meats for lunches.” (M, Age 23, Student) |
“Because of a limited income on a pension, the [high] cost is a big factor.” (M, Age 76, Retired) | “I tend to buy them only because they’re cheap and because they’re quick to prepare, so I purchase them when time is short and money is tight.” (F, Age 48, Employed) | |||
Health | 12 | “As far as red meat, with health, I have a really difficult time getting things like iron and protein and while I am aware that you can get these things in other foods like eggs and vegetables, between weird allergies and personal preference, it is easier to get these things out of meat products.” (F, Age 21, Unemployed) | 2 | “I’d be looking at preservatives knowing they’re not great for us in large quantities. We don’t need all that extra stuff.” (F, Age 23, Student) |
“In terms of health, I consider red meat an essential aspect of a balanced diet. It is a good source of iron for the children when it is lean beef, and it is a good source of nutrition.” (F, Age 32, Student) | “Generally, it has been hampered that processed foods are less healthy.” (M, Age 36, Student/Employed) | |||
Family Preferences/Tradition | 20 | “For tradition, it is more so that it is how my parents have eaten for a long time. I live at home and abide by those rules and none of us have been into veganism. I am not the one paying for the food, while I help, from the standpoint of what’s in the fridge, I’m not going to complain and there is no moral shift from what my parents eat.” (M, Age 23, Student) | 5 | “I would personally not buy ham, but my mother does, so I eat it because of that.” (F, Age 23, Student) |
“In terms of family preferences, I lived with my dad most of the time when I was younger and red meats would make up most of the meals in a week, so I grew up with it.” (M, Age 29, Student) | “Because of the way it tends to work in the house, my wife comes up with meal plans and I execute.” (Cited same reason for both unprocessed red and processed meat) (M, Age 36, Student/Employed) | |||
Convenience/Availability | 6 | “It is very easily available in the meat section of any grocery store you go to, so you don’t have to go searching for it, so that kind of influences your buying decisions because it stares you in the face.” (M, Age 35, Employed) | 7 | “When you go in any store, you will see pork on sale. If it is in Superstore this week, it will be on sale at Walmart the next week. For example, this week Superstore, the advertisement stated that the price was reduced for pork. Next week, it will be Sobey’s.” (M, Age 47, Employed) |
“In terms of availability, it is usually more easily and widely available in the places I go a lot and it is usually cheaper and more widely available and it is just easier to prepare and usually the convenient option and you don’t run into time and funds issues.” (F, Age 21, Unemployed) | “They are prepared, easy to use, readily available. It makes it easy to have those.” (F, Age 27, Student) | |||
Cooking Time | 2 | “I think that for me, on a practical level, the cooking time is a big factor, like recipes. If I want to eat less meat, I have to work at developing new recipes because most of the things I normally make include meat in them.” (M, Age 25, Student) | 9 | “It is easier to not cook processed sandwich meats that are ready made.” (M, Age 23, Student) |
“I’m always a hyper and want to get things done person. With cooking time, the faster things get done, the faster I eat [unprocessed red meat is a relatively quick meal to prepare compared to alternatives].” (M, Age 76, Retired) | “My son and I will often go on birding trips, so I can make a lot of sandwiches and it is inexpensive, quick to do, but I have been doing other things to give us more energy like taking boiled eggs. I use pepper not salt.” (M, Age 79, Retired) | |||
Environmental Concerns | 3 | “I know how bad beef is for the environment. So that makes me eat less.” (F, Age 23, Employed) | 1 | “Environmental aspect, I have been told on several different occasions that producing processed meat has a large carbon footprint and is contributing to negative environmental issues.” (M, Age 25, Student) |
“The effects that the animal industry has on the planet given the climate crisis right now. We have to start doing something. This would be what pushes me over the edge to stop eating it.” (F, Age 23, Student) | ||||
Social Context | 2 | “The social context, it makes me eat more because family barbeques usually include steaks or hamburgers.” (M, Age 24, Student) | 1 | “It is not generally something I pick first. I don’t do it by myself for supper, I’ll do it with my friends or be out for supper (charcuterie board). It is a pairing as opposed to a meal. More likely to have a sausage with my friends at a barbeque.” (M, Age 36, Student/Employed) |
“Barbecues in the summer are good times to have red meat and at parties and social situations.” (F, Age 27, Student) | ||||
Religious Beliefs | 3 | “I am Muslim, so I do not eat pork, so I always check labels for pork and don’t buy processed meat because it usually has pork in it.” (M, Age 51, Employed) | 1 | “Similarly, I look on the label to make that the processed meat does not have any pork (Islam).” (F, Age 23, Student) |
