Interventions designed to increase adult fruit and vegetable intake can be effective: a systematic review of the literature

Tailored, iterative, printed dietary feedback is as effective as group education in improving dietary behaviours: results from a randomised control trial in middle-aged adults with cardiovascular risk factors

Background

Tailored nutrition interventions have been shown to be more effective than non-tailored materials in changing dietary behaviours, particularly fat intake and fruit and vegetable intake. But further research examining efficacy of tailored nutrition education in comparison to other nutrition education methods and across a wider range of dietary behaviours is needed. The Stages to Healthy Eating Patterns Study (STEPs) was an intervention study, in middle-aged adults with cardiovascular risk factors, to examine the effectiveness of printed, tailored, iterative dietary feedback delivered by mail in improving short-term dietary behaviour in the areas of saturated fat, fruit, vegetable and grain and cereal intake.

Methods

STEPs was a 3-month randomised controlled trial with a pre and post-test design. There were three experimental conditions: 1) tailored, iterative, printed dietary feedback (TF) with three instalments mail-delivered over a 3-month period that were re-tailored to most recent assessment of dietary intake, intention to change and assessment of self-adequacy of dietary intake. Tailoring for dietary intake was performed on data from a validated 63-item combination FFQ designed for the purpose 2) small group nutrition education sessions (GE): consisting of two 90-minute dietitian-led small group nutrition education sessions and 3) and a wait-listed control (C) group who completed the dietary measures and socio-demographic questionnaires at baseline and 3-months later. Dietary outcome measures in the areas of saturated fat intake (g), and the intake of fruit (serves), vegetables (serves), grain and cereals as total and wholegrain (serves) were collected using 7-day estimated dietary records. Descriptive statistics, paired t-tests and general linear models adjusted for baseline dietary intake, age and gender were used to examine the effectiveness of different nutrition interventions.

Results

The TF group reported a significantly greater increase in fruit intake (0.3 serves/d P = 0.031) in comparison to GE and the C group. All three intervention groups showed a reduction in total saturated fat intake. GE also had a within-group increase in mean vegetable intake after 3 months, but this increase was not different from changes in the other groups.

Conclusions

In this study, printed, tailored, iterative dietary feedback was more effective than small group nutrition education in improving the short-term fruit intake behaviour, and as effective in improving saturated fat intake of middle-aged adults with cardiovascular risk factors. This showed that a low-level dietary intervention could achieve modest dietary behaviour changes that are of public health significance.

Direct and mediated effects of two theoretically based interventions to increase consumption of fruits and vegetables in the Healthy Body Healthy Spirit trial

This study tested the effects of two theory-based interventions to increase fruit and vegetable intake. Hypothesized intervention mediators included self-efficacy (SE), social support (SS), autonomous motivation (AM), and controlled motivation (CM). At baseline, 1,021 African American adults were recruited from 16 churches randomized to one comparison and two intervention groups: Group 1 (standard educational materials), Group 2 (culturally targeted materials), and Group 3 (culturally targeted materials and telephone-based motivational interviewing). A well-fitted model based on structural equation modeling-χ(2)(df = 541, N = 353, 325) = 864.28, p < .001, normed fit index = .96, nonnormed fit index = .98, comparative fit index = .98, root mean square error of approximation = .042-demonstrated that AM was both a significant mediator and moderator. In the subgroup with low baseline AM, AM mediated 17% of the effect of the Group 3 intervention on fruit and vegetable intake. Conversely, SS, SE, and CM were not significant mediators. Implications related to theory and intervention development are discussed.

Relationship of fruit and vegetable intake with adiposity: a systematic review

Fruit and vegetable (FV) intake has been proposed to protect against obesity. The purpose of this paper was to assess the FV consumption to adiposity relationship. Twenty-three publications were included.

INCLUSION CRITERIA

longitudinal or experimental designs; FV intake tested in relation to adiposity; child, adolescent or adult participants; published in English-language peer-reviewed journals.

EXCLUSION CRITERIA

dietary pattern and cross-sectional designs; participants with health concerns. Experimental studies found increased FV consumption (in conjunction with other behaviours) contributed to reduced adiposity among overweight or obese adults, but no association was shown among children. Longitudinal studies among overweight adults found greater F and/or V consumption was associated with slower weight gain, but only half of child longitudinal studies found a significant inverse association. Limitations in methods prevented a thorough examination of the role of increased FV intake alone or mechanisms of effect. An inverse relationship between FV intake and adiposity among overweight adults appears weak; this relationship among children is unclear. Research needs to clarify the nature of, and mechanisms for, the effects of FV consumption on adiposity. Whether increases in FV intake in isolation from lower caloric intake or increased physical activity will result in declines or slower growth in adiposity remains unclear.

Awareness of chronic disease diagnosis amongst family members is associated with healthy dietary knowledge but not behaviour amongst Inuit in Arctic Canada

BACKGROUND

The extent to which awareness of chronic disease (CD) diagnosis affects one's healthy food knowledge, self-efficacy and intentions or healthy dietary and physical activity (PA) behaviours remains unexplored among Inuit in Canada.

METHODS

A food frequency questionnaire and an adult impact questionnaire were used in a cross-sectional study to collect self-reported data on daily energy and nutrient intake, PA and the diagnosis of hypertension, diabetes, heart disease and cancer amongst adult Inuit and their family members. Associations between awareness of personal and family CD status and healthy food knowledge, self-efficacy and intentions, percentage of energy consumed from non-nutrient-dense foods and PA were assessed via ordinal logistic regression.

RESULTS

Of the 266 participants, those who self-reported CD for both themselves and their relative(s) were more likely to have high healthy food knowledge [odds ratio (OR)=2.45] than those who did not. Reporting hypertension and heart disease amongst only relatives increased the likelihood of high knowledge (OR=5.20) and intentions (OR=5.10) for healthy eating. Heart disease in both participants and their relatives was associated with high levels of PA (OR=12.24). However, there were no associations when only participants (but not their relatives) reported having CD. A joint effect between a high level of education and awareness of CD was positively related to high food knowledge (OR=38.93). An inverse association between awareness of CD and unhealthy eating was not observed.

CONCLUSIONS

Awareness of a relative having a CD was a more important factor in increasing knowledge and, to a lesser degree, self-efficacy or intentions to eat healthy than participants' awareness of personal CD. However, awareness was not associated with lower non-nutrient-dense food intake.

Improving the diet of employees at blue-collar worksites: results from the ‘Food at Work’ intervention study

Objective

To examine the impact of a 6-month participatory and empowerment-based intervention study on employees’ dietary habits and on changes in the canteen nutrition environment.

Design

Worksites were stratified by company type and by the presence or absence of an in-house canteen, and randomly allocated to either an intervention group (five worksites) or a minimum intervention control group (three worksites). The study was carried out in partnership with a trade union and guided by an ecological framework targeting both individual and environment levels. Outcome measures included: (i) changes in employees’ dietary habits derived from 4 d pre-coded food diaries of a group of employees at the worksites (paired-data structure); and (ii) the canteen nutrition environment as identified by aggregating chemical nutritional analysis of individual canteen lunches (different participants at baseline and at endpoint).

