Social support and readiness to make dietary changes

Salutogenesis intervention improves cardio-cerebrovascular health in at-risk office workers: A quasi-experimental study

OBJECTIVE

Cardio-cerebrovascular disease is the major cause of work-related deaths. Salutogenesis indicates individual differences in health levels occur owing to differences in the sense of coherence (SOC). A salutogenesis-based intervention may promote cardio-cerebrovascular health at work. This study examined the effects of a SOC promotion program based on salutogenesis.

DESIGN

Quasi-experimental study.

SAMPLE

Fifty-six office workers who were above the "low risk" of cardio-cerebrovascular disease from two workplaces were included in the final analysis.

MEASUREMENTS

Data collected pre- and postintervention. To determine the intervention's effectiveness, repeated-measures analysis of variance was used.

INTERVENTION

The intervention group was provided with the SOC promotion program, whereas the control group was provided with educational materials alone for 12 weeks.

RESULTS

Generalized resistance resources (GRRs; knowledge of cardio-cerebrovascular disease prevention, stress-coping strategies, and social support) and SOC significantly improved in the intervention group. The intervention group showed significant improvements in occupational stress, physical activity, dietary behavior, total cholesterol level, fasting glucose level, hemoglobin A1C level, body mass index, waist circumference, diastolic and systolic blood pressure, and cardio-cerebrovascular risk.

CONCLUSIONS

Systematic salutogenesis-based SOC promotion programs should be established to enhance the cardio-cerebrovascular health of office workers at-risk of cardio-cerebrovascular diseases.

TRIAL REGISTRATION

Trial Registration Number is KCT0007029. The date of registration is February 23, 2022.

Peer Support Programs to Reduce Organizational Stress and Trauma for Public Safety Workers: A Scoping Review

BACKGROUND

Public safety workers (PSWs), including correctional officers (COs), law enforcement, firefighters, emergency medical service, and military personnel, are at risk of organizational stress and burnout. Exposure to traumatic events, job hazards, injuries, fatalities, and work-related stressors such as work overload, irregular shift assignments, and lack of administrative support can negatively impact PSWs' mental health. Peer support programs (PSPs) have been cited as an intervention to address the mental health of PSWs.

PURPOSE

The purpose of this review is to explore the use, including facilitators and barriers, of PSPs to reduce organizational stress and trauma for PSWs. Implications for COs will be discussed.

METHOD

A scoping review was conducted using the Arksey and O'Malley methodology. A search was conducted for articles published between 1996 and 2021 using six databases. Selected articles described, implemented, or evaluated peer support as an intervention to reduce PSW organizational stress and trauma.

FINDINGS

Thirteen articles met eligibility criteria. Organizational support, including policies, practices, and peer leadership training, contributed to the sustainability of PSPs. Confidentiality, trust, and shared lived experience were also essential to PSP. Stigma was identified as the primary barrier to participation. Public safety workers found PSP helpful in normalizing experiences, increasing hope, and decreasing stigma. Peer support programs also serve to bridge the gap in mental health services use.

CONCLUSIONS

Peer support programs are a potential mental health intervention to reduce organizational stress and trauma for COs. Awareness of the facilitators and barriers to PSPs is the first step in developing such programs.

Autonomous motivation, goal-facilitating behaviours, and dietary goal progress in individuals transitioning to a veg*n diet: A longitudinal study

Previous studies have consistently shown that autonomous motivation - pursuing goals because one wants to, rather than has to - is associated with greater behaviour maintenance in the context of healthy eating, exercise, and diet maintenance. The present study used a 7-wave longitudinal design to examine how autonomous motivation is related to dietary goal progress in individuals (N = 222) transitioning to a veg*n (i.e., vegetarian or vegan) diet. We hypothesized that when people reported more autonomous motivation (compared to their own average) they would be more successful in reaching their dietary goals. We also explored the role of goal-facilitating behaviours in this process. We found no directional effects of relative autonomous motivation on goal progress or goal-facilitating behaviours, although the concurrent relations were significant. There were also no within-person effects of behaviours on progress. These findings shed light onto the relationship between autonomous motivation, behaviours, and goal progress both at the same time and over time, and highlight the importance of examining within-person fluctuations over time.

Group-based healthy lifestyle workplace interventions for shift workers: a systematic review

Objective

Shift work is a risk factor for many chronic diseases and has been associated with unhealthy lifestyle behaviors. Workplaces have great potential for promoting and supporting behavior change. We conducted a systematic review of group-based lifestyle workplace interventions for shift workers to (i) identify adaptations and intervention components that accommodate shift working and (ii) assess their impact on weight, physical activity, sedentary behavior and healthy eating.

Methods

A systematic search was conducted in Scopus, Web of Knowledge, EBSCO and Ovid databases. Using pre-established criteria, independent pairs of researchers conducted the study selection, quality appraisal and data extraction.

Results

In total, 22 studies on group-based workplace interventions for shift workers were included. Many demonstrated organizational level adaptations, such as flexible delivery times and paying employees’ time for their involvement. Delivery locations near the workplace and management support were other key features. Common intervention components included competitive group activities, individualized goal setting, self-monitoring and feedback, staff involvement in intervention delivery, and incentives. There was moderate evidence for effectiveness on weight and physical activity outcomes, but insufficient evidence for healthy eating outcomes. No interventions focusing on sedentary behavior among shift workers were found.