“We don’t eat pork for religious reasons.” (F, Age 32, Student) | ||||
Other—Dietary considerations | 2 | “Because I have to eat around 240g of protein per day for the diet I am trying to follow, the fact that the red meat has one of the highest bioavailabilities of the protein ingested plays an important factor to me.” (M, Age 49, Employed) | 1 | “It comes down to the fact that I eat keto and the only grab and go snack I can have is cheese and meat. With keto, depending on the processed meat we have the higher fat content.” (F, Age 30, Student/Military) |
“With regards to ketogenic diet, it is considered to be 70-80% fat of my daily calorie consumption and red meat has the highest fat to protein ratio.” (F, Age 30, Student/Military) | ||||
Other—Origin | 1 | “Buying local—the further it gets away from my home, the less I trust it.” (F, Age 67, Retired) | 0 |
Participant # | Main Determinant 1 | Willingness to Reduce | Example Quotations |
---|---|---|---|
1 | Factors | Definitely | “I like to know the mechanisms, with the data; if I knew how unprocessed meats at the cellular level could result in cancer, then that would be convincing for me.” |
Yes | |||
2 | Evidence | Somewhat | “I can’t tell you for sure what the threshold would be but needs to be more substantial than that. A direct order from a physician would probably do it.” |
No | |||
3 | Factors | Somewhat | “I think that if it weren’t on the menu in restaurants, I wouldn’t order it. If I hadn’t grown up with it, then it would be easier. Socially, barbeques promote a lot of hotdogs and hamburgers.” |
Yes | |||
4 | Evidence | Somewhat | “[I would need to see] very high evidence showing that meat will significantly put you at risk for cancer death and rare cancer incidences.” |
Yes | |||
5 | Factors | Somewhat | “[I would need to have] methods of obtaining proteins and nutrients from other food sources for free or cheaper. I’m not going to eat meat to get protein when I could get it somewhere else for less expensive and cheaper.” |
Yes | |||
6 | Factors | Definitely | “I through many years of trial and error, have found a way of eating that makes me feel more energetic and healthier. My bloodwork reflects this and my diet has high red and processed meat, so I am unlikely to stop or reduce my intake.” |
No | |||
7 | Factors | Definitely | “Yes, the main thing would be the cancer mortality that I was thinking about, but those factors are what would keep me from not eliminating it. Cost is mainly the one: if I could switch all processed to unprocessed, I would, but the price and convenience outweigh this.” |
Yes | |||
8 | Both | Somewhat | “A clear health risk, if the certainty was higher in the association between cancer and red meat consumption. Another factor is if the price were really high, and it weren’t available.” |
Yes | |||
9 | Factors | Somewhat | “Because the study you showed me is definitely showing something, I would consider reducing based on the data you showed me, but because I really like the taste of meat I do not think I am really willing to cut it out of my diet completely.” |
No | |||
10 | Factors | Somewhat | “I think the only thing that would change my intake would be reactive, so if I had some sort of disease would make a difference… I would have to already be there. I would say that if cost continued to go up, I would consider it because beef is getting more and more expensive, so if it continued, I would switch to cheaper alternatives.” |
Yes | |||
11 | Evidence | Somewhat | “I think that the reason that I decided that I wouldn’t stop eating red meat is that the evidence isn’t convincing—it isn’t that strong. The effect and association isn’t that strong and the evidence isn’t very certain, so it’s both of those together.” |
Yes | |||
12 | Factors | Somewhat | “I think that all those factors that we discussed pushed me toward the side of wanting to not reduce, but if I am honest, I don’t think I would ever stop eating it, but it could push me to wanting to reduce red meat/processed meat consumption.” |
Yes | |||
13 | Both | Somewhat | “What influenced my responses to the graphics was the fact that I didn’t feel the differences were significant enough for me to change the factors that influence my meat. I did not feel that the graphics were enough to override them.” |
Yes | |||
14 | Evidence | Definitely | “What affected me there was the very low probability on each of those studies (referring to mortality and incidence scenarios). Probably also the fact that with every new study, things change.” |
No | |||
15 | Evidence | Somewhat | “Not really, when you showed me the pictures, I saw the risk of getting and dying from cancer, which is why I said I want to reduce. When I said I cannot stop, it is because my health does not show any risks right now with that.” |
Yes | |||
16 | Factors | Somewhat | “I think it’s a bit of routine, so I’m in the routine at home right now eating meat, so when I move and switch up my routine that that will be the big push for me to make that change versus trying to incorporate it into my current lifestyle.” |
Yes | |||
17 | Factors | Definitely | “Yes, I like the taste, so I can’t stop eating it.” |
No | |||
