Déterminants de l’intention de consommer au moins cinq portions de légumes et de fruits chaque jour chez des jeunes adultes aux études postsecondaires

[A joint study of the multidimensional factors associated with the overall quality of adult diets in Canada]

BACKGROUND

With 26% of Canadians suffering from obesity, significant steps are needed to reduce the social and economic costs entailed by their condition. Given its major contribution to this phenomenon, the quality of diet has been at the heart of numerous previous studies. The objective of the study is to analyze, based on recent data, the association between the quality of the diet of Canadian adults (18 years old and over), and their individual characteristics as well as those of their living environment, including several new elements (prices of fruits and vegetables, food security status).

METHODS

Using data from the 2015 CCHS-Nutrition Survey and information from the 2007 Canadian Food Guide, a diet quality score (also called healthy eating index) was first calculated and then associated with different factors (identified in a literature review) through multiple linear regressions.

RESULTS

In addition to confirming its association with age, gender, overall well-being and other socio-economic factors, this study reveals that quality of adult diets is negatively correlated with the evolution of people's food insecurity status and the increase of vegetable prices in the Canadian provinces since 2002. The positive link between diabetes and the quality of diet could reflect healthier eating behaviors due to the constraints generated by this disease. While city dwellers generally have access to a more diversified food supply, they nevertheless do not have a better diet than the rural population. Finally, non-North American immigrants appear to have a better diet than non-autochthonous Canadians.

CONCLUSION

Paying more attention to food insecurity and to the affordability of vegetables are avenues to explore in view of improving the quality of nourishment in Canada. In any event, longitudinal studies shall be required to confirm the role and to measure the actual influence of these variables on the quality of individual adult diets.

Using a Multitheory Model to Predict Initiation and Sustenance of Fruit and Vegetable Consumption Among College Students

Context

Consuming a diet rich in fruits and vegetables offers numerous health benefits. However, many college students do not consume the recommended amount of fruits and vegetables daily.

Objective

To predict change in fruit and vegetable consumption behavior among college students who were not eating the recommended amount of fruits and vegetables using the multitheory model (MTM) of behavior change.

Methods

In this cross-sectional study, a 38-item face-, content-, and construct-valid survey was sent to college students at a large university in the southeastern United States. Students were included in the analysis if they were aged at least 18 years and ate less than 5 cups of fruits and vegetables per day. The survey was broken into sections based on the MTM constructs of initiation of behavior change (participatory dialogue, behavioral confidence, and changes in physical environment) and sustenance of behavior change (emotional transformation, practice for change, and changes in social environment). Stepwise multiple regression was conducted to predict behavior change regarding fruit and vegetable consumption.

Results

Of the 5000 potential respondents, 175 completed the survey and were included in the analysis. Behavioral confidence and changes in physical environment were statistically significant predictors of the intention to initiate fruit and vegetable consumption (F2,173=59.700; P<.001) and accounted for 40.2% of the variance. Emotional transformation, practice for change, and changes in social environment were statistically significant predictors for the intention to sustain fruit and vegetable consumption (F3,171=26.374; P<.001) and accounted for 30.4% of the variance.

Conclusion

Survey results showed that the MTM is a useful framework for designing behavior change interventions to promote fruit and vegetable consumption among college students.

Self-Report Dietary Assessment Tools Used in Canadian Research: A Scoping Review

Choosing the most appropriate dietary assessment tool for a study can be a challenge. Through a scoping review, we characterized self-report tools used to assess diet in Canada to identify patterns in tool use and to inform strategies to strengthen nutrition research. The research databases Medline, PubMed, PsycINFO, and CINAHL were used to identify Canadian studies published from 2009 to 2014 that included a self-report assessment of dietary intake. The search elicited 2358 records that were screened to identify those that reported on self-report dietary intake among nonclinical, non-Aboriginal adult populations. A pool of 189 articles (reflecting 92 studies) was examined in-depth to assess the dietary assessment tools used. Food-frequency questionnaires (FFQs) and screeners were used in 64% of studies, whereas food records and 24-h recalls were used in 18% and 14% of studies, respectively. Three studies (3%) used a single question to assess diet, and for 3 studies the tool used was not clear. A variety of distinct FFQs and screeners, including those developed and/or adapted for use in Canada and those developed elsewhere, were used. Some tools were reported to have been evaluated previously in terms of validity or reliability, but details of psychometric testing were often lacking. Energy and fat were the most commonly studied, reported by 42% and 39% of studies, respectively. For ∼20% of studies, dietary data were used to assess dietary quality or patterns, whereas close to half assessed ≤5 dietary components. A variety of dietary assessment tools are used in Canadian research. Strategies to improve the application of current evidence on best practices in dietary assessment have the potential to support a stronger and more cohesive literature on diet and health. Such strategies could benefit from national and global collaboration.

Role of Psychosocial Factors and Health Literacy in Pregnant Women's Intention to Use a Decision Aid for Down Syndrome Screening: A Theory-Based Web Survey

BACKGROUND

Deciding about undergoing prenatal screening is difficult, as it entails risks, potential loss and regrets, and challenges to personal values. Shared decision making and decision aids (DAs) can help pregnant women give informed and values-based consent or refusal to prenatal screening, but little is known about factors influencing the use of DAs.

OBJECTIVE

The objective of this study was to identify the influence of psychosocial factors on pregnant women's intention to use a DA for prenatal screening for Down syndrome (DS). We also added health literacy variables to explore their influence on pregnant women's intention.