Setting

Eight blue-collar worksites (five of these with canteens).

Subjects

Employees.

Results

In the intervention group (n102), several significant positive nutritional effects were observed among employees, including a median daily decrease in intake of fat (−2·2 %E,P= 0·002) and cake and sweets (−18 g/10 MJ,P= 0·002) and a median increase in intake of dietary fibre (3 g/10 MJ,P< 0·001) and fruit (55 g/d,P= 0·007 and 74 g/10 MJ,P= 0·009). With regard to the canteen nutrition environment, a significant reduction in the percentage of energy obtained from fat was found in the intervention group (median difference 11 %E,P< 0·001,n144).

Conclusions

The present study shows that moderate positive changes in dietary patterns can be achieved among employees in blue-collar worksites.

Increased consumption of fruit and vegetables and future cancer incidence in selected European countries

Cancer is one of the major causes of death in western countries. Fruit and vegetable consumption may reduce the risk of cancers of the oropharynx, oesophagus, lung, stomach and colorectum. We investigated the potential effect of interventions aimed at increasing the intake of fruits and vegetables to the recommended level (500 g/d) on future cancer incidence in Europe. Data on cancer incidence and daily intake of fruit and vegetables were compiled for France, Germany, The Netherlands, Spain and Sweden. We also performed a meta-analysis of European observational studies to arrive at a quantitative estimate on the association between fruit and vegetable intake and cancer risk. Predictions on the future cancer incidence were modelled using PREVENT 3.01. Our study predicted 212,000 fruit- and vegetable-related cancer cases in these countries in 2050, out of which 398 (0.19%) might be prevented if the 500 g/d fruit and vegetable intake were achieved in the aforementioned countries. The largest absolute impact was observed for lung cancer with 257 (out of 136,517) preventable cases if the intervention was successfully implemented. Sweden would benefit the most from intervention to increase fruit and vegetable consumption with a 2% reduction in expected cases. Increasing fruit and vegetable consumption has a small impact on reducing the burden of cancer in Europe. Health impact assessment tools such as PREVENT can provide the basis for decision making in chronic disease prevention.

Effect of preventive messages tailored to family history on health behaviors: the Family Healthware Impact Trial

PURPOSE

We wanted to determine the impact of automated family history assessment and tailored messages for coronary heart disease, stroke, diabetes, colorectal, breast, and ovarian cancer on preventive behaviors compared with a standard preventive message.

METHODS

The study was a cluster-randomized clinical trial that included 41 primary care practices, the majority in the Midwest, using Family Healthware, a self-administered, Web-based tool that assesses familial risk for the diseases and provides personalized risk-tailored messages. Patients in the control group received an age- and sex-specific health message related to lifestyle and screening. Smoking cessation, fruit and vegetable intake, physical activity, aspirin use, blood pressure, and cholesterol and blood glucose screening were assessed at baseline and 6 months after the intervention.

RESULTS

Of 4,248 participants, 3,344 (78%) completed the study. Participants were white (91%), female (70%), and insured (97%), and had a mean age of 50.6 years (range 35-65 years). Intervention participants were more likely to increase daily fruit and vegetable consumption from 5 or fewer servings a day to 5 or more servings a day (OR = 1.29; 95% confidence interval [CI], 1.05-1.58) and to increase physical activity (OR = 1.47; 95% CI, 1.08-1.98) to 5 to 6 times a week for 30 minutes or more a week. The absolute differences in proportion were 3% and 4%, respectively. Intervention participants were less likely to move from not having cholesterol screening in the last 5 years to having their cholesterol measured within 5 years (OR = 0.34; 95% CI, 0.17-0.67), with an absolute difference of 15%.

CONCLUSIONS

Messages tailored to an individual's familial risk for 6 common diseases modestly increased self-reported physical activity and fruit and vegetable intake but reduced the likelihood of receiving cholesterol screening.

Inverse association between fruit and vegetable intake and BMI even after controlling for demographic, socioeconomic and lifestyle factors

OBJECTIVE

To estimate fruit and vegetable (FV) intake levels of US adult population and evaluate the association between FV intake and BMI status after controlling for confounding demographic, socioeconomic and lifestyle factors. We also sought to identify moderating factors.

METHODS

We used 2007 Behavior Risk Factors Surveillance System (N > 400,000) data. FV intake was dichotomized as ≥5 servings (FV5+) versus <5 servings/ day. BMI status was categorized as normal, overweight, and obese. Identification of moderators was performed by testing interactions between BMI status and other variables using bivariate analyses followed by multiple logistic regression analysis incorporating complex survey sampling design features.

RESULTS

Only 24.6% of US adults consumed ≥5 servings per day and less than 4% consumed 9 or more servings. Overweight (% FV5+ = 23.9%) and obese (21.9%) groups consumed significantly less FV than the normal-weight (27.4%) group (p < 0.0001). This inverse association remained significant even after controlling for potential confounding factors. Multivariate analysis identified five significant moderators (p < 0.0001) after controlling for all evaluated variables: race, sex, smoking status, health coverage, and physical activity. Notably, physically inactive obese males tended to consume the least FV (% FV5+ = 14.7%).

CONCLUSION

Current US population FV intake level is below recommended levels. The inverse association between FV intake and obesity was significant and was moderated by demographic, socioeconomic status, and lifestyle factors. These factors should be considered when developing policies and interventions to increase FV intake.

Five-a-day, a price to pay: an evaluation of the UK program impact accounting for market forces

We provide an ex-post assessment of the UK 5-a-day information campaign, where the positive effects of information are disentangled from potentially conflicting price dynamics. Using 4 years of data from the Expenditure and Food Survey between 2002 and 2006, we estimate that the 5-a-day program has lifted fruit and vegetable consumption by 0.3 portions, on average. We also provide quantitative evidence of a differentiated impact by income group, ranging from 0.2 to 0.7 portions. All impacts are larger than those observed by simply comparing pre-policy and post-policy intakes.

Impact of an intervention on the availability and consumption of fruits and vegetables in the workplace

OBJECTIVE

To evaluate the impact of an educational and environmental intervention on the availability and consumption of fruits and vegetables in workplace cafeterias.

DESIGN

This was a randomized intervention study involving a sample of companies that were divided into intervention and control groups. The intervention, which focused on change in the work environment, was based on an ecological model for health promotion. It involved several different aspects including menu planning, food presentation and motivational strategies to encourage the consumption of fruits and vegetables. The impact of the intervention was measured by changes (between baseline and follow-up) in the availability of fruits and vegetables that were eaten per consumer in meals and the consumption of fruits and vegetables in the workplace by workers. We also evaluated the availability of energy, macronutrients and fibre.

SETTINGS

Companies of São Paulo, Brazil.

SUBJECTS

Twenty-nine companies and 2510 workers.

RESULTS

After the intervention we found an average increase in the availability of fruits and vegetables of 49 g in the intervention group, an increase of approximately 15 %, whereas the results for the control group remained practically equal to baseline levels. During the follow-up period, the intervention group also showed reduced total fat and an increase in fibre in the meals offered. The results showed a slight but still positive increase in the workers' consumption of fruits and vegetables (about 11 g) in the meals offered by the companies.

