Perceptions of older, low-income women about increasing intake of fruits and vegetables

Habit is the Bridge between Intention and Behavior: A Look at Fruit and Vegetable Consumption among Low-Income Older Adults

OBJECTIVE

To examine the influence of habit and theory of planned behavior (TPB) variables in predicting low-income older adults' fruit and vegetable (F&V) consumption.

DESIGN

Cross-sectional study.

SETTING

A city in the southeast United States.

PARTICIPANTS

A total of 372 low-income older adults participated in this study.

RESULTS

Participants completed a validated survey measuring TPB variables (attitude, subjective norm, perceived behavioral control, and intention), F&V intake using the Block Dietary Fruit-Vegetable Screener, and self-reported habit index to measure F&V consumption. Perceived behavioral control was the largest factor influencing intention to consume F&V, followed by attitude and subjective norm. In addition, there was a significant interaction between habit strength and intention, such that intention influenced F&V consumption only among individuals with average or higher habit strength.

CONCLUSIONS

Findings from this study suggest health promotion programs aimed at increasing F&V intake among low-income older adults should focus on establishing F&V intake as a habit so that an individual's intentions to consume F&V can be transformed into actual F&V intake. Also, emphasizing how to overcome potential barriers would improve low-income older adults' actual F&V intake by increasing their sense of control over consuming F&V.

Healthy eating beliefs and the meaning of food in populations with a low socioeconomic position: A scoping review

Profound understanding of healthy eating beliefs in populations with a low socioeconomic position (SEP) can benefit attempts to improve diet quality in this population, but literature on this subject is fragmented. The purpose of this scoping review was to systematically map healthy eating beliefs and the meaning of food and eating in populations with a low SEP. Systematic search of electronic databases yielded 35 relevant publications that were included in a qualitative synthesis. Populations with a low SEP perceived healthy eating as important, although they expressed various meanings of 'healthy' and 'good' eating. Lack of time and money posed perceived barriers to healthy eating, as well as social influences, and desired identities that can be expressed by specific foods. Traditions were important influences on food and eating practices. Eating behavior was perceived as one's own responsibility and desirably within one's own control. Parents expressed the role of food to regulate children's (eating) behavior. In conclusion, perceived limited control over what is eaten due to various barriers as described by populations with a low SEP, may also be viewed as competing values. Deeper understanding of reasons and thoughts underlying healthy eating beliefs and what it means to eat 'well' is largely lacking in this domain. The findings call for an in-depth exploration of the origin and construction of beliefs regarding 'healthy' and 'good' eating in populations with a low SEP.

Health and Nutritional Beliefs and Practices among Rural Elderly Population: An Ethnographic Study in Western Spain

Background: Demographic transition is causing an increasingly aged society, which has a significant impact on public health strategies. Increases in the size of the elderly cohort create a wider stratification and pose specific challenges. Nutrition and diet are one key issue. This study aims to describe food-related practices, beliefs, and representations of non-institutionalized older adults in rural communities in Extremadura (Western Spain). Method: The ethnographic-based fieldwork was conducted from January to July 2019. Empirical material was collected through different research relationships (semi-structured interviews and informal conversations) and direct observation in various locations in Extremadura―involving a variety of agents associated with different aspects of the nutritional process. Results: Data analysis revealed four major themes: (1) Limitations on choice and quality of food available; (2) food preferences and cooking methods; (3) the role of nostalgia in the construction of taste preferences; and (4) perceptions of what “healthy” food is and how respondents relate to the advice provided by health professionals. Conclusions: Nutritional choices among the group studied presented significant differences from medical advice―which was seen as a series of “bans” that did not carry enough authority to alter the symbolic value attached to their traditions.

Ripple Effects of a Community-Based Randomized Trial for Rural Women: Strong Hearts, Healthy Communities

OBJECTIVE

This study aimed to examine (1) whether the Strong Hearts, Healthy Communities intervention (SHHC) improved social network members' (SNMs') weight, exercise, and diet and (2) whether SNMs' weight and behavioral changes were modified by their relationship closeness and/or spatial closeness with trial participants.

