Do beliefs, knowledge, and perceived norms about diet and cancer predict dietary change?

Parents' knowledge of the 2019 Canada's Food Guide recommendations

Little is known about Canadians' knowledge of the 2019 Canada's Food Guide (CFG) recommendations. Using cross-sectional survey data from the Guelph Family Health Study, our brief communication aimed to explore parents' knowledge of the 2019 CFG recommendations through descriptive statistics and content analysis. Among a sample of 122 parents, we found that parents had a general understanding of the 2019 CFG's recommendations but poor knowledge of specific details of the recommendations, such as the names of the three food groups and which foods contain unhealthy fats.

Association between dietary habits and incident thyroid cancer: A prospective cohort study

Background

In addition to the thyroid cancer (TC) risk from lifestyle and environmental factors such as radiation exposure, some studies have indicated that diet may affect TC development; however, previous findings are inconsistent. The objective of our study was to investigate the association between dietary habits and TC risk in a Korean population.

Materials and methods

A total of 13,973 participants were selected after excluding ineligible subjects from the Cancer Screenee Cohort at National Cancer Center in Korea from October 2007 to December 2021. Participants were followed until May 2022 to identify incident TC cases. Information on dietary habits and general characteristics was collected using a self-report questionnaire administered at enrollment without keeping track of changes in eating habits during the follow-up period. A Cox proportional hazards model was used to determine the hazard ratio (HR) and 95% confidence interval (CI) of TC risk for each dietary factor.

Results

A total of 138 incident TC cases were identified during the median follow-up period of 7.6 years. Of the 12 dietary habits evaluated, only two habits showed significant associations with TC. A significantly decreased TC risk was found among participants who consumed milk and/or dairy products 5 or more days a week [adjusted HR (aHR), 0.58; 95% CI, 0.39-0.85]. Notably, a stronger protective effect of dairy consumption was observed in participants aged ≥ 50 years (aHR, 0.44; 95% CI, 0.26-0.75), in women (aHR, 0.53; 95% CI, 0.35-0.81), and in non-smokers (aHR, 0.60; 95% CI, 0.39-0.92). There was a reduced risk of TC in participants with meal durations longer than 10 min (aHR, 0.58; 95% CI, 0.41-0.83). However, this association was limited to individuals aged ≥ 50 years (aHR, 0.49; 95% CI, 0.31-0.79), women (aHR, 0.61; 95% CI, 0.41-0.90), and non-smokers (aHR, 0.62; 95% CI, 0.41-0.92).

Conclusion

Our findings suggest that consuming milk and/or dairy products 5 or more days a week and having a meal duration longer than 10 min could be protective factors against TC, especially in individuals aged ≥ 50 years, women and non-smokers. Further prospective studies are needed to investigate the association of dietary intake with specific types of TC.

Psychological aspects of diet: Development and validation of three measures assessing dietary goal-desire incongruence, motivation, and satisfaction with dietary behavior

OBJECTIVE

The current research created and validated three new measures of psychological mechanisms associated with dietary behavior: (i) a Dietary Goal-Desire Incongruence scale assessed the degree of conflict between ideal dietary behavior and incongruent tempting desires; (ii) a Motivation for Dietary Self-control scale measured the extent and type of motivation, according to Self-Determination Theory, which may be experienced when trying to control dietary behavior; and (iii) a Satisfaction with Dietary Behavior scale measured successful dietary goal-behavior alignment.

METHOD

A representative sample of Australian adults (N = 448, M_age = 45.7 years, SD = 16.98, 50.2% women) rated items assessing the three target constructs and also completed established scales that measure related and unrelated constructs.

RESULTS

Exploratory factor analyses indicated a 1-factor Dietary Goal-Desire Incongruence scale (6 items), 3-factor Motivation for Dietary Self-control scale (11 items), and a 1-factor Satisfaction with Dietary Behavior scale (8 items). Confirmatory factor analyses also supported the model fit of each scale's factor solution. Internal consistency as assessed by Cronbach's alpha (α) was 0.94, 0.78, and 0.94 for the three scales, respectively. A follow-up mediation analysis revealed a stage model of psychological factors related to dietary behavior (as assessed by these three scales) that build on each other. Test-retest reliability was high for each scale (r = .71-.84) and showed sound predictive validity.

CONCLUSION

The Dietary Goal-Desire Incongruence scale, Motivation for Dietary Self-control scale, and Satisfaction with Dietary Behavior scale show good psychometric properties and are brief, easy to administer measures. The utility of the scales can be explored further with other populations and in intervention studies.

