The role of religiosity in dietary beliefs and behaviors among urban African American women

Religion and mental health in young adulthood: a register-based study on differences by religious affiliation in sickness absence due to mental disorders in Finland

BACKGROUND

Religiosity and spirituality are known to be positively correlated with health. This is the first study to analyse the interrelation between religious denomination and sickness absence due to mental disorders using population register data with detailed ICD codes.

METHODS

The follow-up study was based on the entire population born in Finland between 1984 and 1996 (N=794 476). Each person was observed from age 20 over the period from 2004 to 2018. Cox proportional hazards models were applied to analyse the association between religious denomination and first-time sickness allowance receipts for any cause and mental disorder. Mental disorders were categorised as severe mental illness (F20-F31), depression (F32-F33), anxiety (F40-F48) and any other mental disorder (all other F codes). Men and women were analysed separately.

RESULTS

The differences in sickness absence due to mental disorder were substantial between religious affiliations. Compared with members of the Evangelical Lutheran state church, the relative hazard for mental disorders among non-affiliated women was 1.34 (95% CI 1.30 to 1.39), while that among women with other religions was 1.27 (95% CI 1.19 to 1.35), after adjusting for own and parental characteristics. The corresponding numbers for men were 1.45 (95% CI 1.39 to 1.50) and 1.42 (95% CI 1.30 to 1.54), respectively. The gradient was larger for severe mental illness and depression than for anxiety and other mental disorders. For any cause of sickness absence, there was no difference between Lutherans, non-affiliated individuals and those with other religions.

CONCLUSIONS

Epidemiologists and public health practitioners should further examine the association between mental disorders and church membership using administrative registers.

Associations between religious/spiritual beliefs and behaviours and dietary patterns: analysis of the parental generation in a prospective cohort study (ALSPAC) in Southwest England

OBJECTIVE

Religious/spiritual beliefs and behaviours (RSBB) have been associated with health outcomes, with diet a potential mediator of this relationship. We therefore explored whether RSBB were associated with differences in diet.

DESIGN

Dietary patterns and nutrient intakes were derived from food frequency questionnaire completed by pregnant women in 1991-1992 (mean age = 28·3 years, range = 15-46) and by the mothers and partners 4 years post-partum (mothers mean age = 32·3, range = 19-49; partners mean age = 34·5, range = 18-74). RSBB exposures measured in pregnancy included religious belief, affiliation and attendance. We first explored whether RSBBs were associated with dietary patterns in confounder-adjusted linear regression models. If associations were found, we examined whether RSBB were associated with nutrient intake (linear regression) and following nutrient intake guidelines (logistic regression).

SETTING

Prospective birth cohort study in Southwest England (Avon Longitudinal Study of Parents and Children; ALSPAC).

PARTICIPANTS

13 689 enrolled mothers and their associated partners.

RESULTS

In pregnant women, RSBB were associated with higher 'traditional' (i.e. 'meat and two veg') and lower 'vegetarian' dietary pattern scores. Religious attendance and non-Christian religious affiliation were associated with higher 'health-conscious' dietary pattern scores. Religious attendance was associated with increased micronutrient intake and following recommended micronutrient intake guidelines, with weaker effects for religious belief and affiliation. Comparable patterns were observed for mothers and partners 4 years post-partum, although associations between RSBB and nutrient intakes were weaker for partners.

CONCLUSIONS

RSBBs are associated with broad dietary patterns and nutrient intake in this cohort. If these reflect causal relationships, diet may potentially mediate the pathway between RSBB and health.

Beliefs, fear and awareness of women about breast cancer: Effects on mammography screening practices

AIM

This study sought to investigate the beliefs, fear and awareness about breast cancer and mammography screening practices of women in Iran.

METHODS

This descriptive-correlational study was conducted at Tabriz, East Azerbaijan Province, northwest of Iran from February-July 2017. One hundred and fifty-two women aged 40 years and older, who were referred to 12 health centres for health services were selected via clustering sampling. Associations between variables and mammography screening practices were examined using bivariate and multivariate logistic regression analyses. Participants who had a mammogram within the last 24 months were compared with those who had none. Sociodemographic questionnaire, Champion's Breast Cancer Fear Scale, Champion's Health Belief Model Scale for Mammography Screening, Breast Cancer Awareness Scale and Powe Fatalism Inventory were the tools used for data gathering.