Conclusion

Current evidence demonstrates that group-based workplace interventions can be effective for supporting shift workers to lose weight and increase physical activity, while further research is needed to change healthy eating and sedentary behaviors. Our findings offer decision support on organizational-level adaptations and intervention components that are important to make interventions that promote healthy lifestyles more accessible to shift workers.

Work Characteristics as Predictors of Correctional Supervisors' Health Outcomes

OBJECTIVE

This study examined associations among health behaviors, psychosocial work factors, and health status.

METHODS

Correctional supervisors (n = 157) completed a survey that assessed interpersonal and organizational views on health. Chi-square and logistic regressions were used to examine relationships among variables.

RESULTS

Respondents had a higher prevalence of obesity and comorbidities compared with the general US adult population. Burnout was significantly associated with nutrition, physical activity, sleep duration, sleep quality, diabetes, and anxiety/depression. Job meaning, job satisfaction, and workplace social support may predict health behaviors and outcomes.

CONCLUSIONS

Correctional supervisors are understudied and have poor overall health status. Improving health behaviors of middle-management employees may have a beneficial effect on the health of the entire workforce. This paper demonstrates the importance of psychosocial work factors that may contribute to health behaviors and outcomes.

Evaluation of worksite policies and practices promoting nutrition and physical activity among hospital workers

Purpose

– As posited by the ecological model of health, improvements in the nutrition and physical activity environments of worksites may facilitate healthier dietary intakes and physical activity patterns of employees. This cross-sectional study describes current policies and practices targeting these environments in five large Texas-based hospitals employing approximately 40,000 adults. The paper aims to discuss these issues.

Design/methodology/approach

– The environmental assessment tool survey, an observation tool, was used to assess these policies and practices in August and September 2012.

Findings

– Results demonstrated major policy and practice deficiencies, including a lack of policies supporting on and offsite employee physical fitness, no healthy catering or healthy meeting policies, minimal subsidizing of healthy food and beverage options, few health-promoting vending services, and no performance objectives related to worksite health improvement. Hospitals having an active employee wellness staff consistently performed better on implementation of policies and practices supporting healthy eating and physical activity.

Practical implications

– This study supports practice recommendations including engaging executive leadership to prioritize worksite wellness and using policies to create an infrastructure that promotes healthy eating and encourages physical activity among employees.

Originality/value

– This study is the first to compare and contrast the nutrition and the physical activity environments of large hospitals, allowing for the identification of common environmental barriers and supports across multiple hospital and foodservice systems.

Psychosocial mediators between socioeconomic status and dietary habits among Japanese older adults

INTRODUCTION

OBJECTIVES

The purpose of this study was to examine psychosocial mediators between socioeconomic status (SES) and eating habits in older Japanese adults.

SUBJECTS AND METHODS

A questionnaire was mailed to a representative sample of people who were 60 years and older (N=1,000) living in a suburban area within the Tokyo city metropolitan limits, in Japan. There were 552 effective participants in the study.

DESIGN

Dietary habits were evaluated by assessing the diversity of food that was consumed. SES was evaluated by educational attainment and household income. Four dimensions of psychosocial mediators were assessed: control expectancy, self-efficacy, social influence, and social support. Indirect effects of SES through the mediators were evaluated by using a multiple mediator model.

RESULTS

The relationship between education and dietary habits was mediated by three variables excluding social support. Especially, social influence had the strongest mediating effect. These three significant variables explained the majority of differences in dietary habits resulting from education. The effects of household income were also similarly mediated by the identical variables.

CONCLUSIONS

Control expectancy, self-efficacy, and social influence mediate the relationship between SES and dietary habits.

Effects of environmental intervention in workplace cafeterias on vegetable consumption by male workers

OBJECTIVE

To assess the effects of an environmental intervention based on the transtheoretical model to increase access to nutritional information about vegetable consumption in workplace cafeterias.

DESIGN

Nonrandomized controlled trial.

SETTING

Sixteen workplaces with cafeterias in Niigata, Japan, were assigned to intervention (n = 8) or comparison sites (n = 8).

PARTICIPANTS

A total of 349 Japanese male workers aged 20-59 years, who visited the cafeterias ≥ 3 times/wk.

INTERVENTION

For the intervention group, 12 types of table tents containing information on increasing vegetable consumption, based on the transtheoretical model stages and processes of change, were distributed to cafeterias for 24 weeks in 2009. Information was presented according to the sequence suggested by the stages of change.

MAIN OUTCOME MEASURES

Vegetable consumption in the cafeteria and per day and stage of change were assessed using self-administered questionnaires.

ANALYSIS

Differences between groups were tested using a generalized linear model adjusted for age, work environment, and position.

RESULTS

The difference in the stage of change was not statistically significantly different (P = .05), but the intervention group (n = 181) had increased vegetable consumption in the cafeteria (+0.18 servings; P = .01) and per day (+0.32 servings; P = .01) vs the comparison group.