Desigualdades sociais no perfil de consumo de alimentos da população brasileira: Pesquisa Nacional de Saúde, 2013

RESUMO: Introdução: É amplamente reconhecido que elevada concentração de renda prevalece no Brasil e que a posição socioeconômica dos segmentos sociais exerce influência nas condições de vida e saúde, incluindo a qualidade da alimentação. Objetivo: Medir a magnitude das desigualdades sociais no perfil da qualidade alimentar da população brasileira. Método: Analisaram-se dados da amostra de 60.202 adultos da Pesquisa Nacional de Saúde de 2013. Foram estimadas as prevalências de indicadores de qualidade alimentar segundo sexo, raça/cor, renda, escolaridade e posse de plano de saúde. Razões de prevalência foram estimadas por meio de regressão múltipla de Poisson. Resultados: Maior prevalência de consumo de alimentos saudáveis foi verificada no sexo feminino, entre os brancos e no grupo de melhor nível socioeconômico. Entretanto,para alguns alimentos considerados não saudáveis, como doces, sanduíches, salgados e pizzas, também foi observada maior prevalência nos segmentos sociais mais favorecidos, nas mulheres e nos brancos, expressando a concomitância de escolhas alimentares saudáveis e não saudáveis. Desigualdade de maior magnitude foi observada quanto à comparação do consumo de leite desnatado e semidesnatado segundo renda (razão de prevalência - RP=4,48). Conclusão: Além de expressiva desigualdade social no perfil alimentar dos brasileiros, foram detectados perfis mistos, incluindo alimentos saudáveis e não saudáveis, sinalizando a necessidade de monitoramento e de intervenções de promoção de alimentação saudável que levem em conta as desigualdades sociais e as contradições no consumo alimentar.

Examining Internet Access and Social Media Application Use for Online Nutrition Education in SNAP-Ed Participants in Rural Illinois

OBJECTIVE

To examine Internet access and interest in receiving nutrition education via social media applications among low-income adults participating in the Supplemental Nutrition Assistance Program Education (SNAP-Ed).

METHODS

A cross-sectional survey was distributed during 25 SNAP-Ed classes throughout the 16 southernmost counties of Illinois.

RESULTS

From 188 responses, the majority of participants had Internet access (76%). Among participants aged 18-32 years (n = 51), 92% owned a smartphone with Internet access and 57% indicated that they would use online nutrition education, with most interest in e-mail (41%), Facebook (40%), and text messaging (35%). There was little interest in using blogs, Vine, Twitter, Tumblr, and Pinterest. Overall, 49% of middle-aged adults aged 33-64 years and 87% of seniors aged ≥65 years reported they would not use online nutrition education.

CONCLUSIONS AND IMPLICATIONS

Results indicated similar Internet accessibility in southern Illinois among low-income populations compared with national rural rates. Interest in using online nutrition education varied among SNAP-Ed participants according to age. Young adults appeared to be the most captive audience regarding online nutrition education. Results may be useful to agencies implementing SNAP-Ed to supplement current curriculum with online nutrition education for audiences aged ≤32 years.

Perceptions of Cancer Risk/Efficacy and Cancer-Related Risk Behaviors: Results From the HCHS/SOL Sociocultural Ancillary Study

This study evaluated the associations among perceived risk, perceived efficacy, and engagement in six cancer-related risk behaviors in a population-based Hispanic/Latino sample. Interviews were conducted with 5,313 Hispanic/Latino adults as part of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. Participants were recruited from the study's four field centers (Bronx, NY; Chicago, IL; Miami, FL; San Diego, CA) between February 2010 and June 2011. Perceived risk and perceived efficacy were assessed with questions drawn from the Health Interview National Trends Survey. More than half of the sample endorsed perceived risk of cancer associated with the six evaluated behaviors, as well as general perceived efficacy for preventing cancer. Adjusted logistic regression analyses demonstrated significant differences across Hispanic/Latino background groups for perceived risk associated with high consumption of alcohol and saturated fat, low consumption of fruits and vegetables, and insufficient exercise but not with smoking or low consumption of fiber. Differences were also found for the belief, "It seems like everything causes cancer" but not for other perceived efficacy items. Perceived cancer risk and perceived efficacy for preventing cancer were neither independently nor interactively associated with engagement in cancer-related risk behaviors after controlling for sociodemographic covariates. Results suggest that perceptions of risk and efficacy with regard to cancer vary across Hispanic/Latino background groups, and therefore background group differences should be considered in prevention efforts. Perceived risk and perceived efficacy were not related to cancer-related risk behaviors among Hispanics/Latinos. Further work is needed to evaluate determinants of cancer-related risk in this population.

Similarities and differences in underlying beliefs of socio-cognitive factors related to diet and physical activity in lower-educated Dutch, Turkish, and Moroccan adults in the Netherlands: a focus group study

BACKGROUND

Unhealthy eating patterns and a lack of physical activity (PA) are highly prevalent in most Western countries, especially among lower-educated people, including people of non-Western origin. The aim of this study was to investigate and compare the beliefs and barriers that underlie socio-cognitive and planning constructs related to healthy eating and PA among lower-educated Dutch, Turkish, and Moroccan adults.

METHODS

Focus group interviews were conducted with 90 Dutch, Turkish, and Moroccan lower-educated adults between March and August 2012. Five semi-structured group interviews were conducted with Dutch participants, five with Turkish participants, and four with Moroccan participants. Men and women were interviewed separately. The question route was based on the Theory of Planned Behavior and self-regulation theories. The theoretical method used for the qualitative data analysis was content analysis. The interviews were recorded, transcribed, and analyzed by applying the framework approach.