RESULTS

Just 38.2% of women reported having a mammogram within the last 24 months. Self-efficacy (OR = 5.36, B = 1.68, p < .001), susceptibility (OR = 2.83, B = 1.04, p < .001), motivation (OR = 2.11, B = 0.75, p = .024) and lower perceived barriers (OR = 0.25, B = -1.37, p < .001) were associated with being screened. Neither fatalistic belief nor awareness towards breast cancer was significant.

Dietary Intake Among Church-Affiliated African Americans: The Role of Intentions and Beliefs

Diabetes and heart disease disproportionately burden African Americans, who tend to have worse nutritional intake than Whites. Many Black churches are influential institutions in the Black community, with potential to assist with promotion of healthy eating behaviors. The purpose of the current study was to use the Theory of Planned Behavior (TPB) to examine intention to eat a healthy diet and dietary behaviors among church-affiliated African Americans. It was hypothesized that TPB constructs would positively predict intention to eat a healthy diet and that intention to eat a healthy diet would be a predictor of fat and fruit and vegetable intake. It was also hypothesized that control beliefs would predict reduced fat intake and increased fruit and vegetable intake. Path analyses indicated behavioral, normative, and control beliefs were predictive of intention to eat a healthy diet. Intention to eat healthy was a significant predictor of dietary intake behaviors. These findings provide support for the use of the TPB in examining diet among church-affiliated African Americans. This study represents an opportunity to inform dietary interventions for the African American faith community.

Positive religious coping predicts self-reported HIV medication adherence at baseline and twelve-month follow-up among Black Americans living with HIV in the Southeastern United States

This paper presents the results of secondary data analyses investigating the influence of religious coping on HIV medication adherence across time among 167 Black Americans living with HIV (BALWH) in the Southeastern United States. Participants were recruited from a large urban clinic in Atlanta, GA and completed questionnaires about their religious coping at baseline assessment and about their medication adherence at baseline and 12-month follow-up assessment. Descriptive analyses and multiple linear regression were used to determine the association between religious coping and HIV medication adherence. Findings indicated that after controlling for age and depressive symptoms at baseline, positive religious coping significantly predicted medication adherence at baseline and 12-month follow-up. Negative religious coping was inversely associated with medication adherence at baseline after controlling for age and depressive symptoms but not at 12-month follow-up. The implications of these findings for future research and intervention work related to medication adherence among BALWH are discussed.

Effect of Religiosity on Voice

The aim of this study was to examine the relationship between religiosity and phonatory behavior. A total of 186 participants participated in a survey that included four sections: demographic data, extent of religiosity, history of dysphonia, phonatory behavior and laryngeal manipulation, in addition to the Voice Handicap Index (VHI-10). There was no significant association between the prevalence of phonatory symptoms and any of the religiosity questions. There was no significant association between phonatory behavior, history of laryngeal manipulation and any of the religiosity questions. There was also no significant association between the score of the Voice Handicap Index and any of the five religiosity questions. There is no association between religiosity and prevalence of phonatory disturbances, phonotraumatic behavior and/or history of laryngeal manipulation.

Predictors of Participation in Mammography Screening among Non-Hispanic Black, Non-Hispanic White, and Hispanic Women

INTRODUCTION

Many factors influence women's decisions to participate in guideline-recommended screening mammography. We evaluated the influence of women's socioeconomic characteristics, health-care access, and cultural and psychological health-care preferences on timely mammography screening participation.

MATERIALS AND METHODS

A random digit dial survey of United States non-Hispanic Black, non-Hispanic White, and Hispanic women aged 40-75, from January to August 2009, determined self-reported time of most recent mammogram. Screening rates were assessed based on receipt of a screening mammogram within the prior 12 months, the interval recommended at the time by the American Cancer Society.

RESULTS

Thirty-nine percent of women reported not having a mammogram within the last 12 months. The odds of not having had a screening mammography were higher for non-Hispanic White women than for non-Hispanic Black (OR = 2.16, 95% CI = 0.26, 0.82, p = 0.009) or Hispanic (OR = 4.17, 95% CI = 0.12, 0.48, p = 0.01) women. Lack of health insurance (OR = 3.22, 95% CI = 1.54, 6.73, p = 0.002) and lack of usual source of medical care (OR = 3.37, 95% CI = 1.43, 7.94, p = 0.01) were associated with not being screened as were lower self-efficacy to obtain screening (OR = 2.43, 95% CI = 1.26, 4.73, p = 0.01) and greater levels of religiosity and spirituality (OR = 1.42, 95% CI = 1.00, 2.00, p = 0.05). Neither perceived risk nor present temporal orientation was significant.