CONCLUSIONS

Interventions focused on the work environment can be effective in promoting the consumption of healthy foods.

Cost-effectiveness of interventions to promote fruit and vegetable consumption

Background

Fruits and vegetables are an essential part of the human diet, but many people do not consume the recommended serves to prevent cardiovascular disease and cancer. In this research, we evaluate the cost-effectiveness of interventions to promote fruit and vegetable consumption to determine which interventions are good value for money, and by how much current strategies can reduce the population disease burden.

Methods/Principal Findings

In a review of published literature, we identified 23 interventions for promoting fruit and vegetable intake in the healthy adult population that have sufficient evidence for cost-effectiveness analysis. For each intervention, we model the health impacts in disability-adjusted life years (DALYs), the costs of intervention and the potential cost-savings from averting disease treatment, to determine cost-effectiveness of each intervention over the lifetime of the population, from an Australian health sector perspective. Interventions that rely on dietary counselling, telephone contact, worksite promotion or other methods to encourage change in dietary behaviour are not highly effective or cost-effective. Only five out of 23 interventions are less than an A$50,000 per disability-adjusted life year cost-effectiveness threshold, and even the most effective intervention can avert only 5% of the disease burden attributed to insufficient fruit and vegetable intake.

Conclusions/Significance

We recommend more investment in evaluating interventions that address the whole population, such as changing policies influencing price or availability of fruits and vegetables, to see if these approaches can provide more effective and cost-effective incentives for improving fruit and vegetable intake.

Barriers and facilitators of dietary sodium restriction amongst Bangladeshi chronic kidney disease patients

BACKGROUND

People of Bangladeshi origin have the highest mortality ratio from coronary heart disease of any minority ethnic group in UK and their rate of kidney disease is three- to five-fold higher than that of the European UK population. However, there is little information regarding their dietary customs or knowledge, beliefs and attitudes towards health and nutrition. This multi-method qualitative study aimed to identify: (i) barriers and facilitators to dietary sodium restriction; (ii) traditional and current diet in the UK; and (iii) beliefs and attitudes towards development of hypertension, and the role of sodium.

METHODS

Methods included focus group discussions, vignettes and food diaries. Twenty female chronic kidney disease patients attended four focus group discussions and maintained food diaries; ten responded to vignettes during telephone interviews. Triangulation of the results obtained from the three methods identified categories and themes from qualitative thematic analysis.

RESULTS

Identified barriers to sodium restriction were deeply-rooted dietary beliefs, attitudes and a culturally-established taste for salt. Facilitators of change included acceptable strategies for cooking with less salt without affecting palatability. Dietary practices were culturally determined but modified by participants' prosperity in the UK relative to their previous impoverished agrarian lifestyles in Bangladesh.

CONCLUSIONS

Cultural background and orientation were strong determinants of the group's dietary practices and influenced their reception and response to health communication messages. Efforts to understand their cultural mores, interpret and convey health-promotion messages in culturally-appropriate ways met with a positive response.

Use of mass media campaigns to change health behaviour

Mass media campaigns are widely used to expose high proportions of large populations to messages through routine uses of existing media, such as television, radio, and newspapers. Exposure to such messages is, therefore, generally passive. Such campaigns are frequently competing with factors, such as pervasive product marketing, powerful social norms, and behaviours driven by addiction or habit. In this Review we discuss the outcomes of mass media campaigns in the context of various health-risk behaviours (eg, use of tobacco, alcohol, and other drugs, heart disease risk factors, sex-related behaviours, road safety, cancer screening and prevention, child survival, and organ or blood donation). We conclude that mass media campaigns can produce positive changes or prevent negative changes in health-related behaviours across large populations. We assess what contributes to these outcomes, such as concurrent availability of required services and products, availability of community-based programmes, and policies that support behaviour change. Finally, we propose areas for improvement, such as investment in longer better-funded campaigns to achieve adequate population exposure to media messages.

Long-term sustainability of a worksite canteen intervention of serving more fruit and vegetables

OBJECTIVE

To analyse the 5-year sustainability of a worksite canteen intervention of serving more fruit and vegetables (F&V).

DESIGN

Average F&V consumption per customer per meal per day was assessed in five worksite canteens by weighing F&V served and subtracting waste. Data were collected by the canteen staff during a 3-week continuous period and compared to data from the same five canteens measured at baseline, at end point and at 1-year follow-up. The intervention used a participatory and empowering approach, self-monitoring and networking among the canteen staff, management and a consultant. The method focused on providing ideas for increased F&V for lunch, making environmental changes in the canteens by giving access to tasteful and healthy food choices and reducing the availability of unhealthy options.

SETTING

Five Danish worksites serving from 50 to 500 meals a day: a military base, an electronic component distributor, a bank, a town hall and a waste-handling facility.

SUBJECTS

Worksite canteen managers, canteen staff.

RESULTS

Four of the five worksite canteens were able to either maintain the intervention or even increase the consumption of F&V. The average increase from baseline to 5-year follow-up was 95 g per customer per meal per day (18, 144, 66, 105 and 141 g, respectively). On average, the five canteens at the long-term follow-up had an F&V consumption of 208 g/meal per customer.

CONCLUSIONS

The present study indicates that sustainability of F&V is possible in worksites where the participatory and empowering approach, self-monitoring, environmental change, dialogue with suppliers and networking among worksite canteens are applied.

Sociodemographic factors and attitudes toward food affordability and health are associated with fruit and vegetable consumption in a low-income French population

Determinants of fruit and vegetable consumption, including affordability and attitudes, have been poorly investigated, especially in European deprived populations. Our objective was to analyze various determinants of low consumption of fruits and vegetables in disadvantaged participants. Our participants were randomized into 2 groups, 1 which received nutritional advice alone and 1 that also received vouchers that were exchangeable for fruits and vegetables during a 12-mo period. Socioeconomic characteristics, food insufficiency, affordability, and motivation for eating fruits and vegetables were assessed. A short FFQ was administered. Determinants of consumption of <1 fruit or vegetable/d were analyzed using multivariate logistic regression. A total of 295 participants were included (mean age 44.8 y; 133 men, 162 women). At baseline, mean daily consumption of fruits and vegetables was 2.13 +/- 1.57 times/d. Nearly 30% of the sample did not eat fruits and vegetables every day. Determinants of low fruit and vegetable consumption were: age younger than 55 y, education level lower than tertiary, and absence of financial means for buying fruits and vegetables daily. Other determinants were affordability (whether fruits and vegetables are affordable, lack of money in preventing healthy diet) and attitudes (whether one's own diet is healthy, whether or not fruits and vegetables improve health, whether eating fruits and vegetables is a pleasure). Thus, determinants of inadequate consumption of fruits and vegetables in this deprived French population are numerous. The impact of financial difficulties is crucial, as is the perception of affordability of fruits and vegetables.

Increasing fruit and vegetable consumption: a cost-effectiveness analysis of public policies

BACKGROUND

In many countries, consumption of fruits and vegetables (F&V) is below recommended levels. We quantify the economic and health effects of alternative policy (P) scenarios aiming to increase F&V consumption: (P1) 3.4% reduction in VAT, (P2) €100/year/person F&V stamp policy designed for low-income consumers (LIC) and (P3) €10 M information campaign.