RESULTS

Some participants seemed to lack knowledge of healthy eating and PA, especially regarding the health consequences of an unhealthy lifestyle. Important attitude beliefs concerning healthy eating and PA were taste and health benefits. Participants suggested that social support can encourage the actual performance of healthy behavior. For instance, exercising with other people was perceived as being supportive. Perceived barriers to PA and cooking healthily were a lack of time and tiredness. These previously mentioned beliefs arose in all the ethnic groups. Differences were also found in beliefs between the ethnic groups, which were mainly related to religious and cultural issues. Turkish and Moroccan participants discussed, for example, that the Koran contains the recommendation to eat in moderation and to take care of one's body. Furthermore, they reported that refusing food when offered is difficult, as it can be perceived as an insult. Finally, men and women usually cannot exercise in the same location, which was perceived as a barrier. These factors did not emerge in the Dutch groups.

CONCLUSIONS

The same cognitive beliefs were discussed in all three ethnic groups. The importance of cultural and religious factors appeared to be the most significant difference between the Turkish/Moroccan groups and the Dutch groups. Accordingly, interventions for all three ethnic groups should focus on socio-cognitive beliefs, whereas interventions for Turkish and Moroccan populations can additionally take religious and cultural rules into account.

Diet-Related Colorectal Cancer Prevention Beliefs and Dietary Intakes in an Urban Minority Population

In the United States, colorectal cancer (CRC) is the third leading cause of cancer-related death and third most commonly diagnosed cancer among adults. This study is the first to examine the relationship between diet-related beliefs for colorectal cancer prevention and dietary intake among an urban, predominantly Black population (n = 169). More than two-thirds reported diet-related CRC prevention beliefs. Those with diet-related CRC prevention beliefs had healthier intakes for dietary fiber (p = .005), fruit, vegetable, bean (p = .027), red meat (p = .032), vitamin C (p = .039), and cholesterol (p = .045). Most people may already have diet-related CRC prevention beliefs and having them is associated with a more healthful dietary intake.

Recent population adherence to and knowledge of United States federal nutrition guides, 1992-2013: a systematic review

The Dietary Guidelines for Americans dictates the federal nutrition programs, policies, and recommendations of the United States. Corresponding nutrition guides have been established to help educate the public about the dietary intake patterns recommended in these guidelines as well as to ameliorate the US obesity epidemic and its health-related outcomes. The purpose of this systematic review was to summarize population adherence to and knowledge of these guiding US nutrition guides issued since 1992, including the Food Guide Pyramid, MyPyramid, and MyPlate. Of the 31 studies included in the review, 22 examined adherence, 6 examined knowledge, and 3 examined both adherence and knowledge. Across studies, adherence to nutrition guides was low, with participants consuming inadequate levels of fruit, vegetables, and dairy in particular. Knowledge of nutrition guides increased over time since publication and decreased with age of the participants. An association between knowledge of and adherence to nutrition guides was not found. Disparities in knowledge and adherence existed across demographic groups. Based on these findings, it is suggested that federal dietary guidance can be strengthened by increasing dissemination of nutrition guides to the public and tailoring promotional activities to specific demographic and socioeconomic groups.

Nutrition knowledge and associated behavior changes in a holistic, short-term nutrition education intervention with low-income women

OBJECTIVE

To assess the impact of a short-term nutrition intervention using education on a comprehensive array of nutrition and health topics in low-income women.

DESIGN

Pre- and postintervention surveys; 1 study condition (intervention group); experiential learning; pilot testing of education sessions.

SETTING

Community centers, homeless shelters, or University of Minnesota, in Minneapolis-St Paul metropolitan area.

PARTICIPANTS

Ethnically diverse, low-income women (n = 118), 23-45 years of age.

INTERVENTION

Three educational sessions providing a comprehensive curriculum of nutrition and health education via experiential and interactive lectures, activities, and demonstrations. One week to implement knowledge and behavioral changes, and pre- and postsurvey sessions to collect anthropometric data and evaluate changes in knowledge and behavior.

MAIN OUTCOME MEASURES

Health benefits of all food groups; identification of healthful foods; shopping, cooking, and gardening; and energy balance.

ANALYSIS

Paired t tests, Pearson correlations.

RESULTS

Postintervention increases in nutrition knowledge and favorable nutrition behavioral changes (P < .05).

CONCLUSIONS AND IMPLICATIONS

A short-term nutrition intervention using comprehensive nutrition and health education through experiential and interactive lessons, activities, and demonstrations has the capacity to increase nutrition knowledge and favorably change nutrition behaviors in a sample of low-income women.

Lifestyle and cancer prevention in women: knowledge, perceptions, and compliance with recommended guidelines

BACKGROUND

Most women in the United States do not meet minimum recommendations for physical activity or fruit/vegetable consumption. Thus, many are overweight/obese and are at increased risk for cancer morbidity and mortality. This study investigated women's perceptions about the importance of physical activity and a healthy diet in preventing cancer, perceptions of engaging in these behaviors, and whether or not the behaviors met cancer prevention recommendations.

METHOD

A cross-sectional, national, random-digit-dialed telephone survey was conducted with 800 women, ages 18 and older. The response rate was 24.5%. Measures assessed demographics, perceived health status, beliefs about the role of physical activity and diet in cancer prevention, perceived engagement in these behaviors, and actual behaviors.