CONCLUSIONS AND IMPLICATIONS

The findings suggest a beneficial effect of providing access to nutrition information about vegetable consumption as an environmental intervention in workplace cafeterias.

Family and Community Influences on Diabetes-Related Dietary Change in a Low-Income Urban Neighborhood

Purpose

The purpose of this study is to explore the influence of the social environment, including family and community relationships, on diabetes-related dietary change behaviors in a low-income, predominantly African American community with limited access to healthy foods.

Methods

Study methods included interviews and focus groups with adults with diabetes and family members of individuals with diabetes in a low-income African American community. In this analysis, interview participants included 11 participants with diabetes, one with prediabetes, and 8 family members or close friends with diabetes. Information from 4 participants with diabetes and 6 with family members with diabetes was included from 6 focus groups. Transcripts were analyzed via thematic iterative coding influenced by social cognitive theory to understand the influence of family and community relationships on dietary change.

Results

Participants’ social environments strongly influenced diet-related behavioral change. Family members without diabetes provided reinforcements for dietary change for those with diabetes by preparing healthy food and monitoring intake, as well as by adopting dietary changes made by those with diabetes. Family and community members served as sources of observational learning about the potential impacts of diabetes and enhanced behavioral capability for dietary change among people with diabetes by providing dietary advice and strategies for making healthy choices.

Conclusions

This study demonstrates the ways in which family and community members can influence dietary change in people with diabetes. Interventions targeting diabetes management should incorporate families and communities as sources of information, learning, and support.

Perceived Social Support for Diet and Exercise Among Persons With Serious Mental Illness Enrolled in a Healthy Lifestyle Intervention

OBJECTIVE

There is a lack of research on social support for health behavior change among persons with serious mental illness who face disproportionate morbidity and premature death due to cardiovascular disease. This study examined social contact and the demographic, health and clinical characteristics associated with perceived social support for diet and exercise among persons living with serious mental illness enrolled in a healthy lifestyle intervention.

METHOD

Baseline data from two ongoing studies of the In SHAPE healthy lifestyle intervention for persons with serious mental illness were included in this analysis (N = 158). Cross-sectional analyses examined social contact and correlates of both negative and positive experiences of social support for diet and exercise. Multiple linear regression was used to assess the relationship between demographic characteristics, symptoms, health, and social support.

RESULTS

The majority (80.3%) of participants reported face-to-face contact at least twice monthly with a family member or friend. Readiness to change physical activity was associated with greater criticism from family for exercise behaviors, r(64) = .29, p < .05. Depressive symptoms (β = .30, p < .01) were significantly associated with more unhealthy family eating environments while controlling for the amount of family contact (β = .27, p < .01), while readiness to change dietary portion size (β = .34, p < .01) was associated with encouragement for healthy eating from friends.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Participants had regular contact with significant others who were a source of both positive and negative support for healthy eating and exercise. Engaging natural supports in supporting healthy behaviors may help persons with serious mental illness initiate and maintain lifestyle change.

The ACTIVATE Study: Results from a Group-Randomized Controlled Trial Comparing a Traditional Worksite Health Promotion Program with an Activated Consumer Program

Purpose.

This study compares a traditional worksite-based health promotion program with an activated consumer program and a control program

Design.

Group randomized controlled trial with 18-month intervention.

Setting.

Two large Midwestern companies.

Subjects.

Three hundred and twenty employees (51% response).

Intervention.

The traditional health promotion intervention offered population-level campaigns on physical activity, nutrition, and stress management. The activated consumer intervention included population-level campaigns for evaluating health information, choosing a health benefits plan, and understanding the risks of not taking medications as prescribed. The personal development intervention (control group) offered information on hobbies. The interventions also offered individual-level coaching for high risk individuals in both active intervention groups.

Measures.

Health risk status, general health status, consumer activation, productivity, and the ability to evaluate health information.

Analysis.

Multivariate analyses controlled for baseline differences among the study groups.

Results.

At the population level, compared with baseline performance, the traditional health promotion intervention improved health risk status, consumer activation, and the ability to recognize reliable health websites. Compared with baseline performance, the activated consumer intervention improved consumer activation, productivity, and the ability to recognize reliable health websites. At the population level, however, only the activated consumer intervention improved any outcome more than the control group did; that outcome was consumer activation. At the individual level for high risk individuals, both traditional health coaching and activated consumer coaching positively affected health risk status and consumer activation. In addition, both coaching interventions improved participant ability to recognize a reliable health website. Consumer activation coaching also significantly improved self-reported productivity.

Conclusion.

An effective intervention can change employee health risk status and activation both at the population level and at the individual high risk level. However, program engagement at the population level was low, indicating that additional promotional strategies, such as greater use of incentives, need to be examined. Less intensive coaching can be as effective as more intensive, albeit both interventions produced modest behavior change and retention in the consumer activation arm was most difficult. Further research is needed concerning recruitment and retention methods that will enable populations to realize the full potential of activated consumerism.

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.