METHODS

Eight towns received the SHHC intervention, which focused on building individual healthy behaviors and creating supportive social and built environments for exercise and healthy eating. Eight towns received an education-only control intervention. SNMs (n = 487) were recruited to complete a questionnaire at baseline and at 6 months that asked about demographics, weight, height, exercise, and eating habits.

RESULTS

SHHC's effect on SNMs differed depending on their relationship closeness with trial participants. Among SNMs who had a very close relationship with trial participants, those associated with the intervention group lost more weight and decreased BMI more than those associated with the control group (weight [kilograms] between-group difference: Δ = -1.68; 95% CI: -3.10 to -0.25; P = 0.021; BMI between-group difference: Δ = -0.60; 95% CI: -1.16 to -0.04; P = 0.034). Spatial closeness did not modify any of SHHC's ripple effects.

CONCLUSIONS

Relationship closeness, rather than spatial closeness, played an important role in influencing a rural community-based intervention's ripple effects.

Confusion and nutritional backlash from news media exposure to contradictory information about carbohydrates and dietary fats

OBJECTIVE

To test the effect of news media exposure to contradictory information about carbohydrates and dietary fats on levels of confusion, nutritional backlash and dietary intentions.

DESIGN

We conducted an online survey experiment between 11 and 28 February 2018, randomizing participants to one of six experimental conditions. Two 'contradictory information' conditions asked participants to read one news article on the risks of a low-carbohydrate diet and one article on the risks of a low-fat diet. Two 'convergent information' conditions asked participants to read two articles with similar information on the risks of one of these two diets. A fifth 'established health recommendations' control condition asked participants to read two articles on the harms of smoking and sun exposure. A sixth 'no information' condition served as a second control group. We used general linear models to test hypotheses on the effects of exposure on confusion, nutritional backlash and dietary intentions.

SETTING

USA.

PARTICIPANTS

Adults (n 901) registered with Amazon's Mechanical Turk (M-Turk).

RESULTS

Exposure to contradictory information about carbohydrates and dietary fats increased confusion and nutritional backlash compared with exposure to established health recommendations for non-dietary behaviours and a no-exposure control. Exposure to contradictory information also increased confusion compared with exposure to consistent nutrition information regarding carbohydrates and dietary fats.

CONCLUSIONS

Contradictory nutrition information in the news media can negatively affect consumers' attitudes, beliefs and behavioural intentions. Dietary debates that play out in the media may adversely influence both short-term dietary decisions and future efforts to communicate about unrelated nutrition issues.

Consumption of a High Quantity and a Wide Variety of Vegetables Are Predicted by Different Food Choice Motives in Older Adults from France, Italy and the UK

BACKGROUND

Consumption of a high quantity and wide variety of vegetables is currently recommended for health. Dietary variety can be low, however, particularly for older adults. This study investigated the affective factors associated with the quantity and variety of vegetables consumed by older adults in France, Italy and the UK.

METHODS

Adults aged 65 years plus completed questionnaires on self-reported vegetable intake (quantity and variety), liking for vegetables, attitudes towards intake, and demographic variables.

RESULTS

In 497 older adults (France, n = 187, Italy, n = 152, UK, n = 158), higher quantities of vegetables consumed were associated with a higher age, affluence score and liking for vegetables, and a lower importance in consumption of familiarity (smallest β = 0.11, p = 0.03). Greater variety was associated with a higher liking and importance of health benefits, and a lower importance of familiarity (smallest β = -0.11, p < 0.01). Higher quantity and variety combined (quantity × variety) was associated with a higher age, liking and importance of health benefits, and a lower importance of familiarity (smallest β = 0.14, p = 0.02). Country-specific effects were also found (smallest β = 0.20, p < 0.01).

CONCLUSIONS

These findings demonstrate a role for liking and a lower concern for eating familiar foods in vegetable consumption, and a particular role for concern for health benefits in the consumption of a greater variety of vegetables.