DISCUSSION

Odds of not having a mammogram increased if women were uninsured, without medical care, non-Hispanic White, older in age, not confident in their ability to obtain screening, or held passive or external religious/spiritual values. Results are encouraging given racial disparities in health-care participation and suggest that efforts to increase screening among minority women may be working.

A Comparison Between Caucasians and African Americans in Willingness to Participate in Cancer Clinical Trials: The Roles of Knowledge, Distrust, Information Sources, and Religiosity

This study aims to (a) examine the roles of knowledge, distrust in medical professionals, information sources, and 2 dimensions of religiosity (i.e., religious activity and religious belief) in influencing willingness to participate (WTP) in cancer clinical trials and to (b) compare the results for Caucasians and African Americans in order to inform future recruitment. An online survey was fielded via a Knowledge Networks panel with a nationally representative sample including 478 Caucasians and 173 African Americans. The results showed that distrust in medical professionals was a strong barrier to WTP for both ethnic groups, whereas factual knowledge about trial procedures was not associated with WTP for either ethnic group. Seeking trial information from doctors was positively associated with WTP for Caucasians; seeking trial information from hospitals was positively associated with WTP for African Americans. More interestingly, levels of religious activity negatively predicted WTP for Caucasians but positively predicted WTP for African Americans. Self-reported religious belief was not associated with WTP for either ethnic group. In sum, although distrust is a common barrier to WTP, the influence of preferred information sources and religious activity on WTP varies as a function of ethnicity.

Residential Segregation and Overweight/Obesity Among African-American Adults: A Critical Review

The relationship between residential segregation and overweight/obesity among African-American adults remains unclear. Elucidating that relationship is relevant to efforts to prevent and to reduce racial disparities in obesity. This article provides a critical review of the 11 empirical studies of segregation and overweight/obesity among African-American adults. Results revealed that most studies did not use a valid measure of segregation, many did not use a valid measure of overweight/obesity, and many did not control for neighborhood poverty. Only four (36% of the) studies used valid measures of both segregation and overweight/obesity and also controlled for area-poverty. Those four studies suggest that segregation contributes to overweight and obesity among African-American adults, but that conclusion cannot be drawn with certainty in light of the considerable methodologic problems in this area of research. Suggestions for improving research on this topic are provided.

Utility of a congregational health assessment to identify and direct health promotion opportunities in churches

PURPOSE

The church is a focal point for health education efforts in minority communities due to its status as one of the most prominent and stable institutions. This paper highlights an approach for identifying health programming targets in minority churches.

METHODS

Twenty-four churches participated in a one-year Health Ministry Institute (HMI), designed to help churches develop sustainable ministries for health promotion. HMI attendees were instructed on conducting a Congregational Health Assessment (CHA) to identify prevalent health conditions and related behaviors in their churches. Churches collected CHAs over a one-month period. Data were analyzed and results were discussed during a HMI session and used to prioritize health-related issues that could be addressed at individual churches.

RESULTS

Seventeen churches (71%) returned surveys (n=887; 70% female; 73% African American). Prevalent health conditions, participation in health-promoting behaviors, interest in learning to live healthy, and interest in health ministry activities were identified using the CHA.

CONCLUSIONS

The CHA shows promise for health assessment, and can be used to identify health issues that are of interest and relevance to church congregants and leaders. The CHA may assist churches with implementing effective and sustainable programs to address the identified health issues.

Religion and health in African Americans: the role of religious coping

OBJECTIVES

To test a model of the religion-health connection to determine whether religious coping plays a mediating role in health behaviors in a national sample of African Americans.

METHODS

Participants completed a telephone survey (N = 2370) assessing religious involvement, religious coping, health behaviors, and demographics.

RESULTS

Religious beliefs were associated with greater vegetable consumption, which may be due to the role of positive and negative religious coping. Negative religious coping played a role in the relationship between religious beliefs and alcohol consumption. There was no evidence of mediation for fruit consumption, alcohol use in the past 30 days, or smoking.