Applying the transtheoretical model to eating behaviour change: challenges and opportunities

This review provides a rigorous investigation of the question of whether the transtheoretical model (TTM) (or stages of change model) is applicable to eating behaviour change. The TTM is currently the most popular of a number of stage theories being used to examine health behaviour change. Stage theories specify an ordered set of ‘stages of readiness to change’ into which people can be classified and identify the factors that can facilitate movement from one stage to the next. If eating behaviour change follows a stage process, then nutritionists could identify the predominant stage or stages in a population and focus resources on those issues most likely to move people to the next stage (e.g. from no intention of changing, to thinking about changing). In addressing this question, the review draws on the defining characteristics of stage theories as clarified by Weinstein et al. (1998), provides an in-depth coverage of methodological considerations, and a detailed summary table of dietary studies applying the TTM. Specific recommendations are made for improving the accuracy of dietary stage classifications. Among the key conclusions are: (1) dietary studies using the TTM have been hampered by a focus on nutritional outcomes such as dietary fat reduction, rather than clearly understood food behaviours (e.g. five servings of fruit and vegetables per day); (2) accurate stage classification systems are possible for food-based goals, but major misclassification problems occur with nutrient-based goals; (3) observation of an association between stage and dietary intake is not sufficient to demonstrate the validity of the model for dietary behaviour; (4) there is a need for valid questionnaires to measure all aspects of the TTM, and more research on the whole model, particularly the ‘processes of change’, rather than on single constructs such as ‘stage’ (5) cross-sectional studies generally support the predicted patterns of between-stage differences in decisional balance, self-efficacy, and processes of change; (6) studies which test the key hypothesis that different factors are important in distinguishing different stages are rare, as are prospective studies and stage-matched interventions. Only such studies can conclusively determine whether the TTM is applicable to eating behaviour. Since the ultimate test of the TTM will be the effectiveness of stage-matched dietary interventions, the review ends by exploring the requirements for such studies.

Evaluating psychosocial and behavioral mechanisms of change in a tailored communication intervention

This study examined the impact of a tailored nutrition intervention at 3 and 6 months postintervention. In all, 357 Latinas were randomly assigned to one of three conditions: (1) a control condition comprised of previously developed Spanish language targeted materials, (2) tailored print materials, or (3) tailored print materials accompanied by personalized dietary counseling via lay heath advisors (promotoras). At 6 months postintervention, significant group by time interactions were observed on the dietary behavioral strategies scales. The promotora condition resulted in significant behavior change initially; however, receipt of tailored and control materials was instrumental in continued behavior change after intervention activities had ceased. Group main effects suggested that the promotora condition was superior at reducing barriers and improving family interactions supporting healthy behaviors. The promotora model is an effective method for changing important dietary behaviors and psychosocial determinants, but longer term behavior change is achievable with less expensive intervention methods.

Diet-specific social support among rural adolescents

OBJECTIVE

The relationships among primary sources of social support in adolescents' environments (family and friends) and eating behaviors (fat and fiber consumption) were examined in a sample of rural adolescents.

DESIGN

Cross-sectional baseline health surveys were administered in classrooms as part of a larger randomized trial evaluating a cancer education program.

SETTING

Data were collected in middle schools drawn from 22 rural counties in Virginia and New York.

PARTICIPANTS

1942 sixth graders with a modal age of 12 years, roughly equal gender distribution, and racially diverse (53% white, 37% black).

MAIN OUTCOME MEASURE

Variables included a 10-item scale of social support from family and friends for healthy eating, a brief food frequency questionnaire estimating daily grams of fat and fiber intake, and demographics (age, gender, race).

ANALYSIS

Hierarchical multiple regressions and analyses of variance (ANOVAs).

RESULTS

Controlling for demographics, family and friend support were found to significantly predict fat (P < .05) and fiber (P < .01) intake. Black respondents reported higher support from friends than did white adolescents (F = 47.49, P < .01).

IMPLICATIONS FOR RESEARCH AND PRACTICE

Support for healthful eating was related to healthful dietary practices and differed among racial subgroups. Identifying and fostering sources of positive support for healthful eating is critical to developing effective health promotion programs targeting high-risk adolescents.

The relationship between the social environment within religious organizations and intake of fat versus fruits and vegetables

The authors explored associations of social environment with dietary behavior among participants in the Eating for a Healthy Life study, a randomized, low-fat, high-fruit-and-vegetable dietary intervention trial in religious organizations. Data in this report are from baseline telephone surveys of 1,520 persons that assessed dietary behaviors (Fat- and Fiber-Related Diet Behavior Questionnaire) and social environment (Moos Group Environment Scale). After adjusting for demographic characteristics, higher scores on the Cohesion and Order/Organization subscales were associated with higher fruit/vegetable scores (indicating higher fruit and vegetable consumption). Higher scores on the Cohesion, Leader Support, and Order/Organization subscales were also associated with lower fat scores (indicating lower fat intake). Dietary behaviors within religious organizations may be related to positive perceptions of the social environment. These results support further exploration of the potential influence of religious organizations' social environment on health behaviors and its applicability to dietary change interventions.

Association between family variables and Mexican American children's dietary behaviors

OBJECTIVE

To examine the association between family variables and children's diets.

DESIGN

Cross-sectional study with households sampled using random-digit dialing. Children completed a one-time, self-administered survey, and mothers participated in a face-to-face structured interview.

