Exploring the role of positive body image in healthy orthorexia and orthorexia nervosa: A gender comparison

Current scholarship on orthorexia nervosa remains undecided about the role of body image in this novel eating disorder. This study aimed to explore the role of positive body image in differentiating between healthy orthorexia and orthorexia nervosa and assess how this might differ for men and women. A total of 814 participants (67.1% women; age M = 40.30, SD = 14.50) completed the Teruel Orthorexia scale, as well as measures of embodiment, intuitive eating, body appreciation and functionality appreciation. A cluster analysis revealed four distinct profiles characterized by high healthy orthorexia and low orthorexia nervosa; low healthy orthorexia and low orthorexia nervosa; low healthy orthorexia and high orthorexia nervosa; and high healthy orthorexia and high orthorexia nervosa. A MANOVA identified significant differences for positive body image between these four clusters, as well as that there were no significant differences between men and women for healthy orthorexia and orthorexia nervosa, despite men scoring significantly higher than women on all measures of positive body image. Cluster × gender interaction effects were found for intuitive eating, functionality appreciation, body appreciation and experience of embodiment. These findings indicate that the role of positive body image in healthy orthorexia and orthorexia nervosa may differ for men and women, making these relationships worthy of further exploration.

Patterns and Determinants of Weight Gain among People Who Use Drugs Undergoing Treatment for Recovery in Lebanon

Substance use disorder compromises the nutritional status and the eating habits of drug users, often leading to malnutrition. Once referred for treatment, hyperphagia and poor lifestyle practices leading to weight gain are observed. This study aimed to examine the patterns and extent of weight change as well as the determinants of weight gain in a sample of drug users who were receiving treatment in Lebanon. A total of 172 male participants undergoing either rehabilitation or opioid substitution treatment (OST) were included. Multivariate regression analysis was applied to assess the effect of different variables on weight gain while adjusting for potentially confounding variables. Approximately two-thirds (65.1%) of the participants gained weight (OST: 54.3%, rehabilitation: 78.2%; p < 0.05). The mean weight gain was 5.9 kg and was mainly reported among participants in the underweight, normal, and overweight pre-treatment categories and accentuated in the rehabilitation group (OST: 2 kg, Rehabilitation: 10.6 kg). Around half of the participants moved from the normal weight category to the overweight and obese categories during treatment. Weight gain was negatively associated with the number of previous treatment attempts (Odds Ratio = 0.86; Confidence Interval: 0.74-0.99), duration of current treatment (Odds Ratio = 0.98; Confidence Interval: 0.96-0.99), and pre-treatment body mass index (BMI) (Odds Ratio = 0.88; Confidence Interval: 0.80-0.96). Investigating other nutrition and lifestyle practices, neither nutrition knowledge, food addiction, physical activity level, nor sleep quality were associated with weight gain. Treatment through drug use was associated with meaningful weight gain that might lead to health risk factors. Developing health promotion programs is crucial to enhance treatment and decrease the risk of relapse.

Use of the Spectroscopy-Based Veggie Meter® to Objectively Assess Fruit and Vegetable Intake in Low-Income Adults

Reflection spectroscopy is an emerging approach for noninvasively assessing dermal carotenoids as a biomarker of fruit and vegetable (FV) intake. This study sought to profile and identify determinants of scores from a reflection spectroscopy device (the Veggie Meter (VM)®) among 297 urban, primarily Hispanic low-income adults served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The repeatability of the scores and bi- and multivariate relationships between VM scores, self-reported FV intake measured by a brief screener, and participant characteristics were examined. The mean VM score was 270 (range 0-695); 3- and 6-month test-retest correlations were positive and strong (r = 0.79 and 0.55, respectively). VM scores were negatively associated with body mass index (BMI; r = -0.22) and were higher among participants of Ecuadorian, Dominican, and Mexican Hispanic origin relative to those of Puerto Rican origin; foreign- vs. US-born participants, breastfeeding vs. non-breastfeeding participants, nonsmokers vs. smokers, and participants who consumed three or more cups of FV/day relative to those who consumed less than three cups of FV/day. Foreign-born nativity, consumption of three or more cups of FV/day, and smaller body size were determinants of increased VM scores. Although replication studies are needed to confirm these findings, investigators working with similar populations are encouraged to use the VM to longitudinally track FV intake and to target determinants of the scores in observational and intervention studies of FV intake as measured by the VM.

Orthorexia nervosa is associated with positive body image and life satisfaction in Chinese elderly: Evidence for a positive psychology perspective

OBJECTIVE

Obsessive attention to healthy eating might paradoxically lead to physical and psychosocial impairments, a potential eating disorder termed orthorexia nervosa (ON). An ongoing debate concerns whether ON should be categorized as an eating disorder, an obsessive-compulsive disorder, or a mental disorder at all. A missing voice in this debate is ON in the elderly, which remains unknown, despite health being a more central issue in everyday life during old age. Similarly missing is ON in East Asia, which remains largely unexplored.

METHOD

The current study investigated ON in 313 Chinese elderly (M = 67.90, SD = 7.94) using the Chinese version of the Düsseldorf Orthorexia Scale (C-DOS). Questionnaires were used to measure traditional eating disorder symptomatology, body image (body dissatisfaction, body appreciation, and functionality appreciation), lifestyle behaviors (fruit and vegetable consumption and time spent on physical activity), and indexes of well-being (psychological distress, food-related quality of life, and life satisfaction).