RESULTS

Only 9.9% of women who reported eating a healthy diet met minimum fruit and vegetable recommendations; 39.7% of women who reported regular physical activity met the minimum recommendation. Analyses adjusted for demographics indicated that low education was associated with reporting regular physical activity to prevent cancer, yet failing to meet the minimum recommendation (odds ratio [OR]=0.90, 95% confidence interval [CI]: 0.82-0.98, p=0.01). Racial/ethnic minority status was marginally significantly associated with reporting eating a healthy diet to prevent cancer, yet failing to consume sufficient fruits and vegetables (OR=2.94, 95% CI: 0.99-8.71, p=0.05).

CONCLUSIONS

Most women who reported eating a healthy diet and being physically active to prevent cancer failed to meet the minimum cancer prevention recommendations. Furthermore, low socioeconomic status and racial/ethnic minority women may be particularly vulnerable to discrepancies between beliefs and behavior.

Between-group differences in nutrition- and health-related psychosocial factors among US adults and their associations with diet, exercise, and weight status

BACKGROUND

Large disparities exist across ethnic and socioeconomic status groups regarding obesity and other chronic diseases. Eliminating health disparities is a national priority in the United States.

OBJECTIVE

To test between-group differences in nutrition- and health-related psychosocial factors (NHRPF) and their associations with US adults' diet, exercise, and weight status. DESIGN AND PARTICIPANTS/SETTING: Nationally representative data from the Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey 1994-96 from 4,356 US adults aged 20 to 65 years were used. Diet was assessed using 24-hour recalls, NHRPF was assessed by 25 questions, and weight status was determined by self-reported weight and height. Index scores were created to measure NHRPF. Diet quality was assessed using the US Department of Agriculture 2005 Healthy Eating Index (HEI).

STATISTICAL ANALYSES

Multivariate linear and logistic regression models were conducted to examine the associations.

RESULTS

Some ethnic differences in NHRPF existed but were small. There were statistically significant (P<0.05) and large ethnic differences in diet (blacks had the worst average HEI and whites the best at 47.6 vs 52.3, respectively). Groups with higher socioeconomic status had better NHRPF (ie, had better nutrition knowledge and beliefs, made better food choices, and had better awareness of nutrition-related health risks) and HEI score. Subjects with high school education had higher NHRPF score (37.2 vs 35.7) and HEI score (54.5 vs 49.5) than those with less than a high school education.

CONCLUSIONS

Ethnic differences among American adults' NHRPF were small, but socioeconomic status differences were greater. More efforts are needed to study the influences of the complex interactions between individual and social environmental factors that affect Americans' diet and weight status and to explain related ethnic disparities.

Factors related to self-perception of diet quality among South Korean adults

OBJECTIVE

Improvements in diet can decrease the cancer rates. The aim of the present study was to determine the relationships between self-perception of diet quality and personality, impulsiveness, stress, coping strategy, sense of coherence, self-efficacy, and social support.

METHODS

This cross-sectional study was conducted using a multiple-stratified random sampling method based on the Korea Census of 2007. In October 2009, investigators conducted 15-minute face-to-face interviews with 1,530 South Korean volunteers who ranged from 30 to 69 years of age without a history of cancer.

RESULTS

Respondents were more likely to perceive that they consumed a healthy diet if they were older than 50 years, lived with a partner, had a monthly family income greater than $4,000 USD, had a low perceived risk of cancer, consumed less alcohol, exercised regularly, had a less agreeable or conscientious personality, had low stress levels, had a high sense of coherence or self-efficacy, and had ample social support.

CONCLUSION

Psychosocial factors, such as personality, stress, sense of coherence, self-efficacy, and social support, are associated with the self- perception of diet quality. Analysis of the factors that contribute to a perceived healthy diet could assist with the design of educational campaigns.

Breast cancer recurrence risk reduction beliefs in breast cancer survivors: prevalence and relation to behavior

OBJECTIVE

There is a growing body of evidence suggesting breast cancer (BC) recurrence risk might be linked to behavioral factors. However, little is known about BC survivors' beliefs regarding the link between their behavior and recurrence risk. The objective of this study was to describe BC survivors' beliefs regarding performance of behaviors potentially associated with BC recurrence risk reduction, and to examine the link between these behaviors and BC recurrence risk reduction beliefs, worry, and risk perception.

METHODS

200 female BC survivors (age, years: mean=57.7, standard deviation=9.2) completed a questionnaire assessing beliefs about the effectiveness of 14 potential BC recurrence risk reduction behaviors, their performance of these potential risk reduction behaviors, recurrence worry, and perception of personal lifetime BC recurrence risk.

RESULTS

The behaviors most frequently endorsed as potentially reducing BC recurrence risk included avoiding tobacco use (84%), exercising at least three times per week (74%), eating an average of five servings a day of fruits and vegetables (72%), and limiting food intake to maintain current weight or lose weight (70%). Multivariate logistic regression analyses predicting behavioral performance showed that beliefs were consistently associated with behavior while worry and risk perception were largely unrelated to behavior.

CONCLUSIONS

BC survivors' beliefs about the effectiveness of potential BC recurrence risk reduction behaviors are largely consistent with empirical findings and relate strongly to actual behavioral performance. Misconceptions about the effects of behavior to reduce BC recurrence risk are important targets for clinical and public health efforts.

How much of racial/ethnic disparities in dietary intakes, exercise, and weight status can be explained by nutrition- and health-related psychosocial factors and socioeconomic status among US adults?