"I feel good and I am not overweight" - A qualitative study of considerations underlying lay people's self-assessments of unhealthy diets

It has been suggested that optimistic self-assessments of unhealthy diets constitute a barrier to the promotion of healthier eating practices. In order to discuss possible reasons for such optimistic assessments, knowledge about the considerations underlying self-assessments of unhealthy diets is needed. The aim of this qualitative study is to explore this issue by comparing considerations underlying the assessments of people who overestimate the healthiness of their unhealthy diets with those of people who express more realistic assessments. Interviewees were recruited among those respondents to the Danish National Survey of Diet and Physical Activity 2011-2013, who had been accorded a low diet index score. A thematic analysis of qualitative interviews is undertaken (N = 16). When interviewees are asked to assess the healthiness of their diets, they draw upon their nutritional knowledge and their perceptions of healthy eating practices. However, these considerations tend to be overruled by more decisive criteria. Thus, diets are assessed as being not exactly healthy, but nevertheless healthy enough - so long as interviewees feel good. Moreover, a personal history of weight status and weight concerns emerge as decisive criteria in self-assessments. Those who experience problems in these areas tend to be realistic about the unhealthy character of their diets, while optimistic assessments appear to be linked to tendencies to perceive oneself as not being overweight, not having experienced weight gain or loss, or not being concerned about weight. This study concludes that decisive criteria in lay people's self-assessments of unhealthy diets - with regard to feeling and looking good - differ markedly from the criteria employed in food-based dietary guidelines. These broader criteria of assessment should be recognized by professionals engaged in planning health promotion strategies with reference to dietary health.

A multi-level intervention in subsidized housing sites to increase fruit and vegetable access and intake: Rationale, design and methods of the 'Live Well, Viva Bien' cluster randomized trial

BACKGROUND

Adequate fruit and vegetable (F&V) intake is important for disease prevention. Yet, most Americans, especially low-income and racial/ethnic minorities, do not eat adequate amounts. These disparities are partly attributable to food environments in low-income neighborhoods where residents often have limited access to affordable, healthful food and easy access to inexpensive, unhealthful foods. Increasing access to affordable healthful food in underserved neighborhoods through mobile markets is a promising, year-round strategy for improving dietary behaviors and reducing F&V intake disparities. However, to date, there have been no randomized controlled trials studying their effectiveness. The objective of the 'Live Well, Viva Bien' (LWVB) cluster randomized controlled trial is to evaluate the efficacy of a multicomponent mobile market intervention at increasing F&V intake among residents of subsidized housing complexes.

METHODS/DESIGN

One housing complex served as a pilot site for the intervention group and the remaining 14 demographically-matched sites were randomized into either the intervention or control group. The intervention group received bimonthly, discount, mobile, fresh F&V markets in conjunction with a nutrition education intervention (two F&V campaigns, newsletters, DVDs and cooking demonstrations) for 12 months. The control group received physical activity and stress reduction interventions. Outcome measures include F&V intake (measured by two validated F&V screeners at baseline, six-month and twelve-months) along with potential psychosocial mediating variables. Extensive quantitative and qualitative process evaluation was also conducted throughout the study.

DISCUSSION

Modifying neighborhood food environments in ways that increase access to affordable, healthful food is a promising strategy for improving dietary behaviors among low-income, racial and ethnic minority groups at increased risk for obesity and other food-related chronic diseases. Discount, mobile F&V markets address all the major barriers to eating more F&V (high cost, poor quality, limited access and limited time to shop and cook) and provide a year-round solution to limited access to healthful food in low-income neighborhoods. LWVB is the first randomized controlled trial evaluating the effectiveness of mobile markets at increasing F&V intake. If proven efficacious at increasing F&V consumption, LWVB could be disseminated widely to neighborhoods that have low access to fresh F&V.

TRIALS REGISTRATION

Clinicatrials.gov registration number: NCT02669472 First Received: January 19, 2016.

The role of perceived barriers in explaining socio-economic status differences in adherence to the fruit, vegetable and fish guidelines in older adults: a mediation study

OBJECTIVE

We aimed to identify barriers for meeting the fruit, vegetable and fish guidelines in older Dutch adults and to investigate socio-economic status (SES) differences in these barriers. Furthermore, we examined the mediating role of these barriers in the association between SES and adherence to these guidelines.

DESIGN

Cross-sectional.

SETTING

Longitudinal Aging Study Amsterdam (LASA), the Netherlands.

SUBJECTS

We used data from 1057 community-dwelling adults, aged 55-85 years. SES was measured by level of education and household income. An FFQ was used to assess dietary intake and barriers were measured with a self-reported lifestyle questionnaire.