METHODS

An economic model of the F&V market provides F&V consumption variations to a health impact model, leading to the number of deaths avoided (DA) and life-years saved (LYS). We compare the cost per statistical DA and LYS, taking into account the public costs of alternative policies. This analysis is applied to France in 2006.

RESULTS

Relative risks of death for one additional F&V portion are disease dependent (range: 0.84-0.99). The highest variations in F&V consumption levels (less than +10 g/day/person on average) and health effects (<+600 DA, <+10 000 LYS) are modest. The costs/LYS are smaller for information campaign (€3 k), followed by VAT reduction (€99 k) and food stamp policy (€403 k). However, the information campaign leads to less LYS than VAT reduction. The food stamp policy reduces health inequalities between LIC and others, whereas the other ones can increase them.

CONCLUSION

Our results suggest that (i) LYS are larger with VAT reduction than F&V stamps policies, (ii) information campaigns are the most cost-effective and (iii) market forces can limit the impacts of public health policies designed to favour F&V consumption increase.

Cost analyses of a web-based behavioral intervention to enhance fruit and vegetable consumption

Background

The purpose of this paper is to evaluate costs associated with the online intervention trial, Making Effective Nutritional Choices for Cancer Prevention (MENU), and to connect the findings to the study outcomes.

Methods

Using prospective data collected during the MENU development and implementation phases, we estimated overall costs per person, incremental costs for the three arms of the MENU intervention, and incremental costs per change in fruit and vegetable (F&V) consumption across the studied population. The MENU study was conducted in five HMO sites of the Cancer Research Network. The number of eligible study participants who were enrolled in the study was 2,540. Recruited participants were randomized into (1) an untailored website program, (2) tailored website program, or (3) tailored web program plus personalized counseling (HOBI) via email. The primary measures for these analyses include the total intervention costs, average cost per participant, and the average cost per mean change in daily intake of F&V, stratified by study arm.

Results

The mean change in F&V consumption was greater in both the tailored arm and statistically higher in the HOBI arm relative to the untailored arm. The untailored arm achieved +2.34 servings increase vs. the tailored website arm (+2.68) and the HOBI arm (+2.80) servings increase. Total intervention costs for MENU participants who completed the 12-month follow-up assessment, by study arm, were estimated to be $197,197 or $110 respectively. This translates to $69 per participant in the untailored web site intervention, $81 per participant in the tailored website intervention, and $184 per participant in the HOBI intervention and a cost per average change in F&V consumption to be $35, $27 and $61 respectively.

Conclusions

Providing personalized "tailored" messages and additional personalized support via email generated an additional $12-$115 per participant, over the untailored web program. Incremental increases in F&V consumption associated with the email support arm were associated with considerable increases in intervention costs, suggesting that the most cost effective arm of the MENU study by servings gained was the tailored website.

Focus groups inform a web-based program to increase fruit and vegetable intake

OBJECTIVE

To use focus groups to inform a web-based educational intervention for increased fruit and vegetable (FV) consumption.

METHODS

Twelve groups (participants=137, aged 21-65) were recruited from four geographically diverse health systems. Four groups were stratified by gender and eight by race (white and African American) and gender. Questions included perceptions of healthy eating, factors that encourage or serve as barriers to FV consumption and features preferred for a web-based educational intervention.

RESULTS

Though knowledgeable about healthy eating, participants did not know how to achieve or always care about healthy nutritional choices. Motivators for FV consumption included being role models and health concerns. Barriers included: lack of time, expense and FV availability. Website preferences included: visuals, links, tailored materials, menu suggestions, goal setting assistance, printable summaries and built in motivation. The developers incorporated nearly all suggestions.

CONCLUSION

Focus groups provided needs-based tactical strategies for an online, education intervention targeting factors to improve FV consumption.

PRACTICE IMPLICATIONS

Focus groups can provide valuable input to inform interventions. Further, web-based programs' abilities to offer information without time or geographic constraints, with capacity for tailoring and tracking progress makes them a valuable addition in the arsenal of efforts to promote healthy behaviors.

Fatores associados ao consumo de frutas, legumes e verduras em adultos de uma cidade no Sul do Brasil

O objetivo deste estudo foi descrever a freqüência de consumo de frutas, legumes e verduras por adultos de 20 a 69 anos de Pelotas, Rio Grande do Sul, Brasil, e analisar fatores associados. Foi realizado em 2006 um estudo transversal de base populacional, incluindo 972 adultos. A freqüência do consumo de frutas, legumes e verduras foi medida por meio de três perguntas referentes ao consumo habitual destes no ano anterior. O desfecho foi o consumo regular de frutas, legumes e verduras. Cerca de 1/5 da população adulta (20,9%) consumia regularmente frutas, legumes e verduras. Indivíduos do sexo feminino, com 60 anos ou mais, das classes A e B, ex-fumantes e não sedentários apresentaram maior prevalência de consumo de frutas e legumes e verduras. A freqüência do consumo de frutas, legumes e verduras na população adulta residente no Município de Pelotas está aquém das recomendações atuais do Ministério da Saúde, em especial entre os homens mais jovens, de menor nível sócio-econômico e que não praticam atividade física no lazer. Políticas públicas que estimulem uma alimentação saudável são urgentemente necessárias.

Bowel health to better health: a minimal contact lifestyle intervention for people at increased risk of colorectal cancer

Colorectal cancer screening forms part of Scotland's cancer reduction strategy. Screened participants, who had undergone colonoscopy and had adenoma(s) removed, were invited to participate in the bowel health to better health (BHBH) programme. BHBH tested the hypothesis that a minimal contact lifestyle intervention could prove effective in promoting changes in diet and activity. Baseline and follow-up questionnaires on lifestyle and psycho-social measures were undertaken in adults randomised to BHBH or a comparison group (CG). The 3-month intervention comprised personalised lifestyle advice, goal-setting and social support to promote increases in physical activity, fibre, fruit and vegetables. Response rate to BHBH was 51 %. BHBH participants (n 32) increased their intake of fibre (DINE FFQ scores 30 (sd 11)-41 (sd 13)) significantly (P < 0.001) more than the CG (n 30; 31 (sd 8)-30 (sd 11). No significant differences between the groups were detected for changes in fruits, vegetables and moderate activity. At baseline, only one participant from each study arm, met the target recommendations for fibre, fruit and vegetable intakes and physical activity. At follow up a significant number of BHBH participants, 15 (47 %) compared to 4 (13 %) of the CG were achieving all three lifestyle recommendations (chi2 (1, n 62) = 8.196, P = 0.006). If sustained, the positive behaviour change achieved through this intervention has the potential to impact on the progression of chronic disease risk including CVD.

Food Systems and Public Health Disparities

The United States has set a national goal to eliminate health disparities. This article emphasizes the importance of food systems in generating and exacerbating health disparities in the United States and suggests avenues for reducing them. It presents a conceptual model showing how broad food system conditions interplay with community food environments-and how these relationships are filtered and refracted through prisms of social disparities to generate and exacerbate health disparities. Interactions with demand factors in the social environment are described. The article also highlights the separate food systems pathway to health disparities via environmental and occupational health effects of agriculture.

