Concepts of healthful food among low-income African American women

Qualitative Exploration of Cultural Influence on a Rural Health-Promotion Initiative

OBJECTIVE

To develop a conceptualization of cultural influence on perceptions of a rural food and physical activity policy, systems, and environmental (PSE) change project to inform public health research and practice.

DESIGN

Basic qualitative research design, semistructured phone interviews with community health coalition members.

SETTING

Five rural Southern counties (obesity prevalence > 40%).

PARTICIPANTS

Thirty-nine community coalition members.

INTERVENTION

The Centers for Disease Control and Prevention High Obesity Program. PSE initiatives to increase access to healthy food and physical activity opportunities through a community coalition model.

PHENOMENON OF INTEREST

Social norms and cultural influences surrounding community members' food preferences, physical activity behavior, and future hopes for community development.

ANALYSIS

Abductive content analysis.

RESULTS

Major categories on food social norms (subcategories: physical health, eating habits, and food preference), race relations, generational factors, physical activity social norms, and hopes for the community (subcategories: increased engagement, health, awareness, cohesion, and inspiration) were discussed in relation to the progress of PSE initiatives.

CONCLUSIONS AND IMPLICATIONS

Because of community member perceptions, PSE initiatives became associated with factors beyond food and fitness, such as race relations, generational differences, and community cohesion. A focus on increased youth and church involvement, community values, relationship building, and input from diverse voices can be foundational to culturally-appropriate PSE efforts in rural settings.

Comparison of motives underlying food choice and barriers to healthy eating among low medium income consumers in Uruguay

Abstract: Interventions aimed at changing dietary patterns should be designed based on the main motives underlying the food choices of specific target populations. The aim of the present study was to identify motives underlying food choice and barriers to healthy eating among consumers in two socioeconomic levels in Uruguay. Eleven focus groups were carried out with a total of 76 participants. Six of the groups involved low income participants and the others were conducted with middle income participants. Discussions were held around frequently consumed products, motives underlying food choices and barriers to healthy eating. Results confirmed the strong influence of income level on motives underlying food choice and barriers to the adoption of healthy eating. Low income participants described their choices as mainly driven by economic factors and satiety, whereas convenience was the main determinant of food selection for middle income participants. Implications for the design of public policies targeted at each group are discussed.

A qualitative exploration of fishing and fish consumption in the Gullah/Geechee culture

The Gullah/Geechee (G/G) heritage is rooted in a culture largely dependent on fish and seafood as a primary food source. Research suggests that African-American (AA) fishers in the Southeastern US consume larger amounts of fish, potentially exposing them to higher environmental contaminant levels. This in-depth study was conducted to explore G/G and AA Sea Island attitudes, perceptions, and cultural beliefs about fishing in one urban and two rural South Carolina coastal counties. Results indicated that study participants in rural counties had slightly different perspectives of fishing (e.g. fishing as an essential dietary supplement) than in urban counties where fishing was viewed more as relaxation. Major misperceptions existed in all counties between fish consumption advisories related to pollution versus harvesting restrictions associated with fishing regulations. Providing clear, culturally tailored health messages regarding fish advisories will promote more informed choices about fish consumption that will minimize potential exposures to environmental pollutants.

I Eat Healthier Than You: Differences in Healthy and Unhealthy Food Choices for Oneself and for Others

The present study investigated self-other biases in actual eating behavior based on the observation of three different eating situations. To capture the complexity of real life food choices within a well-controlled setting, an ecologically valid fake food buffet with 72 different foods was employed. Sixty participants chose a healthy, a typical, and an unhealthy meal for themselves and for an average peer. We found that the typical meal for the self was more similar to the healthy than to the unhealthy meal in terms of energy content: The mean difference between the typical and healthy meals was MΔ = 1368 kJ (327 kcal) as compared to a mean difference between the typical and unhealthy meals of MΔ = 3075 kJ (735 kcal). Moreover, there was evidence that people apply asymmetrical standards for themselves and others: Participants chose more energy for a peer than for themselves (M = 4983 kJ or 1191 kcal on average for the peers' meals vs. M = 3929 kJ or 939 kcal on average for the own meals) and more high-caloric food items for a typical meal, indicating a self-other bias. This comparatively positive self-view is in stark contrast to epidemiological data indicating overall unhealthy eating habits and demands further examination of its consequences for behavior change.

Perceived purchase of healthy foods is associated with regular consumption of fruits and vegetables

OBJECTIVE

To identify healthy food (HF) purchase habits and intake of fruits and vegetables (FV) in parents responsible for grocery shopping for their families.

METHODS

Survey with mothers and fathers (n = 216) of children aged 7-10 years in Brazil.

RESULTS

Grocery purchases occurred mostly at supermarkets. Purchase of HF was considered to be frequent by 80% of parents, who cited FV as main examples of HF. The more frequent the reported purchase was of HF, the higher was the prevalence of regular consumption of FV (P = .002). Only 34% of respondents reported weekly intakes that could be classified as regular.