Large disparities exist in obesity and other chronic diseases across racial/ethnic and socioeconomic status (SES) groups in the United States. This study examined how much of racial/ethnic differences in diet, exercise, and weight status could be explained by nutrition- and health-related psychosocial factors (NHRPF) and SES among US adults. Nationally representative data of 4,356 US adults from the 1994-1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey were used. NHRPF were assessed using 24 questions and related index scores. Dietary intakes were assessed using two nonconsecutive 24-hour dietary recalls. The US Department of Agriculture 2005 Healthy Eating Index was applied to evaluate diet quality. Body mass index was calculated based on self-reported weight and height. SES was assessed using education and household income. Americans with higher SES had better NHRPF and Healthy Eating Index scores. There were some small racial/ethnic differences in NHRPF, including making food choices and awareness of nutrition-related health risks. Multivariable linear and logistic regression models revealed some racial/ethnic differences in diet, exercise, and body mass index, but few of these disparities was explained by NHRPF, whereas SES explained some. The odds ratio of body mass index ≥25 for non-Hispanic blacks compared with whites decreased by 38% after SES was adjusted for. For exercise, we found a smaller change (9.5%) in the racial/ethnic differences when controlling for SES. In conclusion, NHRPF may explain very few, but SES may contribute some of the racial/ethnic disparities in diet, exercise, and weight status in the United States.

Americans with diet-related chronic diseases report higher diet quality than those without these diseases

Large health disparities exist in the U.S. across ethnic and socioeconomic status groups. Using nationally representative data, we tested whether American patients with diet-related chronic diseases had higher diet quality than nonpatients. We also tested whether nutrition knowledge and beliefs (NKB) and food label (FL) use were associated with the observed differences. The 1994-1996 Continuing Survey of Food Intake by Individuals, and the Diet and Health Knowledge Survey were examined for 4356 U.S. adults. Dietary intakes were assessed using 2 nonconsecutive 24-h recalls and diet quality was assessed by using the USDA 2005 Healthy Eating Index (HEI). Patients' mean HEI was higher than that of nonpatients (mean ± SE: 53.6 ± 0.5 vs. 51.8 ± 0.4; P < 0.001). Among patients, blacks were 92% more likely to report low diet quality (HEI < 20th percentile) than whites. The positive association between chronic diseases and HEI was observed only for patients with good NKB [OR = 1.80 (95% CI = 1.34, 2.43)]. The diabetes-HEI association was stronger among FL users [OR = 2.24 (95% CI = 1.08, 4.63)] than non-FL users [OR = 1.33 (95% CI = 0.65, 2.73)]. Hypertensive patients' and nonpatients' diet quality did not significantly differ; linear regression models showed no difference in their HEI (β ± SE: 0.6 ± 0.6; P > 0.05) or sodium intake (-18.6 ± 91.4 g/d; P > 0.05) between them. In conclusion, U.S. adults with diet-related chronic diseases reported somewhat higher diet quality than nonpatients, especially among those patients with good NKB and use of FL. Efforts are needed to promote healthy eating among Americans with diet-related chronic diseases; nutrition education and promotion of FL use may help.

Knowledge of and adherence to fruit and vegetable recommendations and intakes: results of the 2003 health information national trends survey

Attention to cancer-relevant communication (e.g., fruit/vegetable intake recommendations) through various media has been shown to be a pivotal step in reduction of the cancer burden, thus underscoring the importance of examining associations between exposure to health media and knowledge of and adherence to fruit/vegetable intake recommendations. The purpose of the present study was to assess factors associated with fruit/vegetable intake knowledge and behavior. The authors analyzed data collected from the 2003 Health Information National Trends Survey to evaluate the effect of fruit/vegetable intake knowledge on behavior, and the relationship of this effect with biobehavioral, sociodemographic, and communication characteristics. Participants who were knowledgeable of fruit/vegetable intake recommendations and consumed at least 5 fruit/vegetable servings per day were classified as informed compliers. Associations were observed for being an informed complier and paying "a lot" of attention to health media on the radio, in the newspaper, and in magazines and "a little" or "some" attention to health media in magazines or on the Internet. The recent explosion of available cancer-related information through various media underscores the importance of examining associations between exposure to health media and knowledge of and adherence to fruit/vegetable intake recommendations.

Racial/ethnic disparities in exercise and dietary behaviors of middle-aged and older adults

BACKGROUND

Differences in health behaviors may be important contributors to racial/ethnic disparities in the health status of adults. Studies to date have not compared whether there are health behavior differences in exercise and dietary behaviors among middle-age and older adults in the four largest racial/ethnic categories.

OBJECTIVE

To investigate racial/ethnic differences in exercise and dietary behaviors of middle-aged and older adults.

DESIGN

We used data from the 2007 California Health Interview Survey. Multivariable logistic regression was used to examine interactions between age and race/ethnicity in predicting two categories of health behaviors. Analyses were conducted adjusting for sociodemographic characteristics, health insurance status, and healthcare utilization.

PARTICIPANTS

A population-based sample of 33,189 California adults 45 years old and older: 26,522 non-Hispanic whites, 1,686 African American/blacks, 2,565 Asian/Pacific Islanders (1,741 English-proficient; 824 limited English-proficient), and 2,416 Latinos (1,538 English-proficient; 878 limited English-proficient).