RESULTS

ON symptoms were positively related to physical activity, fruit and vegetable (F&V) consumption, body appreciation, functionality appreciation, and life satisfaction, but negatively related to body dissatisfaction. Compared with those without ON, the elderly with ON scored higher on positive psychological/lifestyle measures but lower on negative psychological measures.

DISCUSSION

Contrary to the dominant characterization of ON as a variant of disordered eating, in Chinese elderly ON was associated with several positive lifestyle and psychological measures. Thus, ON in the elderly might not be viewed as a form of disordered eating but can be protective and beneficial.

The effect of TTM-based nutrition education on decisional balance, self-efficacy and processes of change for fat intake

Purpose

The purpose of this study is to determine how transtheoretical model (TTM) constructions change through nutrition education for fat intake modification among overweight and obese women living in Shazand city, Iran.

Design/methodology/approach

A semi-experimental design with intervention and control groups (50 women in each group) was performed. TTM constructions for dietary fat intake were measured through a questionnaire in four phases: before the intervention, immediately, one month and six months after the intervention. Participants in two groups were classified into inactive and active subgroups, based on their determined stage of change. Then in the intervention group, each subgroup received a separate education program of five or eight sessions for the active and inactive subgroups, respectively.

Findings

The intervention resulted in significant progress in participants' stage of change compared to the control group (p = 0.002). Also, it resulted in an increase in the self-efficacy and decisional balance scores in both of the intervention subgroups, with these effects being more pronounced in the inactive subgroup, and these significant differences, compared to the control group, remained in the third and fourth phases. The intervention also positively impacted the behavioral processes, but this effect was not so long-lasting and decreased after six months.

Originality/value

The results indicated the intervention effectiveness and the necessity of planning educational interventions to change fat consumption behavior. This study provides further insight into effective and sustainable nutrition education strategies based on behavioral change stages rather than traditional approaches. These methods should be used to design group interventions to change individuals' health behavior in future works.

The effect of a fresh produce incentive paired with cooking and nutrition education on healthy eating in low-income households: a pilot study

OBJECTIVE

This study pilot-tested combining financial incentives to purchase fruits and vegetables with nutrition education focused on cooking to increase the consumption of fruits and vegetables and improve attitudes around healthy eating on a budget among low-income adults. The goal of the pilot study was to examine implementation feasibility and fidelity, acceptability of the intervention components by participants and effectiveness.

DESIGN

The study design was a pre-post individual-level comparison without a control group. The pilot intervention included two components, a scan card providing free produce up to a weekly maximum dollar amount for use over a 2-month period, and two sessions of tailored nutrition and cooking education. Outcomes included self-reported attitudes about healthy eating and daily fruit and vegetable consumption from one 24-h dietary recall collected before and after the intervention.

SETTING

Greater Minneapolis/St. Paul area in Minnesota.

PARTICIPANTS

Adults (n 120) were recruited from five community food pantries.

RESULTS

Findings indicated that the financial incentive component of the intervention was highly feasible and acceptable to participants, but attendance at the nutrition education sessions was moderate. Participants had a statistically significant increase in the consumption of fruit, from an average of 1·00 cup/d to 1·78 cups/d (P < 0·001), but no significant change in vegetable consumption or attitudes with respect to their ability to put together a healthy meal.

CONCLUSIONS

While combining financial incentives with nutrition education appears to be acceptable to low-income adult participants, barriers to attend nutrition education sessions need to be addressed in future research.

Impact of a farmers' market nutrition coupon programme on diet quality and psychosocial well-being among low-income adults: protocol for a randomised controlled trial and a longitudinal qualitative investigation

INTRODUCTION

Low-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers' market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers' Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers' markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts.

METHODS AND ANALYSIS

In a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10-15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers' markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25-30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants' experiences with and perceived outcomes from the programme.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT03952338.

Increasing physical activity and healthy diet in outpatients with mental disorders: a randomized-controlled evaluation of two psychological interventions

INTRODUCTION

While physical activity (PA) can play an important role in the treatment of mental disorders (MD), large proportions of patients with MD do not meet PA recommendations. The aim of this trial was to evaluate whether structured psychological intervention (MoVo-LISA) is effective in helping outpatients with MD to increase their level of PA. As active control group (CG) we modified MoVo-LISA to target healthy diet behavior.

METHODS

N = 83 outpatients with MD (F1-F4) were randomized to the two conditions. PA (self-report and accelerometry), dietary behavior, social-cognitive determinants of health behavior change, psychiatric symptoms and health-related quality of life were assessed at baseline, 1 and 12 weeks after the intervention.

RESULTS

Significant time*group interaction effects for objectively measured PA, dietary behavior and fruit and vegetable consumption indicated differential effects of the interventions on these outcomes. PA increased in the MoVo-LISA group (IG) from baseline to follow-up while it decreased in CG. IG showed a significant higher level of objectively measured PA at follow-up compared to CG. Dietary behavior and fruit and vegetable consumption significantly increased from baseline to follow-up in CG, but not IG. IG showed a significant increase in some, but not all social cognitive determinants of health behavior change.

CONCLUSIONS

MoVo-LISA is effective in helping outpatients with MD to increase their level of PA in short- and mid-term. The used intervention strategies are effective for the promotion of healthy diet in patients with MD as well.