Workforce gender, company size and corporate financial support are predictors of availability of healthy meals in Danish worksite canteens

OBJECTIVE

Environmental strategies at worksites may help consumers change dietary behaviour towards a more healthy diet. The present study aimed to evaluate the availability of healthy meal options at Danish worksite canteens and to identify predictors of worksite canteens providing healthy meals.

DESIGN

A self-administered questionnaire was randomly mailed to 1967 worksite canteen managers. Besides information and characteristics about the canteen and the worksite, the canteen managers specified the menus available. Two different health groups (Healthy and Less Healthy) were defined in three different meal categories (Sandwiches, Hot meals and Salads) as well as a combined category (Combined) combining all the three meal categories. The characteristics of the worksites were compared with regard to the different health groups.

SETTING

Randomly selected Danish worksite canteens.

SUBJECTS

553 Danish worksite canteen managers replied, resulting in a response rate of 29 %.

RESULTS

Only 12 % of the canteens applied to the Healthy group combining all the three meal categories. In particular, worksites with more than 75 % female employees served healthy menus on a frequent basis. The size of the worksite was positively correlated with more healthy meal options. Furthermore, the present study suggests a positive relationship between corporate financial support and the availability of healthy meal options.

CONCLUSIONS

Among the selected variables studied, workforce gender, company size and corporate financial support were significant predictors of the availability of healthy meal options in worksite canteens. More research is needed on the role that variance in organisation environment plays for the potential of worksite intervention, to make a difference in terms of healthy eating.

Who is responsible for food risks? The influence of risk type and risk characteristics

The influence of food risk type and risk characteristics on food risk responsibility judgments was studied. A total of 1270 Finnish consumers judged their personal responsibility and the responsibility of three non-personal targets, industry, retail, and society, in relation to six food-related risks. They also evaluated the risks on several psychometric dimensions. The ratings were gathered via internet questionnaire. Industry and society were considered to be most responsible for all risks but the risk of cardiovascular disease, for which personal responsibility was considered to be highest. Judgments of personal controllability predicted personal responsibility judgments, and unnaturalness judgments predicted non-personal targets' judged responsibility. Personal responsibility judgments were related to different risk dimensions than judgments of non-personal targets' responsibility.

Availability of free fruits and vegetables at canteen lunch improves lunch and daily nutritional profiles: a randomised controlled trial

Canteens are known to be promising settings for activities to promote intake of fruits and vegetables, but it remains unclear to what extent distributing free fruits and vegetables can influence dietary patterns of customers. The present study evaluated the effect of providing fruits and vegetables for free in a university canteen on the daily diet of university canteen customers. Canteen customers (n 209) were randomly allocated to a fruit and vegetable group (FVG) and a control group (CG). FVG participants were given two portions of fruits and one portion of vegetables for free at lunchtime. Food and beverage intake was measured using a dietary record for 3 d and dietary quality was appraised using a comprehensive scoring system. The FVG participants ate 80 g more fruits (P < 0.01) and 108 g more vegetables (P < 0.001) on a daily basis compared with the CG participants. No differences were found for energy density, total energy, Na and energy from fat between the groups per day. A higher intake of fruits and vegetables was observed at lunch and of vegetables during the dinner and evening snacks. The FVG participants were more likely to comply with dietary recommendations for fruits and vegetables and had a better dietary profile on the study days and for the lunch consumed on those days. The results of the present study demonstrate how modifications of a canteen lunch can be instrumental to enhance the nutritional quality of lunch as well as the overall quality of the diet of the customers.

Association between folate intake from different food sources in Norway and homocysteine status in a dietary intervention among young male adults

The aim of the present investigation was to study the effect of a dietary intervention which combined nutrition information with increased availability of vegetables, fruits and wholegrain bread. The effect of the intervention was determined by changes in the intake of vegetables, fruits, wholegrain bread and estimated nutrients. Furthermore, the study investigated whether changes in relative contribution from different food sources of folate were related to changes in the concentration of plasma total homocysteine (p-tHcy). The 5-month intervention study included 376 male recruits from the Norwegian National Guard, Vaernes (intervention group) and 105 male recruits from the Norwegian National Guard, Heggelia (control group). The study resulted in an increase in the total consumption of vegetables, fruits, berries and juice (P < 0·001) and of wholegrain bread (P < 0·001). The participants in the intervention group showed a higher increase in the intake of dietary fibre (P < 0·001) and folate (P < 0·001) compared with the control group. The relative contribution of folate intake from fruits, vegetables and wholegrain bread was higher in the intervention group compared with the control group (P < 0·001 for all). The increased intake of folate from wholegrain bread was inversely associated with a reduced concentration of p-tHcy (P = 0·017). In summary, the dietary intervention resulted in an increased intake of vegetables, fruits and wholegrain bread and a subsequent increase in folate intake from these food components. Reduction in the concentration of p-tHcy was significantly related to an increased folate intake due to an increased consumption of wholegrain bread.

Health behavior changes in white and African American prostate cancer survivors

Prostate cancer prognosis may be improved by healthy behaviors; however, little is known regarding whether prostate cancer survivors make health behavior changes after diagnosis, and there are no data on racial/ethnic differences. This study explored patterns of and factors that influence healthy behavior changes in diet, physical activity, and dietary supplement use among whites and African Americans (n = 30) aged 45 to 70 years, approximately 1 year after diagnosis with localized prostate cancer. Data were collected by telephone using semistructured qualitative interviews. The mean participant age was 59.6 years, 77% had attended college, 87% were married, and 22% were retired. Most (58%) had improved their diet since diagnosis, defined as eating more fruits/vegetables and less fat. Although 77% reported regular use of at least 1 dietary supplement before diagnosis, several discontinued use after diagnosis. Sixty-seven percent exercised regularly before diagnosis, and most of these (75%) continued after diagnosis; however, time and health constraints were barriers. Physician recommendation and family support strongly influenced positive changes. Except for more postdiagnosis dietary improvements in African Americans, there were few racial differences in patterns/motives for behavior changes. Most respondents were motivated to maintain and/or adopt healthy behavioral changes after diagnosis. Nurses/physicians are encouraged to inform their prostate cancer patients about the benefits of healthy eating and regular exercise and about the absence of scientific evidence regarding the benefits/risks of most supplements, particularly herbal formulations.

Variations in fresh fruit and vegetable quality by store type, urban–rural setting and neighbourhood deprivation in Scotland

Objective

Neighbourhood differences in access to fresh fruit and vegetables may explain social inequalities in diet. Investigations have focused on variations in cost and availability as barriers to the purchase and consumption of fresh produce; investigations of quality have been neglected. Here we investigate whether produce quality systematically varies by food store type, rural–urban location and neighbourhood deprivation in a selection of communities across Scotland.

Design

Cross-sectional survey of twelve fresh fruit and vegetable items in 288 food stores in ten communities across Scotland. Communities were selected to reflect a range of urban–rural settings and a food retail census was conducted in each location. The quality of twelve fruit and vegetable items within each food store was evaluated. Data from the Scottish Executive were used to characterise each small area by deprivation and urban–rural classification.