MAIN MEASURES

Self-report leisure-time physical activity (moderate and vigorous) and daily consumption of fruits and vegetables.

KEY RESULTS

Racial/ethnic minorities generally engaged in less healthy exercise and dietary behaviors than whites, with differences more pronounced in middle adulthood. The disparities were the greatest among English-proficient minorities. Specifically, among middle-aged respondents, all racial/ethnic minorities engaged in less vigorous physical activity than whites (ORs range = 0.28 to 0.73; 95% CI range = 0.16-1.00). Additionally, middle-aged, English-proficient minorities engaged in less moderate physical activity compared to whites (ORs range =0.57 to 0.67; 95% CI range = 0.45-0.79). Furthermore, middle-aged, English-proficient Latinos had a poorer diet than whites (OR = 0.54; 0.39-0.75). Few significant racial/ethnic differences emerged in the exercise and dietary behaviors of older adults.

CONCLUSIONS

Racial/ethnic disparities in exercise and dietary behaviors are most notable among middle-aged, acculturated minorities. Results highlight the need to promote positive exercise and dietary behaviors during critical preventive ages, when racial/ethnic disparities are large and the potential to prevent chronic disease is great.

Mechanisms underlying comprehension of health information in adulthood: the roles of prior knowledge and working memory capacity

Prior knowledge, working memory capacity (WMC), and conceptual integration (attention allocated to integrating concepts in text) are critical within many contexts; however, their impact on the acquisition of health information (i.e. learning) is relatively unexplored.We examined how these factors impact learning about nutrition within a cross-sectional study of adults ages 18 to 81. Results showed that conceptual integration mediated the effects of knowledge and WMC on learning, confirming that attention to concepts while reading is important for learning about health. We also found that when knowledge was controlled, age declines in learning increased, suggesting that knowledge mitigates the effects of age on learning about nutrition.

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.

Qualitative study to explore Prospect Theory and message framing and diet and cancer prevention-related issues among African American adolescents

BACKGROUND

There is a dearth of knowledge regarding factors that may motivate African American adolescents to consume healthier diets.

OBJECTIVE

To develop and test cancer prevention messages based on Prospect Theory on motivation to improve dietary intake in African American adolescents and to explore other salient factors that may inform dietary intervention design and implementation in this population.

METHODS

Semistructured in-person qualitative interviews were conducted with 13 African American male and female adolescents, aged 12 to 16 years, in North Carolina. Prospect Theory and message framing were used to guide the design of the 4 sets of diet-related messages related to cancer prevention: short-term, gain-framed; long-term, gain-framed; short-term, loss-framed; and long-term, loss-framed messages. Data were also collected on demographic, behavioral, and psychological factors; usual health behaviors; and preferences for intervention delivery.

RESULTS

Most respondents found the gain-framed, short-term messages most salient for both fruits/vegetables (8 [61.5%]) and fat consumption (7 [53.8%]). For fat consumption only, 2 (15.4%) found the loss-framed, short-term messages pertinent; none found the loss-framed, long-term messages relevant for either dietary variable. All indicated interest in participating in a dietary intervention/education program; most preferred the Internet as a channel for intervention delivery. Participants expressed diverse views regarding knowledge, attitudes, and beliefs regarding healthy eating.

CONCLUSION

The gain-framed, short-term messages were most salient for motivating the majority of respondents to consume a healthy diet and most expressed a strong interest in participating in programs about diet and nutrition, with the Internet as the preferred communication channel.

IMPLICATIONS FOR PRACTICE

Researchers conducting dietary interventions and education initiatives and medical professionals who counsel African American adolescents should consider using Prospect Theory as a theoretical framework, should focus on gain-framed, short-term messages regarding cancer prevention, and should use the Internet for data collection and intervention and information delivery.

Results of a rural school-based peer-led intervention for youth: goals for health

BACKGROUND

School-based interventions are critical for enhancing the health of youth. The Goals for Health (GFH) school-based project was a goal-setting and life-skills intervention conducted in rural areas to increase self-efficacy, knowledge, and positive behaviors related to healthy eating. The intervention was peer-led with high school students teaching health and life skills to sixth-grade students. The purpose of this study was to examine the impact of the GFH school-based program on healthy eating outcomes related to self-efficacy, attitudes, knowledge, and behavior, and to examine the impact of quality of program implementation on the above outcomes.

METHODS

Twenty-three rural schools in Virginia (15) and New York (8) participated in the study. Twelve of the schools were intervention schools that received the 12-week GFH program. The remaining 11 were wait-list control schools. Sixth graders (n = 2120 baseline) from all schools were surveyed at 4 time points (preintervention, postintervention, 1 and 2 year follow-up).

RESULTS

Results included significant change patterns across the 4 assessment points in the predicted direction for healthy eating-related self-efficacy and fat and fiber knowledge. No significant change patterns were found at follow-up for fat, fiber, or fruit and vegetable intake. Results also indicated differences across gender and ethnicity and significant findings related to quality of implementation.

CONCLUSIONS

Future interventions need to provide opportunities to practice healthy living skills over an extended period of time, include components that focus on contextual change in the school and the family, and monitor program implementation.