Food as a way to convey masculinities: How conformity to hegemonic masculinity norms influences men’s and women’s food consumption

This study investigated how conformity to hegemonic masculinity norms affects men’s and women’s food consumption and whether such influence was contextually modulated. A total of 519 individuals (65% women; M = 44 years old) participated in a 2 (gender salience: low vs high) × 2 (participants’ sex: male vs female) quasi-experimental between-subjects design, completing the Conformity to Masculinity Norms Inventory (Portuguese version) and reporting their past week’s food consumption. Gender salience moderated the relation between men’s conformity to masculinity norms and food consumption; sex-related differences in food consumption were partially mediated by conformity to masculinity norms. Implications for food consumption interventions are discussed.

When Is Congruency Helpful? Interactive Effects of Frame, Motivational Orientation, and Perceived Message Quality on Fruit and Vegetable Consumption

Health messages framed to be congruent with people's motivational orientation have been shown to be generally effective in promoting health behavior change, but some inconsistencies have been found. This study tested whether the perceived quality of a health message moderated the congruency effect in the domain of fruit and vegetable (FV) consumption. Undergraduate participants (N = 109) read a health message promoting FV intake in which the frame (gain vs. loss) was either congruent or incongruent with their approach/avoidance motivational orientation. Perceived message quality and intention to increase FV intake were assessed after message exposure, and self-reported FV intake was assessed one week later. A significant interaction between congruency and perceived message quality was found on both intention and FV intake. When messages were congruent, higher intentions and FV intake were observed when perceived message quality was high, but the reverse pattern was observed when perceived message quality was low. The findings support the potential utility of using congruently-framed messages to promote fruit and vegetable consumption, while also underscoring the necessity of using high-quality messages in order for congruency to influence health-related behaviors.

Dietary planning, self-efficacy, and outcome expectancies play a role in an online intervention on fruit and vegetable consumption

OBJECTIVE

An online intervention to improve fruit and vegetable (FV) intake examines the role of planning, outcome expectancies, self-efficacy and gender. Women are not only expected to eat more FV than men, but they are also expected to be more responsive to nutritional advice and benefit more from treatment.

METHOD

A two-arm digital intervention with 269 men and 395 women (M_age = 41.2, SD_age = 11.45; range: 19-66 years) was conducted in Italy, Spain and Greece, followed up at three and six months, comparing a static with a dynamic, feedback-intensive platform.

RESULTS

Linear mixed models yielded an increase in FV consumption in both the dynamic and the static intervention arms. In men, outcome expectancies were positively related to follow-up FV intake. Dietary planning interacted with self-efficacy on behavioural outcomes.

CONCLUSION

FV intake increased overall, and being a woman and involvement in planning facilitated behaviour change. Women seemed to be more engaged in the dynamic platform resulting in a higher amount of planning. Initial motivation, as indicated by outcome expectancies, seemed to be beneficial for men. Self-efficacious individuals benefitted from their engagement in planning, but self-efficacy did not compensate for failing to plan.

Developing a food basket for fulfilling physical and non-physical needs in Cyprus. Is it affordable?

Background

An acceptable and affordable food basket (FB) is necessary to meet not only physical (healthy) needs but also the non-physical needs of individuals and communities. FBs were developed based on the Cypriot national food-based dietary guidelines for six types of household: single woman (±40 years), single man (±40 years), a couple (±40 years) without children, single woman (±40 years) with two children (10-year-old boy and 14-year-old girl), single man (±40 years) with two children and a couple (±40 years) with two children. Non-physical needs (kitchen equipment, physical activity and other related functions of food) were added to the baskets. The cost, acceptability and feasibility of FB were examined through the focus group discussions. Affordability was defined as the cost of the each basket as a percentage of household income (Guaranteed Minimum Income [GMI]). The budget for healthy food has the highest proportion in the total food budget (83-89%) compared with the other components. The part of the budget required for other functions of food is small compared with that of healthy food and ranged between 4.7 and 6.7% of the total monthly budget. For low-income families, the proportion of income that needs to be spent on the FB for physical needs and FB for physical and non-physical needs ranged from around 39 to 72% and 47 to 81%, respectively. The FB fulfilling physical and non-physical needs is not affordable among the low-income families (mainly with children) receiving the GMI scheme in Cyprus.

The Role of Social Support and Self-efficacy for Planning Fruit and Vegetable Intake

OBJECTIVE

The aim of the current study was to examine the joint effect of self-efficacy, action planning, and received social support on fruit and vegetable intake.

DESIGN

The study used a longitudinal design with 3 waves of data collection.

SETTING

Major university campus in Beijing, China.

PARTICIPANTS

Young adults (n = 286).

VARIABLES MEASURED

Age, gender, body mass index, dietary self-efficacy, and baseline behavior were measured at time 1. Two weeks after time 1, received social support and action planning were assessed (time 2); 4 weeks after time 1, subsequent fruit and vegetable consumption was measured (time 3).

ANALYSIS

In a path analysis, action planning at time 2 was specified as a mediator between self-efficacy at time 1 and fruit and vegetable intake at time 3, controlling for age, gender, body mass index, and baseline behavior. In addition, in a conditional process analysis, received social support at time 2 was specified as a moderator of the self-efficacy-planning relationship.

RESULTS

Action planning mediated between self-efficacy and subsequent dietary behavior, and received social support moderated between self-efficacy and planning supporting a compensation effect. Action planning served as a proximal predictor of fruit and vegetable intake, and planning one's consumption was facilitated by dietary self-efficacy.