SETTING

Data collection occurred in southern San Diego County on the U.S.-Mexico border.

PARTICIPANTS

One hundred sixty-seven Mexican American children between 8 and 18 years of age and their mothers.

MAIN OUTCOME MEASURES

Diet: number of snacks, candies and sweets, and sodas consumed daily; dietary fat and fiber; and money spent weekly on fast food and snacks. Family variables: household size, family support for healthful eating, number of meals eaten together, availability of fast food in the home, food ads seen on television, and parent purchasing food products that children saw advertised on television.

DATA ANALYSES

Regression analyses were used to examine the independent contributions of family variables on dietary intake. Statistical significance was set at P < .05.

RESULTS

Greater family support for healthful eating was associated with fewer snacks and more fiber consumed. Children of parents who purchased food products that their children had seen advertised on television reported consuming more snacks and more fat, and they spent more money on fast food and snacks.

CONCLUSIONS AND IMPLICATIONS

Family-based interventions are needed to moderate the potential influence of television-advertised food products on children's requests for these food products.

Acculturation and body image perception among Latino youth

OBJECTIVES

Examine the prevalence and predictors of body image dissatisfaction and disordered eating among Latino youth.

DESIGN

One hundred and sixty-seven Latino youth were surveyed as part of a tailored nutrition communication intervention. The youth's mean age was 12.81 years (SD = 2.74) and 54% were female. Mean self-rated health was 2.59 (SD = 1.02; range: 1 = good to 5 = poor), despite 70% reporting a desire to be thinner. Using age and gender-specific growth charts, 16% of the youth were classified as at risk for overweight and 34% were classified as overweight.

RESULTS

Among adolescents, girls (p < or = 0.001), youth who were classified as at risk for or being overweight (p < or = 0.001), and who more strongly recognized and agreed with socially sanctioned standards of appearance as represented in the media (Standardized beta St. beta = 1.86, p < or = 0.001) were more dissatisfied with their body image (R(2) = 0.57). Among children, being at risk for or overweight (p < or = 0.001), reporting a stronger affiliation with the Mexican culture (St. beta = 0.84, p < or = 0.01) and stronger expectations that a healthy diet was associated with improved appearance (St. beta = 0.63, p < or = 0.05) predicted greater body image dissatisfaction (R(2) = 0.55).

CONCLUSION

Interventions that address sociocultural attitudes toward appearance may be effective at reducing both the prevalence of body image dissatisfaction and disordered eating.

Processes underlying young women's decisions to eat fruits and vegetables

OBJECTIVE

To relate the use of identified processes that college women use to eat enough fruits and enough vegetables to their stages of readiness to change and their fruit and vegetable (F/V) intakes.

METHOD

A cross-sectional assessment of college women 18-24 years of age (n = 236) was conducted to assess stage of readiness to eat F/V. Use of seven processes, earlier confirmed in a separate sample of college students the same age (health concerns, self-reevaluation, social liberation, health commitment/action, interpersonal control, external reinforcement and helping relationships) was compared with stage of change for F/V and 3 days of dietary intakes.

RESULTS

In these young college women, use of self-reevaluation, a cognitive process for change, peaked in the preparation stage for both F/V. Use of health commitment/action, a post-action process including counter-conditioning, peaked in those in action/maintenance for F/V. Weight concerns related to the counter-conditioning processes women used to eat more fruit.

CONCLUSION

Health practitioners should focus on weight management, appearance and health benefits of eating fruits and vegetables for this demographic group.

Psychosocial correlates of fruit and vegetable consumption among African American men

OBJECTIVE

To determine the best predictors of fruit and vegetable consumption among African American men age 35 years and older.

DESIGN

Data (n = 291) from a 2001 nationally representative mail survey commissioned by the American Cancer Society.

PARTICIPANTS

291 African American men age 35 years and older.

MAIN OUTCOME MEASURES

DEPENDENT VARIABLES

(1) total fruits and vegetables without fried potatoes, (2) total fruit with juice, and (3) total vegetables without fried potatoes. Independent variables included 3 blocks of predictors: (1) demographics, (2) a set of psychosocial scales, and (3) intent to change variables based on a theoretical algorithm.

ANALYSIS

Linear regression models; analysis of variance for the intent to change group. Alpha = .05.

RESULTS

Regression model for total fruits and vegetables, significant psychosocial predictors: social norms, benefits, tangible rewards, and barriers-other. Total fruit with juice: social norms, benefits, tangible rewards. Total vegetables, no fried potatoes: tangible rewards, barriers-other interests.

CONCLUSIONS AND IMPLICATIONS

For African American men, fruit consumption appears to be motivated by perceived benefits and standards set by important people in their lives; vegetable consumption is a function of extrinsic rewards and preferences for high-calorie, fatty foods. The results suggest that communications to increase fruit and vegetable consumption should be crafted to reflect differences in sources of motivation for eating fruits versus eating vegetables.