CONCLUSIONS AND IMPLICATIONS

Perceived frequent shopping for healthy foods was positively associated with regular consumption of FV but a gap between perception and behavior was identified. Nutrition education strategies need to go beyond a merely informative role and take consumers' opinions and points of view into consideration to become truly effective.

Design of the Lifestyle Improvement through Food and Exercise (LIFE) study: a randomized controlled trial of self-management of type 2 diabetes among African American patients from safety net health centers

The Lifestyle Improvement through Food and Exercise (LIFE) study is a community-based randomized-controlled trial to measure the effectiveness of a lifestyle intervention to improve glycemic control among African Americans with type 2 diabetes attending safety net clinics. The study enrolled African American adults with a diagnosis of type 2 diabetes and HbA1c ≥ 7.0 who had attended specific safety net community clinics in the prior year. 210 patients will be enrolled and randomized to either the LIFE intervention or a standard of care control group, which consists of two dietitian-led diabetes self-management classes. The LIFE intervention was delivered in 28 group sessions over 12 months and focused on improving diet through dietitian-led culturally-tailored nutrition education, increasing physical activity through self-monitoring using an accelerometer, increasing ability to manage blood sugar through modifications to lifestyle, and providing social support for behavior change. In addition to the group sessions, peer supporters made regular telephone calls to participants to monitor progress toward behavioral goals and provide social support. The 12-month intervention phase was followed by a six-month maintenance phase consisting of two group sessions. The primary outcome of the study is change in A1C from baseline to 12 months, and an additional follow-up will occur at 18 months. The hypothesis of the study is that the participants in the LIFE intervention will show a greater improvement in glycemic control over 12 months than participants in the control group.

A self-management intervention for African Americans with comorbid diabetes and hypertension: a pilot randomized controlled trial

Introduction

The objective of this pilot 6-month randomized controlled trial was to determine the effectiveness of an intensive, community-based, group intervention that focused on diet, physical activity, and peer support for reducing weight among urban-dwelling African Americans with comorbid type 2 diabetes and hypertension.

Methods

Sixty-one participants were randomized into an intervention or control group. The 6-month intervention consisted of 18 group sessions led by a dietitian in a community setting and weekly telephone calls from a peer supporter. The intervention featured culturally tailored nutrition education, behavioral skills training, and social support focused on changes to diet and physical activity. The control group consisted of two 3-hour group sessions of diabetes self-management education taught by a community health worker. Outcome measures were assessed at baseline and 6 months. The primary outcome was achievement of a 5% weight reduction at 6 months. A secondary outcome was achievement of a 0.5 percentage-point reduction in hemoglobin A1c (HbA1c).

Results

Groups did not differ in achievement of the weight-loss goal. Intervention participants lost a mean of 2.8 kg (P = .01); control participants did not lose a significant amount of weight. A greater proportion of intervention (50.0%) than control (21.4%) participants reduced HbA1c by 0.5 percentage points or more at 6 months (P = .03).

Conclusion

The intervention was more effective than usual care (short-term diabetes education) at improving glycemic control, but not weight, in low-income African Americans with comorbid diabetes and hypertension. A community-based 6-month group class with culturally tailored education, behavioral skills training, and peer support can lead to a clinically significant reduction in HbA1c.

Understanding African American women's decisions to buy and eat dark green leafy vegetables: an application of the reasoned action approach

OBJECTIVE

Examine intentions to buy and eat dark green leafy vegetables (DGLV).

DESIGN

Cross-sectional survey assessing demographics, behavior, intention, and Reasoned Action Approach constructs (attitude, perceived norm, self-efficacy).

SETTING

Marion County, Indiana.

PARTICIPANTS

African American women responsible for buying and preparing household food.

MAIN OUTCOME MEASURE(S)

Reasoned Action Approach constructs explaining intentions to buy and eat DGLV.

ANALYSIS

Summary statistics, Pearson correlations, and multiple regression analyses.

RESULTS

Among participants (n = 410, mean age = 43 y), 76% and 80%, respectively, reported buying and eating DGLV in the past week. Mean consumption was 1.5 cups in the past 3 days. Intentions to buy (r = 0.20, P < .001) and eat (r = 0.23, P < .001) DGLV were positively associated with consumption. Reasoned Action Approach constructs explained 71.2% of the variance in intention to buy, and 60.9% of the variance in intention to eat DGLV. Attitude (β = .63) and self-efficacy (β = .24) related to buying and attitude (β = .60) and self-efficacy (β = .23) related to eating DGLV explained significant amounts of variance in intentions to buy and eat more DGLV. Perceived norm was unrelated to either intention to buy or eat DGLV.

CONCLUSIONS AND IMPLICATIONS

Interventions designed for this population of women should aim to improve DGLV-related attitudes and self-efficacy.