CONCLUSIONS AND IMPLICATIONS

Through the identification of social cognitive factors influencing dietary planning, interventions can target self-efficacy and received social support to test the efficacy of these mechanisms in increasing individuals' ability to ensure they consume adequate amounts of fruits and vegetables.

Who benefits from a dietary online intervention? Evidence from Italy, Spain and Greece

OBJECTIVE

The traditional Mediterranean diet includes high consumption of fruits, vegetables, olive oil, legumes, cereals and nuts, moderate to high intake of fish and dairy products, and low consumption of meat products. Intervention effects to improve adoption of this diet may vary in terms of individuals' motivational or volitional prerequisites. In the context of a three-country research collaboration, intervention effects on these psychological constructs for increasing adoption of the Mediterranean diet were examined.

DESIGN

An intervention was conducted to improve Mediterranean diet consumption with a two-month follow-up. Linear multiple-level models examined which psychological constructs (outcome expectancies, planning, action control and stage of change) were associated with changes in diet scores.

SETTING

Web-based intervention in Italy, Spain and Greece.

SUBJECTS

Adults (n 454; mean age 42·2 (sd 10·4) years, range 18-65 years; n 112 at follow-up).

RESULTS

Analyses yielded an overall increase in the Mediterranean diet scores. Moreover, there were interactions between time and all four psychological constructs on these changes. Participants with lower levels of baseline outcome expectancies, planning, action control and stage of change were found to show steeper slopes, thus greater behavioural adoption, than those who started out with higher levels.

CONCLUSIONS

The intervention produced overall improvements in Mediterranean diet consumption, with outcome expectancies, planning, action control and stage of change operating as moderators, indicating that those with lower motivational or volitional prerequisites gained more from the online intervention. Individual differences in participants' readiness for change need to be taken into account to gauge who would benefit most from the given treatment.

Food Security Status and Barriers to Fruit and Vegetable Consumption in Two Economically Deprived Communities of Oakland, California, 2013-2014

Introduction

Food security status may moderate how people perceive barriers to fruit and vegetable consumption. This study aimed to 1) describe the association between fruit and vegetable consumption and microbarriers and mezzobarriers to consumption, and 2) test whether these associations differ by food security status.

Methods

We surveyed adults (n = 531) living in 2 economically deprived communities in Oakland, California, in 2013 and 2014. Multivariate linear regression assessed associations between microbarriers (taste, cost, busyness) and mezzobarriers (produce selection, quality, and purchase ease) and fruit and vegetable consumption, derived from a 26-item dietary screener. Interactions were tested by food security status.

Results

Respondents consumed a mean 2.4 (standard deviation, 1.5) servings of fruits and vegetables daily; 39% of the sample was food insecure. Being too busy to prepare healthy foods was associated with reduced fruit and vegetable consumption (β_busyness = −0.40; 95% confidence interval [CI], −0.52 to −0.28) among all respondents. Food security moderated the relationship between fruit and vegetable consumption and taste, cost, and perceived ease of purchase of healthy foods. Among the food secure, disliking healthy food taste (β_taste = −0.38; 95% CI, −0.60 to −0.15) and cost (β_cost = −0.29; 95% CI, −0.44 to −0.15) concerns were associated with lower consumptions of fruits and vegetables. Mezzobarriers were not significantly associated with consumption in either group.

Conclusion

Perceived time constraints influenced fruit and vegetable consumption. Taste and cost influenced fruit and vegetable consumption among the food secure and may need to be considered when interpreting analyses that describe dietary intake and designing diet-related interventions.

Emphasizing the losses or the gains: Comparing situational and individual moderators of framed messages to promote fruit and vegetable intake

Health messages are a commonly used way to promote changes in dietary habits but their efficacy could be enhanced by strategies such as the way in which the presented arguments are framed. This study aimed to test the effectiveness of framed messages (gain vs. loss) on behavioural intention and fruit and vegetable (FV) intake, comparing predictions based on prominent theoretical perspectives on message framing (function of the health behaviour and recipients' motivational orientation) and by further exploring the role of baseline intentions as a potential moderator of the framing effects. Undergraduate students (N = 180) completed the three assessment points in time. At baseline, individual moderators (motivational orientation and intentions) and fruit and vegetable intake were assessed. One week later, participants were randomly assigned to the loss or gain-framed message and indicated their intentions for FV intake the following week. A week later, FV intake over the previous week was assessed. The gain-frame was not conducive, per se, to higher intentions or behaviour. Having intention as the outcome, only baseline intentions moderated the effects of message frame. When considering FV intake as the outcome, both motivational orientation and baseline intentions moderated the effects of message frame, with the loss-frame promoting higher FV intake among individuals who were prevention-oriented and had higher baseline intentions. Findings suggest that the success of framed messages for FV intake depends upon the recipient's characteristics, such as motivational orientation, baseline intentions, and cultural background, with implications for health communication interventions.

Evidence from interventions based on theoretical models for lifestyle modification (physical activity, diet, alcohol and tobacco use) in primary care settings: A systematic review

OBJECTIVE

To determine the effectiveness of health promotion interventions based on theoretical models of behavioral change to modify the main lifestyle factors (physical activity, diet, alcohol and tobacco) in adults receiving primary health care (PHC).

METHODS

We searched the MEDLINE and Cochrane Database of Systematic Reviews from January 2000 to December 2012. Two reviewers independently performed the first screening of titles and abstracts, the methodological quality assessment using the lecturacritica.com tool, and the extraction of necessary data to systematize the available information.