Sisters in health: experiential program emphasizing social interaction increases fruit and vegetable intake among low-income adults

Sisters in Health, a nutrition education program aimed at increasing fruit and vegetable consumption among low-income women, includes active food experiences, positive social settings, a flexible meeting series, and small-group facilitation by paraprofessionals. The program's impact was evaluated in a nonrandom sample of 269 low-income adults in 32 intervention and 10 control groups in New York State using a quasi-experimental, pre-/postprogram evaluation design. Intervention groups reported increased fruit and vegetable consumption, measured by a brief screener, of 1.6 times a day (versus 0.8 times in the control groups) and were 0.44 times more likely to be eating fruits and vegetables 5 or more times a day (P < .05) than control groups. Group support, taste, and food skill experiences can be effective for increasing fruit and vegetable consumption.

Validation of a tool to measure processes of change for fruit and vegetable consumption among male college students

OBJECTIVE

To develop a valid tool to measure processes of change for fruit and vegetable consumption, and examine the relationship between stage and processes of change among several cultural groups.

DESIGN

Cross-sectional, using a self-report questionnaire.

SETTING

Convenience sample of male college students living in apartments.

PARTICIPANTS

105 US white, 53 international Latino, and 92 international Asian males.

MAIN OUTCOME MEASURES

Fruit and vegetable intake, stage and processes of change characterizations.

ANALYSIS

Analysis of covariance, with age as a covariate, was used to determine differences in processes of change scores among 3 cultural groups and stages of change. Two-way analysis of variance investigated relationships between stage of change and fruit and vegetable consumption. The pattern of differences across cultural groups was examined using chi-squared analysis.

RESULTS

Self-reported fruit and vegetable intake was higher (P < .01) in action and maintenance than in other stages. Participants in precontemplation/contemplation used significantly less of any process of change than those in preparation or action/maintenance. There were no significant interactions between stage of change and culture for any of the processes of change, but international Asians used significantly more dramatic relief and environmental reevaluation than did US whites and more stimulus control processes than US whites or international Latinos. At all stages, students used significantly more cognitive/experiential processes than behavioral processes.

CONCLUSIONS AND IMPLICATIONS

The use of processes increased within action-oriented stages, consistent with previous studies using the Transtheoretical Model in the nutritional area. The greater use of cognitive/experiential than behavioral processes at all stages was not consistent with predictions. Evidence of cultural differences in the use of processes of change was found.

Correlates of body mass index and waist-to-hip ratio among Mexican women in the United States: implications for intervention development

INTRODUCTION

This study contributes to our understanding of acculturation and obesity by examining the association between several measures of acculturation, including a bidimensional scale of acculturation, body mass index (BMI), and waist-to-hip ratio (WHR).

METHODS

Exploratory analyses were performed using baseline data from 357 Mexican women recruited into a Spanish-language randomized community trial. The women were randomly sampled by telephone and interviewed in their homes. Women's height, weight, waist, and hip were measured to obtain estimates of their BMI and WHR. A face-to-face interview collected data on dietary intake, physical activity, acculturation, and other demographic and psychosocial variables.

RESULTS

Less than a quarter of the women were normal weight (39% overweight and 41% obese). Univariate analyses revealed that more years living in the United States and less integration into the Anglo culture were associated with a larger BMI and WHR. However, in the multivariate analyses, significant correlates of a larger BMI were less moderate physical activity and unemployment. There were trends linking a larger BMI with older age, no vigorous physical activity, more energy intake, and less integration into the Anglo culture. These same variables plus less household income were associated with a higher WHR. Exploratory analyses on acculturation revealed that bicultural Mexican-American women were more educated, more likely to be employed, reported a higher household income, and perceived fewer barriers to a healthy diet compared with traditional Mexican women.

CONCLUSIONS

Intervention designed to prevent overweight/obesity should consider promoting maintenance of Mexican cultural practices, as well as teach women how to effectively integrate into the Anglo culture.

Associations between perceived parent behaviors and middle school student fruit and vegetable consumption

OBJECTIVE

To examine whether (1) student perceptions of parent behaviors explain variations in fruit and vegetable consumption, (2) self-efficacy mediates this relationship, and (3) perceived home fruit and vegetable availability moderates this relationship.

DESIGN

A cross-sectional survey.

SETTING

Classrooms in 3 middle schools in 2 northeast Georgia counties.

PARTICIPANTS

366 middle school students. The response and participation rates were 59% and 56%, respectively.

VARIABLES MEASURED

Perceived authoritative parenting, perceived parent control, perceived parent modeling, perceived parent support, self-efficacy, perceived fruit and vegetable availability, and fruit and vegetable consumption.

ANALYSIS

Hierarchical multiple regression; P <.05.

RESULTS

Perceived parent modeling, perceived parent support, self-efficacy, and perceived fruit and vegetable availability were significant predictors of fruit and vegetable consumption. The relationship between perceived parent support and fruit and vegetable consumption was mediated by self-efficacy. The relationship between fruit and vegetable consumption and both perceived parent modeling and support was moderated by perceived fruit and vegetable availability.

CONCLUSIONS AND IMPLICATIONS

Parents appear to moderately influence middle school student fruit and vegetable consumption. Educators might focus on improving home fruit and vegetable availability and student self-efficacy, as well as parent support and modeling. The level of availability might indicate where efforts should focus for enhancing parent behaviors.