18 | Factors | Definitely | “We don’t know, really, what the processed meat is made of and what the ingredients really are, so we have to take a little bit of time and see what we’re eating. I don’t think we would reduce to the extent of not eating it altogether.” |
Yes | |||
19 | Factors | Somewhat | “Yes, I really like hamburgers, so I don’t want to stop eating it.” |
Yes | |||
20 | Evidence | Definitely | “I understand that if there is no cancer in your genes there and I don’t consume that much meat to start with (not as likely to get cancer), so I didn’t really think of those factors.” |
No | |||
21 | Factors | Somewhat | “It is just hard to figure out what you would eat and how much it would cost if you stopped eating meat. It seems like we spend a lot of money on groceries.” |
No | |||
22 | Evidence | Definitely | “No. There wasn’t enough of a reduction to make me want to stop.” |
No | |||
23 | Factors | Somewhat | “Yes, I was thinking maybe I should change. I am so limited to my food right now as it is, so I don’t want to stop (does not eat many vegetables).” |
Yes | |||
24 | Factors | Definitely | “I’m on such a low side of eating red meat, that I still don’t feel the need. People tend to eat more than they say (not understanding what a serving is). I was automatically thinking of the iron thing.” |
No | |||
25 | Factors | Somewhat | “I think if the risk were substantial, I would stop eating it, but I don’t know what I would call substantial. Because my risk reduction would be around 0.4 and 0.2% right now- it would have to be around 10%.” |
Yes | |||
26 | Evidence | Definitely | “Yeah, I started thinking about cutting back because you showed me the graphics and it looks like something to be concerned about. I know I eat too much processed stuff and not enough vegetables and fruit.” |
Yes | |||
27 | Evidence | Definitely | “Yes, it makes a person think that the data does make a difference. I may work on it based off what I saw, which we have been already, so it’s probably not too much more to work on.” |
Yes | |||
28 | Evidence | Somewhat | “[I would need] at least moderate to high quality evidence that cancer incidence and I don’t really care about mortality because incidence comes with morbidity, that there is a definite reduction in incidence without cutting out red meat completely.” |
Yes | |||
29 | Factors | Definitely | “I am more aware of how “bad” processed meats are for you, but the general convenience associated with it, is something that it more often than not outweighs the consequences of them. The presented risks don’t seem quite enough to outweigh the consequences to eating them. I also seem to take in enough of the other important aspects of nutrition in other places that it is not a significant factor for me to take it out of my diet.” |
Yes | |||
30 | Both | Somewhat | “Yeah, I would still say that they are the three most prominent, although they (the graphics) did add something to my knowledge of red meat in terms of health benefits, but I wouldn’t say that it would overall sway my current status. In terms of reduction, I was perhaps leaning more on the benefits or the health side of things vs. the cost would help me reduce to maybe one or two servings, but just trying to weigh those three factors.” |
Yes | |||
31 | Both | Somewhat | “I don’t know because I find statistics hard to say show me a graphic and a number, I find it hard to relate to. I think maybe humans are bad at statistics and making decisions based on statistical data. If there were particular things related to my health like cholesterol levels of like actual diagnostics I can do on me to maybe say red meat isn’t helping, so it would have to be some kind of individual health need as opposed to some big external data graphic, I think. |
Yes | |||
32 | Both | Somewhat | “Yeah, I was thinking about the amount of protein that I need to eat to maintain my health and the certainty level did not convince me to reduce. Like the factors are more important to me than reducing my cancer risk because I’m healthy right now and I feel like that would reduce some of my risk already, so I’m not overly concerned about cancer.” |
Yes |
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Howatt, V.; Prokop-Dorner, A.; Valli, C.; Zajac, J.; Bala, M.M.; Alonso-Coello, P.; Guyatt, G.H.; Johnston, B.C. Values and Preferences Related to Cancer Risk among Red and Processed Meat Eaters: A Pilot Cross-Sectional Study with Semi-Structured Interviews. Foods 2021, 10, 2182. https://doi.org/10.3390/foods10092182
Howatt V, Prokop-Dorner A, Valli C, Zajac J, Bala MM, Alonso-Coello P, Guyatt GH, Johnston BC. Values and Preferences Related to Cancer Risk among Red and Processed Meat Eaters: A Pilot Cross-Sectional Study with Semi-Structured Interviews. Foods. 2021; 10(9):2182. https://doi.org/10.3390/foods10092182
Chicago/Turabian StyleHowatt, Victoria, Anna Prokop-Dorner, Claudia Valli, Joanna Zajac, Malgorzata M. Bala, Pablo Alonso-Coello, Gordon H. Guyatt, and Bradley C. Johnston. 2021. "Values and Preferences Related to Cancer Risk among Red and Processed Meat Eaters: A Pilot Cross-Sectional Study with Semi-Structured Interviews" Foods 10, no. 9: 2182. https://doi.org/10.3390/foods10092182