Psychosocial correlates of dietary fat intake in African-American adults: a cross-sectional study

Background

Current dietary guidelines recommend that dietary fat should comprise 20–35% percent of total energy intake, with less than 10% of energy from saturated fat. However, many Americans exceed these goals and data suggest that African Americans tend to consume a higher percentage of energy from dietary fat than Whites. Because diets low in dietary fat, particularly saturated fat, are associated with lower risk for many chronic illnesses, it is important to identify strategies to reduce high fat intakes. This study examined associations of psychosocial factors with dietary fat intake in African American adults 18 to 70 years.

Methods

Data are self-reported from a cross-sectional survey of African Americans (n = 658) using an 11-page questionnaire, collected from June to October 2003. Associations of psychosocial (predisposing, reinforcing, and enabling) factors based on the PRECEDE framework, dietary fat-related behaviors, and participant characteristics (e.g., age, sex, education, BMI) with total and saturated fat consumption are described using linear regression and analysis of variance.

Results

The mean age of participants was 43.9 years, 57% were female, 37% were college graduates, and 76% were overweight/obese. Respondents with lower fat intakes were female, older, had high education and very good/excellent perceived health. Among the psychosocial factors, the strongest (inverse) associations with fat intake were with two predisposing factors: belief in the importance of a low-fat diet (both genders) and high self-efficacy (women only). Fat intake was also significantly lower among participants who could count on those close for encouragement to eat healthy foods (a reinforcing factor) and among men who needed more information about preparing healthy foods (an enabling factor).

Conclusion

Dietary interventions to decrease fat intake in African American adults may benefit from incorporating predisposing factors, such as personal beliefs and self-efficacy, in their design and implementation.

Determinants of healthy eating: motivation, abilities and environmental opportunities

BACKGROUND

In order to promote healthful nutrition, insight is needed in the behavioural determinants of nutrition behaviours. Most research on behavioural determinants has been restricted to individual-level motivational factors. However, health behaviour is influenced by individual motivation and abilities, as well as environmental opportunities.

OBJECTIVE

To provide an overview of motivation, ability and opportunity-related potential determinants of nutrition behaviours and of the evidence for associations of potential environmental determinants with nutrition behaviour.

METHOD

A narrative review informed by a series of six systematic reviews including more than 400 original studies and recent original studies on associations of environmental factors with nutrition behaviours.

RESULTS

Although the number of studies on potential environmental determinants of nutrition as well as physical activity behaviour has increased steeply over the last decades, these include only few well-designed studies with validated measures. Preliminary evidence from the available systematic reviews indicates that social support and modelling, availability and accessibility of healthy and less healthy foods as well as socio-economic status are important for nutrition behaviours; schools and worksites offer good settings for improving healthful nutrition opportunities.

CONCLUSION

Although the evidence to date is inconclusive due to lack of well-designed studies, specific social-cultural, physical and economical environmental factors appear of importance for healthful nutrition.

Desenvolvimento de guias alimentares em diversos países

Os guias dietéticos baseados nos alimentos têm objetivo de favorecer a educação nutricional, utilizando termos que sejam compreensíveis, simples e claros para a maioria dos consumidores e indicando as modificações necessárias nos padrões alimentares. Este trabalho foi realizado com o objetivo de apresentar uma revisão da literatura sobre o desenvolvimento dos guias alimentares em vários países. Para tanto, foi realizado um levantamento bibliográfico no período de 1991 a 2006 nas bases de dados Medline e Lilacs, utilizando como palavras-chave "guia alimentar", "guia dietético" e "desenvolvimento de guia dietético" com o intuito de aprofundar os seguintes itens: elaboração, avaliação, implantação e problemas metodológicos relacionados ao desenvolvimento dos mesmos. Desde 1996, vêm sendo publicadas orientações pelo Comite de Alimentação e Nutrição/Organização Mundial de Saúde para elaboração dos guias alimentares e vários países os desenvolveram de acordo com essas recomendações, apesar dos diversos problemas metodológicos enfrentados. Após o desenvolvimento dos guias alimentares, os maiores desafios são a implantação e a avaliação. Dentre as estratégias para sua divulgação destaca-se a elaboração de ferramentas de educação nutricional, tais como: representação gráfica, folder, apostila e pôster. Com relação à avaliação dos guias alimentares, poucos países realizaram pesquisas abordando o conhecimento e o entendimento dos consumidores. Conclui-se que o processo de desenvolvimento dos guias alimentares é complexo e é necessário realizar um planejamento para sua implantação e avaliação, esta última devendo se voltar tanto ao entendimento como ao impacto sobre a saúde da população.

Does social class predict diet quality?

A large body of epidemiologic data show that diet quality follows a socioeconomic gradient. Whereas higher-quality diets are associated with greater affluence, energy-dense diets that are nutrient-poor are preferentially consumed by persons of lower socioeconomic status (SES) and of more limited economic means. As this review demonstrates, whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher SES. In contrast, the consumption of refined grains and added fats has been associated with lower SES. Although micronutrient intake and, hence, diet quality are affected by SES, little evidence indicates that SES affects either total energy intakes or the macronutrient composition of the diet. The observed associations between SES variables and diet-quality measures can be explained by a variety of potentially causal mechanisms. The disparity in energy costs ($/MJ) between energy-dense and nutrient-dense foods is one such mechanism; easy physical access to low-cost energy-dense foods is another. If higher SES is a causal determinant of diet quality, then the reported associations between diet quality and better health, found in so many epidemiologic studies, may have been confounded by unobserved indexes of social class. Conversely, if limited economic resources are causally linked to low-quality diets, some current strategies for health promotion, based on recommending high-cost foods to low-income people, may prove to be wholly ineffective. Exploring the possible causal relations between SES and diet quality is the purpose of this review.