RESULTS

Overall, 48.9 % of the respondents perceived a barrier to adhere to the fruit guideline, 40.0 % for the vegetable and 51.1 % for the fish guideline. The most frequently perceived barriers to meet the guidelines were the high price of fruit and fish and a poor appetite for vegetables. Lower-SES groups met the guidelines less often and perceived more barriers. The association between income and adherence to the fruit guideline was mediated by 'perceiving any barrier to meet the fruit guideline' and the barrier 'dislike fruit'. The association between income and adherence to the fish guideline was mediated by 'perceiving any barrier to meet the fish guideline' and the barrier 'fish is expensive'.

CONCLUSIONS

Perceived barriers for meeting the dietary guidelines are common in older adults, especially in lower-SES groups. These barriers and in particular disliking and cost concerns explained the lower adherence to the guidelines for fruit and fish in lower-income groups in older adults.

Adverse outcomes associated with media exposure to contradictory nutrition messages

There is increasing concern that the media present conflicting health information on topics including cancer screening and nutrition. Although scholars have speculated that exposure to this information leads to increased public confusion, less trust in health recommendations, and less engagement in health behaviors, there is a lack of empirical research that directly addresses the role of media exposure to conflicting information. Using data from the Annenberg National Health Communication Survey, this study finds that exposure to conflicting information on the health benefits and risks of, for example, wine, fish, and coffee consumption is associated with confusion about what foods are best to eat and the belief that nutrition scientists keep changing their minds. There is evidence that these beliefs, in turn, may lead people to doubt nutrition and health recommendations more generally-including those that are not rife with contradictory information (e.g., fruit/vegetable consumption, exercise). The implications of these findings for healthy eating campaigns and interventions are discussed.

How people interpret healthy eating: contributions of qualitative research

OBJECTIVE

To identify how qualitative research has contributed to understanding the ways people in developed countries interpret healthy eating.

DESIGN

Bibliographic database searches identified reports of qualitative, empirical studies published in English, peer-reviewed journals since 1995.

DATA ANALYSIS

Authors coded, discussed, recoded, and analyzed papers reporting qualitative research studies related to participants' interpretations of healthy eating.

RESULTS

Studies emphasized a social constructionist approach, and most used focus groups and/or individual, in-depth interviews to collect data. Study participants explained healthy eating in terms of food, food components, food production methods, physical outcomes, psychosocial outcomes, standards, personal goals, and as requiring restriction. Researchers described meanings as specific to life stages and different life experiences, such as parenting and disease onset. Identity (self-concept), social settings, resources, food availability, and conflicting considerations were themes in participants' explanations for not eating according to their ideals for healthy eating.

IMPLICATIONS

People interpret healthy eating in complex and diverse ways that reflect their personal, social, and cultural experiences, as well as their environments. Their meanings include but are broader than the food composition and health outcomes considered by scientists. The rich descriptions and concepts generated by qualitative research can help practitioners and researchers think beyond their own experiences and be open to audience members' perspectives as they seek to promote healthy ways of eating.

Increases in fruit intakes in older low consumers of fruit following two community-based repeated exposure interventions

The present study investigated the value of two repeated exposure interventions for increasing intakes of fruit in older people. A total of ninety-five participants (aged 65 years and over) were randomised to receive either one (E1), five (E5) or five plus (E5+) exposures to fruit over a 5-week period. Fruit exposures occurred in community-based church and social groups, through fruit-tasting sessions involving familiar fruits and novel fruit products and dishes (E1, E5, E5+), and through fruit provision (E5+). Daily intakes of fruit and vegetables were assessed before and after all interventions. Liking for all fruits was also measured during repeated exposure (E5, E5+). In low consumers of fruit (one portion/d or less), fruit intakes increased significantly in the repeated exposure groups (E5, E5+) (t(30) = 5·79, P< 0·01), but did not change in the E1 group (t(16) = 0·29, P= 0·78). No differences were found between E5 and E5+ groups (F(3,87) = 1·22, P= 0·31). Similar effects were also found in fruit and vegetable intakes. No effects were found in other participants. Also, no changes in liking were found. These findings suggest that compared to single exposure, repeated exposure to fruit via fruit-tasting sessions once per week for 5 weeks in a community setting significantly improved fruit intakes, and fruit and vegetable intakes in older low consumers of fruit, although no benefits of additional fruit provision were found. Repeated exposure was also easy to implement, of low cost and enjoyable.