Leading the Way in Exercise and Diet (Project LEAD): intervening to improve function among older breast and prostate cancer survivors

The U.S. population is aging, bringing with it an increased prevalence of chronic disease and concomitant declines in physical function. The risk of developing cancer increases significantly with age, and functional decline is much more likely once a cancer diagnosis is rendered. Thus, functional status in later life is a key concern, one that is heightened among elders who have been diagnosed with cancer. To date, however, there have been few trials that have exclusively addressed issues related to cancer survivorship among older cancer patients, and to our knowledge, none has focused on preserving or enhancing physical functioning. This paper describes the study design and methodological considerations of a randomized controlled trial to determine if a personally tailored workbook and telephone counseling program can positively affect physical activity and dietary behaviors and ultimately the physical functioning of up to 420 older men and women newly diagnosed with breast or prostate cancer. This trial is unique because the cancer diagnosis is used not only as a marker of risk for functional decline, but also as a "teachable moment" - an opportune time when elders may be more receptive to making beneficial lifestyle changes. Undoubtedly, as cure rates for cancer increase and intersect with ever-growing numbers of elderly, there will be numerous opportunities to provide and test interventions within this vulnerable population and to target functional status as a primary outcome. In reporting our methods, we hope to give others "a leg up," so that they can hurdle with greater ease the barriers we experienced, and thus advance the field more rapidly.

Sandwiching it in: spillover of work onto food choices and family roles in low- and moderate-income urban households

Lower status jobs, high workloads and lack of control at work have been associated with less healthful diets, but the ways through which work is connected to food choices are not well understood. This analysis was an examination of workers' experience of the relationship of their jobs to their food choices. Fifty-one multi-ethnic, urban, low- and moderate-income adults living in Upstate New York in 1995 participated in a qualitative interview study of fruit and vegetable choices and discussed employment and food choices. The workers who participated in this study described a dynamic relationship between work and food choices that they experienced in the context of their other roles and values. These workers presented a relationship that was characterized by positive and negative spillover between their jobs and their ability to fulfill family roles and promote personal health, linked by a spectrum of food choice strategies. Participants' narratives fit into three different domains: characterizations of work and their resources for food choice, strategies used to manage food choices within the constraints of work, and affect related to the negative and positive spillover of these strategies on family roles and on personal food choices. Characterizations of work as demanding and limiting or demanding and manageable differentiated participants who experienced their food choice strategies as a source of guilt and dissatisfaction (negative spillover) from those who experienced food choices as a source of pride and satisfaction (positive spillover). Ideals and values related to food choice and health were balanced against other values for family closeness and nurturing and personal achievement. Some participants found work unproblematic. These findings direct attention to a broad conceptualization of the relationship of work to food choices in which the demands and resources of the work role are viewed as they spill over into the social and temporal context of other roles and values.

Stages of change and fluid intake in dialysis patients

Nutrition professionals constantly strive to improve adherence to dietary recommendations in hemodialysis patients. The purpose of this study was to evaluate the effects of a 12-week intervention based on stages of change to decrease fluid gain in dialysis patients. Readiness to change, knowledge of appropriate weight gain, and mean weight gains were obtained from patients in five intervention (n=216) and five control (n=100) dialysis units. Intervention had more participants in the maintenance and precontemplation stages at the end of the intervention (P=0.001) compared to the control group. Knowledge scores significantly increased in the intervention group (P<0.001) during the course of the intervention. However, fluid gains did not decrease in either group. Although this intervention did not produce behavior change, the results can aid other educators in planning intervention programs for renal failure and other chronic diseases.

Role of trade unions in workplace health promotion

Since the 19th century, workers have organized in trade unions and parties to strengthen their efforts at improving workplace health and safety, job conditions, working hours, wages, job contracts, and social security. Cooperation between workers and their organizations and professionals has been instrumental in improving regulation and legislation affecting workers' health. The authors give examples of participatory research in occupational health in Denmark and Finland. The social context of workplace health promotion, particularly the role of unions and workers' safety representatives, is described in an international feasibility study. Health promotion is rife with fundamental political, socioeconomic, philosophical, ethical, gender- and ethnicity-related, psychological, and biological problems. Analysis of power and context is crucial, focusing on political systems nationally, regionally, and globally. The authors advocate defending and supporting workers and their trade unions and strengthening their influence on workplace health promotion. In the face of rapid capitalist globalization, unions represent a barricade in defense of workers' health and safety. Health promoters and related professionals are encouraged to support trade unions in their efforts to promote health for workers and other less privileged groups.

The role of social support in the self-management of diabetes mellitus among a Hispanic population

The rising incidence of diabetes mellitus continues to be a major health concern among Hispanic Americans. Social support has been found to be a relevant factor in diabetes self-management, however, it has not been explored within a Hispanic community. This cross-sectional study was therefore conducted with 95 insulin-requiring Hispanic adults to explore the composition of the support network, the type of assistance needed, the degree of satisfaction with support received, and the relationship between social support and diabetes self-management. Overall, the participants had fairly large networks, composed primarily of family members. The greatest need for assistance was associated with transportation or interactions that involved speaking English, and the assistance offered in these areas was viewed as highly satisfactory. Participants were least satisfied with the help they received for diabetes-related self-care, personal care, and financial assistance. Social support was not strongly related to diabetes self-management. Community health nurses must be aware that this population may have needs that are unsatisfactorily met. They should provide education and resources for support persons and carefully evaluate the support network, not only for availability, but also for satisfaction. Effort should also be directed toward developing alternative support for those without available family.