Setting

Scotland.

Results

Quality of fruit and vegetables within the surveyed stores was high. Medium-sized stores, stores in small town and rural areas, and stores in more affluent areas tended to have the highest-quality fresh fruit and vegetables. Stores where food is secondary, stores in urban settings and stores in more deprived areas tended have the lowest-quality fresh produce. Although differences in quality were not always statistically significant, patterns were consistent for the majority of fruit and vegetable items.

Conclusions

The study provides evidence that variations in food quality may plausibly be a micro-environmental mediating variable in food purchase and consumption and help partially explain neighbourhood differences in food consumption patterns.

Changing health behaviour of young women from disadvantaged backgrounds: evidence from systematic reviews

Observational evidence suggests that improving the diets of women of child-bearing age from disadvantaged backgrounds might be an important component of public health strategies aimed at reducing the burden of chronic disease in their offspring. The development of an intervention to improve the nutrition of young women needs to be informed by a systematic collation of evidence. Such a systematic collation of evidence from systematic reviews of interventions directed at changing health behaviours including diet, breast-feeding, physical activity and smoking has been conducted. Of 1847 potentially-relevant abstracts, fourteen systematic reviews met inclusion criteria. Four aspects of intervention design were identified that were effective at changing one or more of the health behaviours considered in the present review: the use of an educational component; provision of continued support after the initial intervention; family involvement; social support from peers or lay health workers. The findings of the present review suggest that interventions to change the health behaviour of women of child-bearing age from disadvantaged backgrounds will require an educational approach and should provide continued support after the initial intervention. Family involvement and social support from peers may also be important features of interventions that aim to improve diet.

Fruit and vegetable intake and knowledge increased following a community-based intervention in older adults in Georgia senior centers

Our purpose was to evaluate a community-based fruit and vegetable intervention conducted in rural and urban areas of Georgia. Participants were a convenience sample from Georgia senior centers that completed a pre-test, the intervention, and a post-test (N = 558, mean age = 75, 83% female, 47% white, 53% black). The 4-month intervention had eight sessions focused on practical ways to increase intake of fruits and vegetables at meals and snacks and included physical activity. Pre- and post-tests examined self-reported intakes of fruits and vegetables at breakfast, lunch, the evening meal, and snacks, knowledge of recommended intakes, and barriers to intake. Following the intervention, the number of participants reporting consumption of at least 7 servings of fruits and vegetables daily increased by 21-percentage points (P < or = 0.001), knowledge that 7 to 10 servings of fruits and vegetables are recommended daily (for 1,600 to 2,200 calories) increased from 7% to 57% (P < or = 0.001), and three barriers to fruit and vegetable intake decreased (P < or = 0.05): "difficulties with digestion," "too many are recommended," and "too much trouble." Regression analyses indicated that increased intake following the intervention was independently associated with living in more urban rather than rural areas, improved knowledge of intake recommendations, decrease in perception of cost as a barrier, and increase in digestive problems as a barrier (P < or = 0.05). These results provide an evidence base for the effectiveness of this community intervention for improving knowledge and intake and decreasing barriers to fruit and vegetable intake in older adults.

Selecting interventions to promote fruit and vegetable consumption: from policy to action, a planning framework case study in Western Australia

Background

The Department of Health in Western Australia identified access to, and daily consumption of recommended amounts of fruit and vegetables, as priority health determinants. The numerous factors that influence supply and consumption of fruit and vegetables indicated that a comprehensive approach would be required.

A government and non-government sector steering group was set up to select priority interventions using the National Public Health Partnership's Framework for Implementing Public Health Strategies. This structured framework was used for developing strategies to improve fruit and vegetable consumption and supply, and to identify implementation priorities.

After one year a desktop audit of progress on framework interventions was undertaken.

Results

The structured framework led to a plan for defined actions, partners, costs, and performance indicators for strategies to improve fruit and vegetable consumption and supply. Lead agency custodians for management of the selected interventions were identified.

After one year there was significant progress in the implementation of a number of the high-ranking interventions. The exception was interventions that provide the infrastructure support such as research and development capacity, information systems.

Conclusion

A structured framework and stakeholder participation assisted in developing a fruit and vegetable implementation strategy. Engagement and commitment of influential and diverse stakeholders is needed, not just for program support, but particularly in the areas of food and nutrition policy development and providing the infrastructure support required. Further work is required to develop performance outcomes and cost effectiveness measures for many of the strategies that have been proposed to address portfolio objectives.

The effect of adding group-based counselling to individual lifestyle counselling on changes in dietary intake. The Inter99 study--a randomized controlled trial

BACKGROUND

Few studies have investigated the specific effect of single intervention components in randomized controlled trials. The purpose was to investigate the effect of adding group-based diet and exercise counselling to individual life-style counselling on long-term changes in dietary habits.

METHODS

The study was a randomized controlled intervention study. From a general Danish population, aged 30 to 60 years (n = 61,301), two random sample were drawn (group A, n = 11,708; group B, n = 1,308). Subjects were invited for a health screening program. Participation rate was 52.5%. All participants received individual life-style counselling. Individuals at high risk of ischemic heart disease in group A were furthermore offered group-based life-style counselling. The intervention was repeated for high-risk individuals after one and three years. At five-year follow-up all participants were invited for a health examination. High risk individuals were included in this study (n = 2 356) and changes in dietary intake were analyzed using multilevel linear regression analyses.

RESULTS

At one-year follow-up group A had significantly increased the unsaturated/saturated fat ratio compared to group B and in men a significantly greater decrease in saturated fat intake was found in group A compared to group B (net change: -1.13 E%; P = 0.003). No differences were found between group A and B at three-year follow-up. At five-year follow-up group A had significantly increased the unsaturated/saturated fat ratio (net change: 0.09; P = 0.01) and the fish intake compared to group B (net change: 5.4 g/day; P = 0.05). Further, in men a non-significant tendency of a greater decrease was found at five year follow-up in group A compared to group B (net change: -0.68 E%; P = 0.10). The intake of fibre and vegetables increased in both groups, however, no significant difference was found between the groups. No differences between groups were found for saturated fat intake in women.

CONCLUSION

Offering group-based counselling in addition to individual counselling resulted in small, but significantly improved dietary habits at five-year follow-up and a tendency of better maintenance, compared to individual counselling alone.

TRIAL REGISTRATION

The Inter99 study was approved by the local Ethics Committee (KA 98 155) and is registered with ClinicalTrials.gov (registration number: NCT00289237).

Promoting fruit and vegetable intake through messages tailored to individual differences in regulatory focus

BACKGROUND

Researchers must identify strategies to optimize the persuasiveness of messages used in public education campaigns encouraging fruit and vegetable (FV) intake.

PURPOSE

This study examined whether tailoring messages to individuals' regulatory focus (RF), the tendency to be motivated by promotion versus prevention goals, increased the persuasiveness of messages encouraging greater FV intake.

METHOD

Participants (n = 518) completed an assessment of their RF and were randomly assigned to receive either prevention- or promotion-oriented messages. Messages were mailed 1 week, 2 months, and 3 months after the baseline interview. Follow-up assessments were conducted 1 and 4 months after the baseline assessment.