CONCLUSIONS

Findings have implications for theory and health promotion activities for African Americans.

Positive self-perceptions as a mediator of religious involvement and health behaviors in a national sample of African Americans

Self-esteem and self-efficacy are theorized to serve as mediators of the relationship between religious involvement and health outcomes. Studies confirming these relationships have produced mixed evidence. This study examined whether self-esteem and self-efficacy mediate the relationship between religious involvement (beliefs, behaviors) and a set of modifiable health behaviors in a national probability sample of African Americans. African Americans, in general, are relatively high in religious involvement and have higher than average rates of chronic disease. Participants were interviewed by telephone, and a Religion-Health Mediational Model was tested using structural equation modeling. Results suggest that self-esteem and self-efficacy at least in part mediate the relationship between religious beliefs (e.g., relationship with God) and greater fruit and vegetable consumption, and lower alcohol consumption. Religious behaviors (e.g., service attendance) were found to have direct, unmediated effects on health behaviors. Findings have implications for church-based health promotion in African American communities such as education or support groups.

Religiosity and spirituality and the intake of fruit, vegetable, and fat: a systematic review

Objectives. To systematically review articles investigating the relationship between religion and spirituality (R/S) and fruit, vegetable, and fat intake. Methods. PubMed, CINAHL, and PsycInfo were searched for studies published in English prior to March 2013. The studies were divided into two categories: denominational studies and degree of R/S studies. The degree of R/S studies was further analyzed to (1) determine the categories of R/S measures and their relationship with fruit, vegetable, and fat intake, (2) evaluate the quality of the R/S measures and the research design, and (3) determine the categories of reported relationship. Results. Thirty-nine studies were identified. There were 14 denominational studies and 21 degree of R/S studies, and 4 studies were a combination of both. Only 20% of the studies reported validity and 52% reported reliability of the R/S measures used. All studies were cross-sectional, and only one attempted mediation analysis. Most studies showed a positive association with fruit and vegetable intake and a mixed association with fat intake. Conclusion. The positive association between R/S and fruit and vegetable intake may be one possible link between R/S and positive health outcome. However, the association with fat intake was mixed, and recommendations for future research are made.

Positive and Negative Religious Beliefs Explaining the Religion-Health Connection Among African Americans

Theory and literature suggests that the reason religiously-involved people tend to have good health outcomes is because they have healthy lifestyles and behaviors in accord with religious beliefs. Other literature suggests that religious involvement may play a negative role in health outcomes due to beliefs about illness originating as punishment for sins. These ideas were tested as part of a theoretical model of the religion-health connection, in a national sample of African Americans. Outcomes included a variety of health-related behaviors. Study participants (N=2,370) randomly selected from a US national call list completed a telephone survey assessing religious involvement, health behaviors, and demographic characteristics. Structural equation modeling was used to analyze study data. Findings indicate that perceived religious influence on health behavior mediated the relationship between religious beliefs and behaviors and higher fruit consumption, and lower alcohol use and smoking. Belief that illness is the result of punishment for sin mediated the relationship between 1) religious beliefs and higher vegetable consumption and lower binge drinking; and 2) religious behaviors and lower vegetable consumption and higher binge drinking. These findings could be applied to health education activities conducted in African American faith-based organizations such as health ministries, in the effort to eliminate health disparities.

Religion, spirituality, and health: the research and clinical implications

This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010. First, I provide a brief historical background to set the stage. Then I review research on R/S and mental health, examining relationships with both positive and negative mental health outcomes, where positive outcomes include well-being, happiness, hope, optimism, and gratefulness, and negative outcomes involve depression, suicide, anxiety, psychosis, substance abuse, delinquency/crime, marital instability, and personality traits (positive and negative). I then explain how and why R/S might influence mental health. Next, I review research on R/S and health behaviors such as physical activity, cigarette smoking, diet, and sexual practices, followed by a review of relationships between R/S and heart disease, hypertension, cerebrovascular disease, Alzheimer's disease and dementia, immune functions, endocrine functions, cancer, overall mortality, physical disability, pain, and somatic symptoms. I then present a theoretical model explaining how R/S might influence physical health. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard.