Measuring Media Exposure to Contradictory Health Information: A Comparative Analysis of Four Potential Measures

There is increasing concern that the news media present conflicting health information on topics including cancer screening and nutrition, yet little is known about whether people notice such content. This study proposes four potential measures of media exposure to contradictory health information, using nutrition as an example (Measures I-IV). The measures varied on two dimensions: (1) content specificity, or whether specific nutrition topics and health consequences were mentioned in the question scripting, and (2) obtrusiveness, or whether "contradictory or conflicting information" was mentioned. Using data from the Annenberg National Health Communication Survey (ANHCS), we evaluated the performance of each measure against a set of validity criteria including nomological, convergent, and face validity. Overall, measure IV, which was moderately content-specific and obtrusive, performed consistently well and may prove most useful to researchers studying media effects of contradictory health information. Future directions and applications are discussed.

Barriers to increasing fruit and vegetable intakes in the older population of Northern Ireland: low levels of liking and low awareness of current recommendations

OBJECTIVE

To investigate barriers to increasing fruit and vegetable (f + v) intakes in a large sample of the older population of Northern Ireland (NI), in relation to current intakes.

DESIGN

The study was conducted using a telephone survey assessing f + v intakes, barriers to increasing intakes and various demographic and lifestyle characteristics. Barriers to increasing intakes were investigated using twenty-two closed-response items and one open-response item.

SETTING

NI.

SUBJECTS

Four hundred and twenty-six older people from NI, representative of the older population of NI.

RESULTS

Principal component analysis of the twenty-two closed-response items revealed five factors affecting f + v consumption. Significant associations with current intakes were found where greater f + v consumption was associated with greater 'liking' for f + v (B = 0.675, P < 0.01), greater 'awareness of current recommendations' for consumption (B = 0.197, P < 0.01) and greater 'willingness to change' (B = 0.281, P < 0.01). 'Ease of consumption' and 'difficulties in achieving consumption' were not associated with f + v intakes. Similar associations between f + v intakes and 'liking' and 'awareness' were also found in those consuming low intakes of f + v or those at risk of consuming low intakes. Low awareness and knowledge of recommendations were also found in response to the open-ended question in all groups, although some weight was also given here to environmental difficulties, such as cost and access.

CONCLUSIONS

These findings suggest that interventions aiming to increase f + v intakes in the older population of NI should focus predominantly on improving liking and improving knowledge and awareness of current recommendations.

Severe tooth loss in older adults as a key indicator of compromised dietary quality

OBJECTIVE

Poor oral health influences the dietary quality of older individuals. The objective of the present study was to relate the number of teeth to adherence to the 2005 Dietary Guidelines for Americans among an ethnically diverse sample of older adults.

DESIGN

A block cluster design was used to obtain a sample of older adults. Data were weighted to census data for ethnicity and gender. Dietary intakes were assessed using an FFQ and converted into Healthy Eating Index-2005 (HEI-2005) scores.

SETTING

Two counties in North Carolina, USA, with large African-American and American Indian populations.

SUBJECTS

Community-dwelling older adults (N 635).

RESULTS

Three hundred and twenty-six participants had severe tooth loss (0-10 teeth remaining), compared with 305 participants with 11+ teeth. After controlling for socio-economic factors, those with 0-10 teeth had lower total HEI-2005 scores and consumed less Total Fruit, Meat and Beans, and Oils, and more energy from Solid Fat, Alcohol and Added Sugar, compared with those with 11+ teeth. Less than 1 % of those with 0-10 teeth and 4 % of those with 11+ teeth met overall HEI-2005 recommendations. Those with 0-10 teeth were less likely to eat recommended amounts of Total Vegetables, Dark Green and Orange Vegetables, and energy from Solid Fat, Alcohol and Added Sugar.

CONCLUSIONS

Older adults with severe tooth loss are less likely than those with moderate to low tooth loss to meet current dietary recommendations. Nutrition interventions for older adults should take oral health status into consideration and include strategies that specifically address this as a barrier to healthful eating.