RESULTS

Only few studies met the inclusion criteria (17 studies from 30 articles). Thirteen were randomized controlled trials, three systematic reviews, and one observational study. The transtheoretical model was the most frequent (13 studies), and obtained strong evidence of its effectiveness for dietary interventions in the short-term and for smoking cessation interventions in the long-term as compared to usual PHC practice. Limited evidence was found for smoking cessation interventions based in the social cognitive theory.

CONCLUSION

There are few studies that explicitly link intervention strategies and theories of behavioral change. A rigorous evaluation of the theoretical principles could help researchers and practitioners to understand how and why interventions succeed or fail.

Cross-behavior associations and multiple health behavior change: A longitudinal study on physical activity and fruit and vegetable intake

This study aimed to examine the interrelation of physical activity and fruit and vegetable intake. The influence of stage congruence between physical activity and fruit and vegetable intake on multiple behavior change was also investigated. Health behaviors, social-cognitions, and stages of change were assessed in 2693 adults at two points in time. Physical activity and fruit and vegetable intake were assessed 4 weeks after the baseline.

Social-cognitions, stages as well as stage transitions across behavior domains were positively interrelated. Stage congruence was not related to changes in physical activity and fruit and vegetable intake. Physical activity and nutrition appear to facilitate rather than hinder each other. Having intentions to change both behaviors simultaneously does not seem to overburden individuals.

Prediction of fruit and vegetable intake: The importance of contextualizing motivation

OBJECTIVES

Motivation is identified as a key antecedent of self-regulated behaviour, such as eating fruit and vegetables. However, inaccurate measurement of this construct may lead to poor prediction of behaviour and inflate the impact of post-motivational factors, such as planning, in models of health behaviour. This study explored the properties of a newly identified measure of motivation, termed behavioural resolve (Rhodes & Horne, 2013, Psychol. Sport Exerc., 14, 455-460), in relation to intention, planning, and fruit and vegetable intake (FVI).

DESIGN

Prospective self-report survey.

METHOD

University students living in the United Kingdom completed two online surveys. The first assessed demographic and predictor variables (intention, behavioural resolve, action planning, and coping planning). The second, completed approximately 2 weeks later, measured average daily FVI and perceived experience of obstacles to FVI. At Time 1, there were 195 respondents, with 139 providing follow-up data.

RESULTS

All predictor variables were significantly correlated with FVI. Two independent multiple hierarchical regression analyses revealed that both intention and behavioural resolve were significant predictors of FVI, but behavioural resolve explained greater FVI variance (40.1%) than intention (36.4%). Furthermore, action planning showed incremental predictive utility over intention, but not behavioural resolve, in predicting FVI.

CONCLUSIONS

The results indicated that motivation is an important determinant of FVI for students, with behavioural resolve demonstrating advantages over intention as a measure of this domain and a predictor of FVI behaviour.

On carrots and curiosity: eating fruit and vegetables is associated with greater flourishing in daily life

OBJECTIVES

Our aim was to determine whether eating fruit and vegetables (FV) is associated with other markers of well-being beyond happiness and life satisfaction. Towards this aim, we tested whether FV consumption is associated with greater eudaemonic well-being - a state of flourishing characterized by feelings of engagement, meaning, and purpose in life. We also tested associations with two eudaemonic behaviours - curiosity and creativity.

DESIGN

Daily diary study across 13 days (micro-longitudinal, correlational design).

METHODS

A sample of 405 young adults (67% women; mean age 19.9 [SD 1.6] years) completed an Internet daily diary for 13 consecutive days. Each day, participants reported on their consumption of fruit, vegetables, sweets, and chips, as well as their eudaemonic well-being, curiosity, creativity, positive affect (PA), and negative affect. Between-person associations were analysed on aggregated data. Within-person associations were analysed using multilevel models controlling for weekday and weekend patterns.

RESULTS

Fruit and vegetables consumption predicted greater eudaemonic well-being, curiosity, and creativity at the between- and within-person levels. Young adults who ate more FV reported higher average eudaemonic well-being, more intense feelings of curiosity, and greater creativity compared with young adults who ate less FV. On days when young adults ate more FV, they reported greater eudaemonic well-being, curiosity, and creativity compared with days when they ate less FV. FV consumption also predicted higher PA, which mostly did not account for the associations between FV and the other well-being variables. Few unhealthy foods (sweets, chips) were related to well-being except that consumption of sweets was associated with greater curiosity and PA at the within-person level. Lagged data analyses showed no carry-over effects of FV consumption onto next-day well-being (or vice versa).

CONCLUSIONS

Although these patterns are strictly correlational, this study provides the first evidence that FV consumption may be related to a broader range of well-being states that signal human flourishing in early adulthood. Statement of contribution What is already known on this subject? There is growing evidence that a diet rich in fruits and vegetables (FV) is related to greater happiness, life satisfaction, and positive affect. These associations are not entirely explained by demographic or health variables including socio-economic status, exercise, smoking, and body mass index (BMI). Recent experimental and daily diary research suggests that FV consumption may be a causal factor in promoting states of positive well-being. Research has examined the links between FV consumption and hedonic well-being - whether people feel good (vs. bad) and satisfied-but has not addressed links between FV consumption and eudaemonic well-being- whether people feel engaged and experience their lives as meaningful and purposeful. What does this study add? It provides the first evidence that eating FV is related to greater eudaemonic well-being in a naturalistic setting. Eating FV was also related to greater self-reported curiosity and creativity. FV consumption may underlie a broad range of experiences that signal flourishing. Future randomised controlled trials of FV should include measures of eudaemonic well-being as outcome variables.