Residential segregation, health behavior and overweight/obesity among a national sample of African American adults

We examined the role of residential segregation in 5+ daily fruit/vegetable consumption, exercise, and overweight/obesity among African Americans by linking data on the 11,142 African American adults in the 2000 Behavioral Risk Factor Surveillance System to 2000 census data on the segregation of metropolitan statistical areas (MSAs). Multi-level modeling revealed that after controlling for individual-level variables, MSA Segregation and Poverty contributed to fruit/vegetable consumption, MSA Poverty alone contributed to exercise, and MSA Segregation alone contributed to overweight/obesity. These findings highlight the need for research on the built-environments of the segregated neighborhoods in which most African Americans reside, and suggest that neighborhood disparities may contribute to health disparities.

Church-based heart health project: health status of urban african americans

One of the major health disparities in the African-American population is the high incidence of underdiagnosed cardiovascular disease prior to onset of symptoms. Cardiovascular diseases are one of the chief causes of decreased longevity, reduced quality of life, and poor treatment outcomes among African Americans. The Church-Based Heart Health Project, a pilot initiative of Kaiser Permanente (KP) Ohio's Center of Excellence for Health Disparities and Cultural Competency for African American Health, was implemented in 2004 as an innovative and proactive response to confront this cardiovascular health disparity in greater Cleveland's African-American population. The goal of this program was to reduce individual participants' risks for cardiac events (that is, heart attack, heart disease, or cardiac death) by 1) providing individual risk assessment and interpretation and 2) cataloging the generalized health status of urban churchgoing African Americans in greater Cleveland. We describe the cardiovascular risk factors present in a random population of urban churchgoing African Americans participating in sponsored health screenings at their church. A convenience sample of 144 African-American adults participated in this study. Twenty-five percent (37) were men and 75% (107) were women, and participants' mean age was 54.2 years. Ninety percent were not members of KP Ohio. Cardiovascular risk factors measured included body mass index, lipid levels (cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides), blood pressure, brief health history, Framingham Coronary Heart Disease Prediction Score, and National Heart, Lung, and Blood Institute prediction score for ten-year risk. A large portion of the population was found to have at least one risk factor for coronary heart disease (CHD).

Religiousness/spirituality and health behaviors in younger adult cancer survivors: does faith promote a healthier lifestyle?

Positive health behaviors are crucial to cancer survivors' well-being, yet little is known about the personal factors that may facilitate positive health behaviors. The current study focuses on the association of religion/spirituality (R/S) and health behaviors, examining links between health behaviors and religious attendance, daily spiritual experiences, and religious struggle in a sample of 167 younger adult survivors of a variety of cancers. The extent to which positive affect (self-assurance) and negative affect (guilt/shame) mediate these links was also investigated. Results revealed that religious attendance had little impact on health behaviors, but that daily spiritual experiences were related to greater performance of health behaviors,while religious struggle was related to less. Self-assurance partially mediated the effects of daily spiritual experiences, while guilt/shame partially mediated the effects of religious struggle. The findings suggest that aspects of R/S may play important and different roles in the lifestyle choices of cancer survivors.

Relationship between religious social support and general social support with health behaviors in a national sample of African Americans

Chronic diseases are the leading cause of death and disability in the United States and have significant behavioral origins. African Americans suffer a disproportionate burden of chronic disease relative to other US racial/ethnic groups. Previous research supports an association between both general and religious social support and health behaviors that impact the risk of chronic disease. The present study examined the relative contributions of these constructs to a variety of health behaviors in a national probability sample of African American men and women (N = 2,370). A telephone interview assessing fruit and vegetable consumption, physical activity, alcohol consumption, and current cigarette use was completed by participants. Results showed that several dimensions of religious social support predicted fruit and vegetable consumption, moderate physical activity, and alcohol use over and above the role of general social support. Findings highlight the unique role of religious support in this population in the context of health behaviors. Implications for health promotion interventions are discussed.

Extant health behaviors and uptake of standardized vs tailored health messages among cancer survivors enrolled in the FRESH START trial: a comparison of fighting-spirits vs fatalists

OBJECTIVE

Cancer coping styles have been associated with several cancer-related outcomes. We examined whether baseline lifestyle behaviors differed between cancer survivors with fatalistic vs fighting-spirit coping styles, and whether there was differential response to two diet-exercise mailed-print interventions, one standardized and another individually tailored.