RESULTS

Regression analyses revealed that at Month 4, the messages were somewhat more efficacious when congruent with participants' RF.

CONCLUSION

RF may be a promising target for developing tailored messages promoting increased FV intake, and particularly for encouraging individuals to meet FV guidelines.

Consumer perceptions of fruit and vegetables serving sizes

OBJECTIVE

To assess consumer understanding of fruit and vegetable serving sizes.

DESIGN

The Western Australian Health Department launched the Go for 2&5(R) campaign to promote fruit and vegetables in March 2002. The Health & Wellbeing Surveillance System surveyed 1108 adults, aged 16 years and over, between September and November 2002 about what constituted a serving of fruit and of vegetables, their usual daily fruit and vegetables intake, and their recall of the campaign.

SETTING

The study was undertaken as a part of a public health intervention - social marketing campaign in Western Australia, which had a population of 1 927 000 in 2002.

RESULTS

Forty-two per cent of respondents knew that the fruit serving size was one piece and only 14.5 % reported the (1/2) cup vegetable serving size. The mean fruit intake was 1.8 (95 % CI 1.7, 1.8) servings/d and the mean vegetable intake was 2.8 (95 % CI 2.7, 3.0) servings/d. Vegetable intake was associated with being female (P = 0.006), increasing age (P < 0.0001), awareness of the campaign (P = 0.031) and knowledge of standard serving size (P = 0.006). Fruit consumption was associated with being female (P = 0.007). Fruit and vegetable intakes were not associated with educational attainment or household income.

CONCLUSIONS

The Go for 2&5(R) campaign uses a prescriptive message to promote increased consumption of fruit and vegetables. Respondent's knowledge of the standard of serving sizes for fruit and vegetables suggests there is value in separating fruit and vegetable recommendations in messages to encourage increased consumption.

Psychosocial predictors of fruit and vegetable consumption in adults a review of the literature

BACKGROUND

Adequate fruit and vegetable intake has been found to promote health and reduce the risk of several cancers and chronic diseases. Understanding the psychological determinants of fruit and vegetable intake is needed to design effective intervention programs.

METHODS

Papers published in English from 1994 to 2006 that described the relationship between psychosocial predictors and fruit and vegetable intake in adults were reviewed. Studies and their constructs were independently rated based on the direction of significant effects, quality of execution, design suitability, and frequency. Methodology from the Guide to Community Preventive Services was used to systematically review and synthesize findings.

RESULTS

Twenty-five psychosocial constructs spanning 35 studies were reviewed (14 prospective and 21 cross-sectional/descriptive studies). Strong evidence was found for self-efficacy, social support, and knowledge as predictors of adult fruit and vegetable intake. Weaker evidence was found for variables including barriers, intentions, attitudes/beliefs, stages of change, and autonomous motivation.

CONCLUSIONS

The findings underscore the need to design future behavioral interventions that use strong experimental designs with efficacious constructs and to conduct formal mediation analyses to determine the strength of these potential predictors of fruit and vegetable intake.

Telephone counseling helps maintain long-term adherence to a high-vegetable dietary pattern

Achieving long-term adherence to a dietary pattern is a challenge in many studies investigating the relationship between diet and disease. The Women's Healthy Eating and Living Study was a multi-institutional randomized trial in 3088 women at risk for breast cancer recurrence. At baseline, the average participant followed a healthy dietary pattern of 7 vegetable and fruit servings, 21 g/d of fiber, and 28.7% energy from fat, although fat intake increased over the enrollment period. Using primarily telephone counseling, the intervention group was encouraged to substantially increase intakes of vegetables, fruits, and fiber while decreasing fat intake. Sets of 24-h dietary recalls were completed on 90% of eligible participants at 1 y and 86% at 4 y. Using a conservative imputation analysis, at 1 y, the intervention group consumed 38% more vegetable servings (100% when including juice) than the comparison group, 20% more fruit, 38% more fiber, 50% more legumes, and 30% more whole grain foods, with a 20% lower intake of energy from fat. At 4 y, the between-group differences were 65% for vegetables (including juice), 25% fruit, 30% fiber, 40% legumes, 30% whole grain foods, and 13% lower intake of energy from fat. The intervention effect on fat intake was similar for early vs. late enrollees. Plasma carotenoid concentrations on a random 28% sample validated self-reported vegetable and fruit intake, with a between-group difference of 66% at 1 y and over 40% at 4 y. This large change will allow testing of hypotheses on the role of dietary change in preventing additional breast cancer events.

The Influence of Sociodemographic Factors on Patterns of Fruit and Vegetable Consumption in Canadian Adolescents

BACKGROUND

Poor dietary habits may increase risk for obesity and chronic diseases among Canadian adolescents.

OBJECTIVES

The aims of the present study were to: (a) establish the patterns of fruit and vegetable intake by Canadian adolescents, and (b) identify the impact of sociodemographic factors-including age, household income, household education, ethnicity, living arrangement, and location-on the pattern of fruit and vegetable intake in this population.

DESIGN

This is a cross-sectional study using the data from the Canadian Community Health Survey, Cycle 2.1, Public Use File. The survey used questions similar to a food frequency questionnaire.

METHODS

Total fruit and vegetable intake of 18,524 Canadian adolescents (12 to 19 years old) was cross-tabulated between two age groups (12 to 14 years old [n=7,410] and 15 to 19 years old [n=11,114]) by sex, level of household education, total household income, ethnicity, living arrangement, and geographical location.

RESULTS

The data revealed that a 38.3% of Canadian adolescents in this study consumed fruits and vegetables five to 10 times per day; fewer older adolescents (15- to 19-year-olds) reported eating fruits and vegetables at that frequency as compared with the younger subgroup (12- to 14-year-olds) (P<0.001). Household education and income independently had a significant (P<0.001) positive impact on fruit and vegetable consumption. Females reported a significantly (P<0.05) higher frequency of intake than did males. Adolescents living in homes with only one parent reported a significantly (P<0.005) lower frequency of intake, as compared with adolescents living with two parents.

CONCLUSIONS

These results may help to identify adolescent groups at risk for poor eating habits and support the implementation of programs to encourage higher fruit and vegetable intakes.

Weight status and perception barriers to healthy physical activity and diet behavior

BACKGROUND

Physical inactivity and insufficient fruit and vegetable consumption are key risk factors for obesity and noncommunicable diseases. Weight perceptions may affect physical activity and diet behaviors. We report current prevalence estimates of Australian adults meeting recommended levels of leisure-time physical activity (LTPA) (> or =150 min/week or more of at least moderate-intensity physical activity (including walking) on > or =5 days/week) and fruit (> or =2 servings/day) and vegetable (> or =5 servings/day) consumption for health benefits, by weight status and perceptions.

METHODS

We conducted a cross-sectional survey analysis of data for 16 314 adults from the Australian National Health Survey 2004-2005. All variables were collected by self-report. Weighted estimates were age- and gender-specific, and data were analyzed using logistic regression with acceptable weight referent categories, adjusting for covariates.