Potassium and fruit and vegetable intakes in relation to social determinants and access to produce in New York City

BACKGROUND

Potassium-rich diets are inversely associated with blood pressure. Potassium intake before this study had not been objectively measured by using potassium excretion in a population-based sample in the United States.

OBJECTIVES

The objectives of the analysis were to 1) report mean potassium excretion in a diverse urban population by using 24-h urine collections, 2) corroborate potassium excretion by using self-reported fruit and vegetable consumption, and 3) characterize associations between potassium excretion and socioeconomic indicators and access to produce.

DESIGN

Participants were from the 2010 Community Health Survey Heart Follow-Up Study-a population-based study including data from 24-h urine collections. The final sample of 1656 adults was weighted to be representative of New York City (NYC) adults as a whole.

RESULTS

Mean urinary potassium excretion was 2180 mg/d, and mean self-reported fruit and vegetable intake was 2.5 servings/d. Adjusted urinary potassium excretion was 21% lower in blacks than in whites (P < 0.001), 13% lower in non-college graduates than in college graduates (P < 0.001), and 9% lower in the lowest-income than in the highest-income group (P = 0.03). Potassium excretion was correlated with fruit and vegetable intake. Most NYC residents reported a <10-min walk to fresh fruit and vegetables; this indicator of access was not associated with potassium excretion or fruit and vegetable intake.

CONCLUSIONS

Potassium intake is low in NYC adults, especially in lower socioeconomic groups. Innovative programs that increase fruit and vegetable intake may help increase dietary potassium and reduce hypertension-related disease. This trial is registered at clinicaltrials.gov as NCT01889589.

Media coverage and awareness of the 2010 Dietary Guidelines for Americans and MyPlate

PURPOSE

To examine the extent and content of coverage of the 2010 Dietary Guidelines for Americans (DGA) and MyPlate in selected mass media outlets and to determine the prevalence of awareness of this recent guidance among adults.

DESIGN

Qualitative content analysis of media coverage, from January 2011 to October 2011, and a cross-sectional survey of the 2010 DGA and MyPlate.

SETTING

Large metropolitan area.

PARTICIPANTS

Four major newspapers (New York Times, Wall Street Journal, New York Daily News, and New York Post), three network television channels (ABC, CBS, and NBC), and six print magazines (Cooking Light, Ebony, Essence, Jet, O! The Oprah Magazine, and Shape). Adults aged ≥50 years (n = 200), college students (n = 219), and African-American women (n = 167); response rates >70%.

METHODS

Number and content of news stories and self-administered survey of prevalence of awareness of DGA and MyPlate.

RESULTS

Twelve newspaper, 14 television, and two magazine stories covered the 2010 DGA and MyPlate. The DGA coverage emphasized population-group-specific sodium recommendations, and MyPlate coverage emphasized the plate icon. Awareness of the DGA and MyPlate varied from approximately 6% in college students to 22% among ≥50-year-olds.

CONCLUSION

The newspapers and television (but not magazines) covered both the 2010 DGA and MyPlate; the content was accurate but brief. However, the awareness of this guidance in study samples was low.

Fruit and vegetable purchasing patterns and preferences in South Delhi

This study examines associations between consumer characteristics, beliefs, and preferences and fruit and vegetable (FV) purchasing and intake in South Delhi, India. Home interviews were conducted with 245 households, using a structured questionnaire to assess FV consumption and purchasing frequency, spending, place of purchase, mode of travel, knowledge and attitudes toward organics, and beliefs about barriers to FV consumption. In-depth interviews with 62 experts and key informants validated survey findings that street vendors and markets are currently the dominant source of FV in South Delhi and that affordability, not accessibility, is the main barrier to increasing FV intake.

Binding of polyphenols to plant cell wall analogues - Part 2: Phenolic acids

Bacterial cellulose and cellulose-pectin composites were used as well-defined model plant cell wall (PCW) systems to study the interaction between phenolic acids (PA) derived from purple carrot juice concentrate (PCJC) and PCW components. Significant PA depletion from solution occurred, with pure cellulose initially (30s-1h) absorbing more than cellulose-pectin composites in the first hour (ca 20% cf 10-15%), but with all composites absorbing similar levels (ca 30%) after several days. Individual PAs bound to different relative extents with caffeic acid>chlorogenic acid>ferulic acid. Extrapolation of data for these model systems to carrot puree suggests that nutritionally-significant amounts of PAs could bind to cell walls, potentially restricting bioavailability in the small intestine and, as a consequence, delivering PAs to the large intestine for fermentation and metabolism by gut bacteria.

Translating intentions into nutrition behaviors via planning requires self-efficacy: evidence from Thailand and Germany

A first step towards the improvement of daily dietary behaviors is forming an intention to change one's nutrition. However, an intention by itself is not sufficient for successful action. Rather, to translate intentions into behavior, careful planning is recommended. Thus, planning constitutes a mediator between the intention and the behavior. However, if a person lacks self-efficacy, this mediation might fail. Previous research in Costa Rica and South Korea has identified perceived self-efficacy as a moderator of the intention-planning-behavior relationship. To examine further the moderator role of self-efficacy, two additional studies were designed in Thailand and Germany. Study 1 surveyed 1718 Thai university students in terms of a low-fat diet; Study 2 surveyed 1140 German internet users in terms of their fruit and vegetable consumption at two measurement points in time, 6 months apart. Intentions served as predictor, planning as mediator, self-efficacy as moderator, and behaviors as outcomes. First, intentions were translated into nutrition behaviors by planning. Second, self-efficacy moderated this mediation in both studies: The strength of the mediated effect increased along with levels of self-efficacy, even when accounting for baseline behaviors. For planning to mediate the intention-behavior relation, people must not harbor self-doubts. If they lack self-efficacy, intentions are not well translated into nutrition behavior through planning.