METHODS

Baseline differences by coping style are presented for 628 breast and prostate cancer survivors who participated in the FRESH START trial, along with multivariable analyses on rates of uptake by coping style and arm assignment for those completing the 2-year trial.

RESULTS

At baseline, several differences were observed between fighting-spirits and fatalists, with the former significantly more likely to be white, younger, leaner, more-educated and at risk for depression, and less likely to consume 5+fruits and vegetables (F&V)/day (p-values<0.05). Improvements in physical activity were observed, with fighting-spirits exhibiting the greatest gains from baseline to Year-1, regardless of intervention type; but by Year-2, these differences diminished as fatalists gained ground. Moreover, fatalists who received standardized intervention material also charted steady improvements in F&V intake over the study period; by Year-2, 58.1% of fatalists achieved the 5-a-day goal vs 44.6% of fighting-spirits (p-value<0.05).

CONCLUSIONS

Lifestyle behaviors and health message uptake differs by cancer coping style. Although tailored interventions appear most effective and minimize differential uptake, standardized interventions also can improve behaviors, though fighting-spirits may require additional boosters to maintain change.

Health-related behavior change after cancer: results of the American cancer society's studies of cancer survivors (SCS)

INTRODUCTION

Cancer survivors are known to make positive health-related behavior changes after cancer, but less is known about negative behavior changes and correlates of behavior change. The present study was undertaken to examine positive and negative behavior changes after cancer and to identify medical, demographic, and psychosocial correlates of changes.

METHODS

We analyzed data from a cross-sectional survey of 7,903 cancer survivors at 3, 6, and 11 years after diagnosis.

RESULTS

Of 15 behaviors assessed, survivors reported 4 positive and 1 or 0 negative behavior changes. Positive change correlated with younger age, greater education, breast cancer, longer time since diagnosis, comorbidities, vitality, fear of recurrence, and spiritual well-being, while negative change correlated with younger age, being non-Hispanic African American, being widowed, divorced or separated, and lower physical and emotional health. Faith mediated the relationship between race/ethnicity and positive change.

CONCLUSIONS

Cancer survivors were more likely to make positive than negative behavior changes after cancer. Demographic, medical, and psychosocial variables were associated with both types of changes.

IMPLICATIONS FOR CANCER SURVIVORS

Results provide direction for behavior interventions and illustrate the importance of looking beyond medical and demographic variables to understand the motivators and barriers to positive behavior change after cancer.

Impact of attitudes and beliefs regarding African American sexual behavior on STD prevention and control in African American communities: unintended consequences

Compared to whites, blacks experience significant health disparities for sexually transmitted diseases, particularly in the rates of chlamydia, gonorrhea, and syphilis. To develop more effective interventions to control and prevent STDs, public health practitioners should better understand and respond to factors that facilitate sexual risk-taking behaviors and impede access to STD health care and make use of factors that promote sexual health. Legacies of slavery, racism, and economic or class discrimination leave many blacks suspicious of interventions aimed at improving the welfare of their communities. Sexual behavior, in particular, has been used to justify social oppression of blacks in the United States. Although efforts to engage affected black communities in improving STD health care delivery have been undertaken, bias, prejudice, and stereotyping continue to contribute to negative experiences for many blacks across health care settings, including those involving STD care. Implementing more effective interventions to reduce the disparate burden of bacterial STDs in black communities requires accessible and acceptable STD health care. Understanding and addressing the potential impact of both provider and patient attitudes can improve these service delivery outcomes.

Variations in meanings of the personal core value "health"

OBJECTIVE

Preventive health behavior patterns and practices are influenced by many factors. Knowledge about a person's core values may improve the ability to predict decisions related to behaviors such as healthy eating.

METHODS

In this cross-case comparison study, we illuminate the meanings ascribed to the core value "health" in relationship to fruit and vegetable intake for colorectal cancer survivors and for persons with no cancer history.

RESULTS

We found that both survivors and non-survivors gave three accounts of how the value "health" influenced having a healthy diet. These were: (1) good health was necessary to fulfill/attain other values; (2) health was a manifestation of God's will; and (3) good health was not possible unless one values responsibility.

CONCLUSION

Understanding a person's core values provides insight about how values may act as motivators for behavior change.

PRACTICE IMPLICATIONS

Practitioners using motivational interviewing techniques should include a values clarification exercise to improve their assessment of how values influence behaviors.

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.