METHODS

We conducted a survey of pregnant women in the province of Quebec (Canada) using a Web panel. Eligibility criteria included age >18 years, >16 weeks pregnant, low-risk pregnancy, and having decided about prenatal screening for the current pregnancy. We collected data based on an extended version of the Theory of Planned Behavior assessing 7 psychosocial constructs (intention, attitude, anticipated regret, subjective norm, descriptive norm, moral norm, and perceived control), 3 related sets of beliefs (behavioral, normative, and control beliefs), 4 health literacy variables, and sociodemographics. Eligible women watched a video depicting the behavior of interest before completing a Web-based questionnaire. We performed descriptive, bivariate, and ordinal logistic regression analyses.

RESULTS

Of the 383 eligible pregnant women who agreed to participate, 350 pregnant women completed the Web-based questionnaire and 346 were retained for analysis (completion rate 350/383, 91.4%; mean age 30.1, SD 4.3, years). In order of importance, factors influencing intention to use a DA for prenatal screening for DS were attitude (odds ratio, OR, 9.16, 95% CI 4.02-20.85), moral norm (OR 7.97, 95% CI 4.49-14.14), descriptive norm (OR 2.83, 95% CI 1.63-4.92), and anticipated regret (OR 2.43, 95% CI 1.71-3.46). Specific attitudinal beliefs significantly related to intention were that using a DA would reassure them (OR 2.55, 95% CI 1.73-4.01), facilitate their reflections with their spouse (OR 1.55, 95% CI 1.05-2.29), and let them know about the advantages of doing or not doing the test (OR 1.53, 95% CI 1.05-2.24). Health literacy did not add to the predictive power of our model (P values range .43-.92).

CONCLUSIONS

Implementation interventions targeting the use of a DA for prenatal screening for DS by pregnant women should address a number of modifiable factors, especially by introducing the advantages of using the DA (attitude), informing pregnant women that they might regret not using it (anticipated regret), and presenting the use of DAs as a common practice (descriptive norm). However, interventions on moral norms related to the use of DA should be treated with caution. Further studies that include populations with low health literacy are needed before decisive claims can be made.

Prevalence of obesity and its associated risk factors among Chinese adults in a Malaysian suburban village

INTRODUCTION

Obesity is a major modifiable risk factor associated with most chronic diseases. The aim of this study was to determine the prevalence of obesity, and its associated risk factors, among apparently healthy Chinese adults in a Malaysian suburban village.

METHODS

This was a cross-sectional study conducted among the Chinese residents in Seri Kembangan New Village, Klang Valley, Selangor, Malaysia. Convenience sampling was used for the selection of participants. Body weight, height, waist and hip circumferences, and blood pressure were measured. Fasting venous plasma was drawn for the measurement of fasting glucose level and lipid profile. Data on sociodemographic factors, dietary habits, physical activity, perceived stress level and sleep duration were collected using interviewer-administered, pretested and validated questionnaires.

RESULTS

Among the 258 Chinese residents (mean age 41.4 ± 10.0 years) recruited, the prevalence of obesity was 40%. The obese participants had significantly higher mean blood pressure, and triglyceride and fasting plasma glucose levels than the non-obese participants (p < 0.05). The obese participants also had a significantly lower high-density lipoprotein cholesterol level than the non-obese participants. Logistic regression analysis showed that drinking soy milk (adjusted odds ratio [OR] 0.447; 95% confidence interval [CI] 0.253-0.787; p < 0.05) and the perception that a balanced diet consists mainly of vegetables (adjusted OR 0.440; 95% CI 0.215-0.900; p < 0.05) were associated with a reduced risk of obesity. The risk of obesity was higher in younger participants (adjusted OR 2.714; 95% CI 1.225-6.011; p < 0.05).

CONCLUSION

The prevalence of obesity was high among the apparently healthy suburban Chinese. Our findings suggest that soy milk consumption and the perception that a balanced diet consists mainly of vegetables are associated with a lower risk of developing obesity in this population.

Promouvoir la consommation de légumes et de fruits chez des collégiens : application du protocole d’intervention mapping

Résumé:

L’objectif de cet article est de présenter le processus suivi lors du développement, de la mise en œuvre et de l’évaluation d’un programme de promotion de la consommation de légumes et de fruits destiné à des collégiens. Un total de 385 collégiens québécois du Canada âgés de 18 ans en moyenne ont accepté volontairement de participer à cette étude. Le modèle de planification en six étapes de Bartholomew et collaborateurs (2006) a été utilisé. Basée sur la théorie du comportement planifié (Ajzen,1991), l’évaluation des besoins a été effectuée avec un questionnaire auto-administré développé à partir d’une revue de la littérature et de groupes de discussion focalisée auprès de collégiens. Cette première étape a permis d’identifier les déterminants psychosociaux sur lesquels intervenir spécifiquement. Les résultats consistent en un programme d’une durée de quatre heures et demie, qui a été offert à 167 collégiens (groupe expérimental). Adaptées à cette clientèle, et sur des bases théoriques, les activités incluaient l’utilisation d’outils d’auto-évaluation de la consommation quotidienne de légumes et de fruits, le calcul de portions avec une nutritionniste, un quiz sur le web, la rédaction d’un plan pour implanter ses intentions, les démonstrations culinaires de recettes d’un pair avec dégustations et tests de goût. Le programme s’est avéré efficace pour augmenter l’intention comportementale ainsi que le nombre de participants à consommer au moins cinq portions de légumes et de fruits chaque jour, à la fin du programme. Ce protocole permet de structurer une intervention sur mesure visant un changement comportemental chez une clientèle ciblée. Le développement d’un partenariat milieu/université accroît les chances de succès, tant pour l’implantation du programme que pour son efficacité.