A feasibility study of a personalised lifestyle programme (HealthForce) for individuals who have participated in cardiovascular risk screening

OBJECTIVE

To assess the feasibility of a lifestyle intervention, focusing on diet and activity, in adults participating in cardiovascular screening.

METHODS

The 12-week lifestyle intervention comprised three personalised counselling sessions plus telephone contact. Outcome data were collected by anthropometry, activity monitoring and lifestyle questionnaires. Acceptability of study measures was assessed by questionnaire and the intervention delivery by in-depth interviews.

RESULTS

Between June 2008 and March 2009, 75 (62%) of 121 eligible individuals were recruited from Tayside, Scotland. Randomisation was to intervention (IV) (n=55) or comparison group (CG) (n=20). Retention was 99% across both groups. In the IV group, 63% increased moderate-vigorous activity by ≥ 30 minutes/week, 82% successfully maintained or lost weight (mean loss 1.1 kg, and 2.6 cm waist circumference) and 85% reported eating five portions of fruit and vegetables compared with 56% at baseline. No behaviour changes were detected in the CG. Feedback highlighted the value of lifestyle "checks," realising that current habits were sub-optimal, receiving personalised advice on specific behaviours, and feeling "healthier" through participation.

CONCLUSIONS

HealthForce was feasible to deliver and implement, acceptable to participants, and associated with reported changes in health behaviours over a 12-week period.

Randomized controlled trial of a brief research-based intervention promoting fruit and vegetable consumption

OBJECTIVE

The present study sought to test the efficacy of a brief research-based, leaflet-like intervention to promote eating the recommended daily intake of fruit and vegetables (RDIFV).

DESIGN

A controlled, pre- post-test experimental study with random allocation and a 1 week self-report behavioural follow-up was conducted.

METHOD

The intervention employed persuasive communication targeting self-efficacy and intention, and invited participants to form implementation intentions in relation to acquiring and preparing fruit and vegetables for consumption.

RESULTS

Intervention participants had stronger post-intervention intentions to consume the RDIFV, and higher anticipated regret in relation to failing to do so, compared with controls, controlling for pre-intervention scores. At follow-up, the intervention group was found to have eaten more fruit and vegetables and to have consumed the RDIFV more frequently.

DISCUSSION

It is concluded that this study supports the previously reported power of implementation intentions to prompt enactment of intentions, and that a brief research-based leaflet-like intervention could result in immediate enhancement of intentions and anticipated regret, and promote greater fruit and vegetable consumption.

Specific psychological variables predict quality of diet in women of lower, but not higher, educational attainment

Our previous work found that perceived control over life was a significant predictor of the quality of diet of women of lower educational attainment. In this paper, we explore the influence on quality of diet of a range of psychological and social factors identified during focus group discussions, and specify the way this differs in women of lower and higher educational attainment. We assessed educational attainment, quality of diet, and psycho-social factors in 378 women attending Sure Start Children's Centres and baby clinics in Southampton, UK. Multiple-group path analysis showed that in women of lower educational attainment, the effect of general self-efficacy on quality of diet was mediated through perceptions of control and through food involvement, but that there were also direct effects of social support for healthy eating and having positive outcome expectancies. There was no effect of self-efficacy, perceived control or outcome expectancies on the quality of diet of women of higher educational attainment, though having more social support and food involvement were associated with improved quality of diet in these women. Our analysis confirms our hypothesis that control-related factors are more important in determining dietary quality in women of lower educational attainment than in women of higher educational attainment.

Investigating fruit and vegetable consumption using the transtheoretical model

PURPOSE

Test the applicability of the transtheoretical model (TTM) to adult fruit/vegetable consumption.

DESIGN

Cross-sectional random-digit dial survey.

SETTING

Hawaii.

SUBJECTS

700 (62.6% female; age [mean +/- SD], 47 +/- 17.1 years; education [mean +/- SD], 14.6 +/- 2.8 years; 35.0% white, 31.1% Asian, 22.1% native Hawaiian/Pacific Islander, 11.8% other).

MEASURES

Stages, processes, self-efficacy, decisional balance, and self-reported fruit/vegetable consumption.

ANALYSIS

Confirmatory factor analysis tested the factor structure. Analyses of variance were used to explore stage differences in constructs.

RESULTS

Stage distribution was precontemplation (33%), contemplation (4%), preparation (37%), action (3%), and maintenance (23%). A 10-factor process model with two higher-order correlated factors (experiential and behavioral) provided the best data fit (chi2 = 1446.12; df = 366; p < .0001; comparative fit index [CFI] = .89; standardized root mean square residual [SRMR] = .05). The self-efficacy structure fit the data well (chi 2 = 81.86; df = 9; p < .0001; CFI = .94; SRMR = .04), as did the decisional balance structure (chi2 = 37.42; df = 19; p = .007; CFI = .99; SRMR = .02). Processes, self-efficacy, decisional balance, and fruit/vegetable consumption behavior differed significantly by stage, with medium effect sizes for most variables.