The relationship between social cohesion and empowerment: support and new implications for theory

Empowerment theory represents an expansive view of individual and collective behavior that includes the active participation of individuals and groups in altering and shaping the socioenvironmental context. Critical to health educators are local interventions that yield participation of community members and empowerment for participants. The concept of social cohesion embraces participation but expands this behavioral emphasis to incorporate notions of trust, connectedness, and civic engagement. This study presents two data sets on the relationship of participation to empowerment. The first replicates and extends previous research by examining participation with interactional as well as intrapersonal empowerment. Second is the examination of how the quality of the participatory experience--the cohesive nature of participation--is related to interactional and intrapersonal empowerment. Findings support and extend previous findings, reliably cluster residents by the degree of connectedness in their participatory experiences, and reveal that social cohesion is related to intrapersonal empowerment.

Association of awareness, intrapersonal and interpersonal factors, and stage of dietary change with fruit and vegetable consumption: a national survey

PURPOSE

To examine associations of awareness, intrapersonal and interpersonal factors, and stage of change with consumption of fruits and vegetables.

DESIGN

Nationally representative, random digit dial survey conducted in 1997 with a response rate of 44.5%. Psychosocial correlates of fruit and vegetable consumption were assessed using regression analyses.

SETTING

United States.

SUBJECTS

A total of 2605 adults who were 18 years and older.

MEASURES

Awareness of the "5 A Day for Better Health" program and its message, along with stage of change; taste preferences; self-efficacy; and perceived benefits, barriers, threats, social support, and norms related to fruit and vegetable consumption.

RESULTS

Awareness and intrapersonal and interpersonal factors explained 24% of the variance in fruit and vegetable consumption beyond the 9% explained by demographic characteristics. Knowledge of the 5 A Day message was associated with a 22% increase in fruit and vegetable consumption. Self-efficacy for eating fruits and vegetables and taste preferences (affect) were the factors most consistently and strongly associated with both higher consumption and higher likelihood of being in action or maintenance stages of change. Affect and perceived barriers were more strongly associated with increased vegetables and salad than fruit.

CONCLUSIONS

Dietary intervention programs to increase fruit and vegetable consumption should emphasize the 5 A Day message, increased self-efficacy, and ways to make vegetables more palatable and easily accessible. Understanding the factors that influence dietary choices should be used when designing dietary interventions.

Defining and measuring stages of change for dietary behaviors: readiness to meet fruit, vegetable, and grain guidelines among Chinese Singaporeans

OBJECTIVE

To assess the ability of 2 algorithms to classify people by stage of change for consuming the recommended servings of grains (cereal foods) and total fruit and vegetables.

DESIGN

Assessment of stage involved an objective behavioral measure in the form of a self-administered food frequency questionnaire, followed by a brief telephone interview to assess intentions of subjects to increase intake to meet the recommended servings. Validity of the stage classification was assessed by comparison with three 24-hour dietary recalls.

SUBJECTS

One hundred and one Singaporean Chinese subjects (mean age = 38.7; 51% men) were recruited from 716 respondents who had taken part in a survey investigating factors influencing consumption of grains, fruit, and vegetables.

STATISTICAL ANALYSES PERFORMED

Differences in mean intake by diet recalls across the stages were investigated using analysis of variance. Sensitivity, specificity, and predictive values of the algorithms were also determined.

RESULTS

There were significant increases across the stages in mean intake of grains (men: F(2,48) = 20.30, P < .001; women: F(2,47) = 23.39, P < .0001), and total fruit and vegetables (men: F(2,48) = 30.29, P < .005; women: F(2,47) = 37.29, P < .0001). Based on diet recalls for grains intake, the algorithms classified 89% of subjects having inadequate intakes into the preaction stages, and 75% of those having adequate intakes into the action or maintenance stages. For fruit and vegetables, 93% of subjects having inadequate intakes were classified into the preaction stages, and 76% of those having adequate intakes were classified into the action or maintenance stages.

CONCLUSION

Algorithms developed to assess stages of change for food-based rather than nutrient goals, and which include an objective assessment of intake, appear to improve the accuracy of stage classifications.

Results of employee involvement in planning and implementing the Treatwell 5-a-Day work-site study

When work-site health promotion programs incorporate theories of community organization, it is likely that employee ownership and participation are enhanced. This article reports quantitative indicators of involvement of Employee Advisory Board (EAB) members in the Treatwell 5-a-Day work-site study and examines relationships between EAB member time spent on project activities and work-site size, with indicators of the extent of implementation and variables associated with behavior change and work-site support. The results reported here indicate that a greater number of EAB member hours spent on program activities was associated with a greater number of events implemented. Smaller work-site size was associated with greater employee awareness of the program and greater participation in project activities as reported on the employee survey. These results suggest that the number of hours employee representatives devote to project activities might be an important consideration in planning employee involvement in work-site health promotion programming.