RESULTS

Among acceptable, overweight and obese adults, the prevalence of LTPA was 26.8, 26.1 and 19.3% for men, and 27.7, 23.7 and 19.7% for women, respectively. Approximately 55 and 15% of adults consumed sufficient fruit servings/day and vegetable servings/day, respectively, and less than 5% of adults met combined LTPA and diet guidelines. Overweight decreased the odds ratio for LTPA among women but not men, and obesity decreased the odds ratio for LTPA among both men and women. Overweight perception conferred odds ratios of 0.83 (95% CI 0.70-0.97, P=0.021) for overweight men, and of 0.74 (95% CI 0.62-0.88, P=0.001) and 0.69 (95% CI 0.59-0.80, P<0.001) for obese men and women, respectively; for LTPA, whereas no significant associations were found for acceptable weight perception. No consistent associations between weight status or perceptions and diet behaviors were found.

CONCLUSIONS

Overweight perception may be another barrier to physical activity participation among men and women with excess body weight. Public health strategies might need to focus on overcoming weight perception as well as weight status barriers to adopting healthy physical activity behaviors.

Health communication campaigns and their impact on behavior

The objective is to review the evidence for the effectiveness of health communication campaigns to inform future nutrition campaigns. The review drew on existing meta-analyses and other literature. The average health campaign affects the intervention community by about 5 percentage points, and nutrition campaigns for fruit and vegetable consumption, fat intake, and breastfeeding, have been slightly more successful on average than for other health topics. The factors affecting success rates are discussed. The conclusion is that nutrition campaigns that pay attention to the specific behavioral goals of the intervention, target populations, communication activities and channels, message content and presentation, and techniques for feedback and evaluation should be able to change nutrition behaviors.

Associations of psychosocial factors with fruit and vegetable intake among African-Americans

OBJECTIVE

To examine associations of various psychosocial factors with fruit and vegetable intake in African-American adults.

METHODS

A cross-sectional survey of a population-based sample of 658 African-Americans, aged 18-70 years, in North Carolina. Information was collected on diet-related psychosocial (predisposing, reinforcing and enabling) factors based on the PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation) planning framework; demographic, lifestyle and behavioural characteristics, and fruit and vegetable intake.

RESULTS

The mean participant age was 43.9 years (standard deviation 11.6), 57% were female and 76% were overweight/obese. Participants expressed healthy beliefs regarding many of, but not all, the psychosocial factors. For example, although half of the respondents believed it is important to eat a diet high in fruits/vegetables, only 26% knew that >or=5 daily servings are recommended. The strongest associations of the psychosocial factors with fruit/vegetable intake were for predisposing factors (e.g. belief in the importance of a high fruit/vegetable diet and knowledge of fruit/vegetable recommendations) and one reinforcing factor (social support), with differences between the healthiest and least healthy responses of 0.5-1.0 servings per day. There was evidence of effect modification by gender in associations between psychosocial factors and fruit/vegetable consumption (e.g. self-efficacy was only significant in women), with higher intakes and generally healthier responses to the psychosocial variables in women than men.

CONCLUSIONS

Interventions to increase fruit/vegetable intake in African-Americans may be more effective if they focus primarily on predisposing factors, such as knowledge, self-efficacy and attitudes, but not to the exclusion of reinforcing and enabling factors. The psychosocial factors that are targeted may also need to be somewhat different for African-American men and women.

Examination of the adherence to the "5 A Day the Color Way" campaign among parents and their preschool children

BACKGROUND

The evidence of health benefits associated with the consumption of a variety fruits and vegetables (FV) is well known. The "5 A Day Color Way" campaign is a national effort to translate the science with a message of increased colorful FV consumption for the public. The extent of the translation and adherence to these recommendations among families in a community setting is an important public health question.

METHODS

Parents enrolled in 8 rural Missouri county parent education programs answered surveys for their preschool children (n = 1658) about FV consumption and barriers to purchasing them by color.

RESULTS

Of parents, 40% (n = 668) and 26% (n = 425) of children ate from all 5 colors some time the previous week. However, no parents and only 1 child attained perfect adherence to the guidelines (all 5 colors most days of the week). Disliking the taste and not in the habit of purchasing colorful FV were significant predictors for not meeting recommendations for red, yellow/orange, and green FV.

CONCLUSIONS

Interventions targeting young children and their families (ie, child care settings, elementary schools) that establish preference for color specific FV may be ideal in rural communities to encourage movement toward adherence to the campaign.

Increases in Plasma Carotenoid Concentrations in Response to a Major Dietary Change in the Women's Healthy Eating and Living Study

BACKGROUND

Cohort studies suggest that higher circulating carotenoid concentrations through food sources may reduce breast cancer events. Other intervention studies have not achieved the level of change in circulating carotenoids required to properly test this hypothesis.

METHODS

In a randomized trial of 2,922 breast cancer survivors, we examined blood and self-reported diet at baseline and 1 year. Intensive telephone counseling encouraged a plant-based diet in the intervention group. Diet was measured via 24-hour recalls, and a panel of plasma carotenoid concentrations was assessed at both time points.

RESULTS

The study intervention was associated with a 51% increase in total carotenoid concentration, from 2.272 +/- 1.294 to 3.440 +/- 2.320 micromol/L, achieved mainly by marked increases in targeted carotenoids: alpha-carotene, beta-carotene, and lutein. For each of these targeted carotenoids, the proportion of the intervention sample remaining below the cutpoint for the lowest baseline quartile decreased by one third to one half. After 1 year of study, half of the intervention group was in the highest baseline quartile. No change in distribution was observed in comparison group. Intervention participants achieved this change by both dietary pattern and vegetable juice consumption. Participants who chose to change dietary pattern without consuming significant quantities of vegetable juice achieved 75% of the level of change observed in other intervention participants.

CONCLUSIONS

Innovative telephone counseling intervention and dietary targets in the Women's Healthy Eating and Living study were associated with the level of change in circulating carotenoid concentration necessary to test the diet and breast cancer hypothesis suggested by cohort studies.

Getting children to eat more fruit and vegetables: a systematic review

BACKGROUND

There is growing recognition of the need to increase consumption of currently suboptimal levels of fruit and vegetables by children, given their known beneficial effects for health. There is, however, a need for a synthesis of the evidence on interventions that might achieve this policy goal.

METHODS

A systematic review of published and unpublished studies was carried out by searching 14 publication databases and contacting experts in the fields. All papers in eight languages were considered if they described individual- and population-based interventions and promotion programmes that encouraged the consumption of a diet relatively higher in fruit and/or vegetables in free-living, not acutely ill children of both genders, with follow-up periods of at least 3 months, measurement of change in intake and a control group.

RESULTS

Fifteen studies focusing on children met the criteria for inclusion in the systematic review. None of the studies reviewed had a detrimental effect on fruit and vegetable consumption. Ten studies had a significant effect, ranging from +0.3 to +0.99 servings/day.

CONCLUSIONS

More research is needed to examine in more depth, for longer follow-up periods, the effectiveness of interventions promoting fruit and vegetable consumption. The evidence is strongest in favor of multi-component interventions to increase fruit and vegetable consumption in children.