CONCLUSION

The variables revealed adequate fit to the theorized measurement models. TTM predictions regarding stage differences in self-efficacy, pros and cons, and fruit/vegetable consumption were confirmed; however, most experiential and behavioral processes increased in the early stages and then leveled off.

Changes in intentions, planning, and self-efficacy predict changes in behaviors: an application of latent true change modeling

Can latent true changes in intention, planning, and self-efficacy account for latent change in two health behaviors (physical activity as well as fruit and vegetable intake)? Baseline data on predictors and behaviors and corresponding follow-up data four weeks later were collected from 853 participants. Interindividual differences in change and change-change associations were analyzed using structural equation modeling. For both behaviors, similar prediction patterns were found: changes in intention and self-efficacy predicted changes in planning, which in turn corresponded to changes in behavior. This evidence confirms that change predicts change, which is an inherent precondition in behavior change theories.

Healthy-eater Identity and Self-efficacy Predict Healthy Eating Behavior: A Prospective View

Identity and Self-efficacy Theories were used to examine the relationship between healthy-eater identity, self-efficacy for healthy eating and healthy eating. Measures of healthy-eater identity, perception of healthy eating, nutrition knowledge, self-efficacy for both intake of fruits and vegetables and foods of low nutritional value were completed by 101 university students and staff. Two weeks later, participants recalled recent consumption of (a) fruits and vegetables and (b) foods of low nutritional value. For both eating outcomes, healthy-eater identity was a significant predictor after controlling for nutrition knowledge. The addition of self-efficacy improved prediction in the case of both eating outcomes.

A review of factors affecting the food choices of disadvantaged women

The diets of young women are important not just for their own health but also for the long-term health of their offspring. Unbalanced unvaried diets are more common amongst poor and disadvantaged women. If the diets of these women are to be improved, it is first necessary to understand why they make the food choices they do. Influences on women's food choices range from the global to the individual: environmental factors, such as difficulty in acquiring and affording good-quality healthy foods; social support and social relationships, such as those with parents, spouses and children; life transitions, such as leaving home, living with a partner or having children; individual factors, such as having low perceived control or self-efficacy in making food choices and placing a low value on health in general and on their own health in particular. These interrelated factors all influence food choice, suggesting that if the diets of disadvantaged women are to be improved, it will be necessary to do more than simply educate about the link between diet and health.

Validated Scales to Assess Adult Self-Efficacy to Eat Fruits and Vegetables

Purpose.

An audience-centered approach was used to develop valid and reliable scales to measure adult self-efficacy to eat fruit and vegetables.

Design.

Cross-sectional survey of a national population.

Setting.

New Zealand.

Subjects.

A sample of 350 adults ages 25 to 60 years was randomly selected from a nationally representative sampling frame. Overall, 231 questionnaires were returned, producing a 72% response rate. The mean age of subjects was 42.7 years; 58% were female; 80% were of European descent; 11% were indigenous Maori.

Measures.

The 76–item, self-administered questionnaire collected data on demographics, fruit and vegetable intakes, stages of change, decisional balance, and self-efficacy (24 items).

Analysis.

Principal components analysis with oblimin rotation was performed.

Results.

Principal components analysis yielded three distinct and reliable scales for self-efficacy to eat “vegetables, ” “fruit, ”and “fruit and vegetables” (Cronbach α = .80, .85, and .73, respectively). These scales were correlated, but only the “vegetable” scale was positively correlated with the “fruit and vegetable” scale (Kendall tau r = 0.30, −0.26 [fruit, “fruit and vegetables”], −0.38 [fruit, vegetable]). As predicted, self-efficacy was associated with intake (r = 0.30 [fruit], 0.34 [vegetables]).

Conclusion.

Assuming the factor structure is confirmed in independent samples, these brief, psychometrically sound scales may be used to assess adult self-efficacy to eat fruit and to eat vegetables but not self-efficacy to eat “fruit and vegetables. ”

Consumption of fruit, vegetables, sweets and soft drinks are associated with psychological dimensions of eating behaviour in parents and their 12-year-old children

Objective

We investigated associations between consumption of fruits, vegetables, sweets and soft drinks and the psychological dimensions of eating in parents and their children. The role of the parent’s characteristics for their children’s food intake was also explored.

Design

Food intake patterns were assessed by self-reported consumption of the respective foods. Eating behaviour was measured by the Dutch Eating Behaviour Questionnaire and self-esteem by Harter self-perception scale. The participants were 1441 families (mother, father and their 12-year-old child), and additionally 354 mothers and thirty fathers.

Results

Among parents, reported intake of fruit and vegetables were associated with restrained eating, higher self-esteem, and higher education and age. Intake of sweets was related to more external and less restrained eating, and for mothers also emotional eating. Parent’s intake of soft drink was foremost related to a younger age, and also weakly associated with psychological characteristics. The food intake of parents was more important for the children’s food intake than any other characteristics. However, children’s intake of sweets showed clear-cut positive associations with external eating.

Conclusions

Psychological dimensions of eating behaviour are associated with patterns of food intake, in particular for consumption of sweets, and are most prominent in the parents. The children’s food intake mirrored their parents’ intake. Being sensitive to external food cues may increase unhealthy food consumption in our society, whereas more restrained eating may indicate proneness or intention to healthier food choices among parents. Emotional eating may imply a proneness to consume sweets for comfort, in particular among mothers.