Predictors of dietary change and maintenance in the Women's Health Initiative Dietary Modification Trial

OBJECTIVE

To identify predictors of dietary change to and maintenance of a low-fat eating pattern (<20% energy from fat, > or = 5 servings fruits/vegetables daily, and > or = 6 servings grains daily) among a cohort of postmenopausal women. Candidate predictors included intrapersonal, interpersonal, intervention program characteristics, and clinical center.

DESIGN

Longitudinal study within the Women's Health Initiative Dietary Modification Trial. Dietary change was evaluated after 1 year of participation in the Women's Health Initiative Dietary Modification Trial, and dietary maintenance after 3 years.

SUBJECTS

Postmenopausal women aged 50 to 79 years at baseline who were randomized to the intervention arm of the Women's Health Initiative Dietary Modification Trial (n=19,541).

STATISTICAL ANALYSIS

Univariate and multivariate linear regression analysis was performed and associations evaluated between candidate predictors and each of the three dietary goals: percent energy from fat, fruit/vegetable servings, and grain servings.

RESULTS

Year 1 (change) predictors of percent energy from fat (P<0.005) included being younger (beta=2.12; 70 to 79 years vs 50 to 59 years), more educated (beta=-.69; college vs high school), more optimistic (beta=-.07), attending more sessions (beta=-.69), and submitting more self-monitoring records (beta=-.74). At year 3 (maintenance), the predictors of percent energy from fat (P<0.005) included attending more sessions (beta=-.65) and submitting more self-monitoring scores (beta=-.71). The analytic model predicted 22% of the variance in fat intake at year 1 and 27% at year 3 (P<0.01).

CONCLUSIONS

The strongest predictors of dietary change and maintenance were attending intervention sessions and self-monitoring dietary intake. Novel was the finding that optimism predicted dietary change.

Nutrition-related cancer prevention attitudes in low-income women

OBJECTIVE

To investigate the nutrition-related cancer prevention attitudes of low-income African American women, determine whether a nutrition education program can alter these attitudes, and determine whether these attitudes are related to diet and dietary changes.

METHOD

One-hundred and fifty-seven African American women from Washington, D.C. public housing communities participated in a nutrition education program from 2001 to 2003. They completed questionnaires assessing their attitudes about the role of nutrition in cancer prevention at baseline, post-intervention, and 4 months later. They also completed 24-hour food recalls at baseline, post-intervention, and 4 months later.

RESULTS

Women agreed that good nutrition prevents cancer, especially women with higher literacy, women with fewer children living at home, women who had not had experience with cancer, and women who were worried about their health. Participation in the program increased agreement that good nutrition prevents cancer over 4 months. Women whose agreement increased over the intervention were able to maintain dietary changes they made over 4 months.

CONCLUSION

Nutrition-related cancer prevention attitudes were strong and were strengthened by a nutrition education program. These attitudes may contribute to people's ability to maintain dietary changes.

Body mass index and intake of selected foods in African American men

BACKGROUND

There are minimal data on the relationship between dietary consumption of fats, vegetables, and fruits and body mass index (BMI) in African American men.

OBJECTIVE

This study tested the relationships between selected dietary consumption and BMI.

DESIGN

The sample was a community-based cohort of 204 African American Southern men who attended a free prostate cancer educational and screening program. The screening was part of an all-day African American celebration that included a health fair. Diet was assessed with a Brief Dietary Scale for Selected Food Intake and Preparation.

RESULTS

Most of the men were overweight (34%) or obese (47%). The majority of men ate their chicken (90%) and fish (96%) fried. Few men ate vegetables at supper (29.4%) or lunch (15.8%). Three fatty food items were significantly associated with BMI: leaving the chicken skin on chicken (p=.03); intake of low-fat or skim milk (p=.02); and cooking vegetables with butter (p=.03).

CONCLUSION

African American men need culturally appropriate dietary interventions to reduce obesity.

The influence of social context on changes in fruit and vegetable consumption: results of the healthy directions studies

As part of the Harvard Cancer Prevention Program Project, we used a social contextual model of health behavior change to test an intervention targeting multiple risk-related behaviors in working-class, multiethnic populations. We examined the relationships between the social contextual factors in our conceptual model and changes in fruit and vegetable consumption from baseline to completion of intervention in health centers and small business studies. We analyzed change in fruit and vegetable consumption, measured at baseline and final assessments by self-report, in 2 randomized controlled prevention trials: 1 in small businesses (n = 974) and 1 in health centers (n = 1954). Stronger social networks, social norms that were more supportive, food sufficiency, and less household crowding were associated with greater change in fruit and vegetable intake. We also observed differences between our intervention sites. Social context can play an important role in promoting changes in fruit and vegetable consumption.

Associations of psychosocial factors with fruit and vegetable intake among African-Americans

OBJECTIVE

To examine associations of various psychosocial factors with fruit and vegetable intake in African-American adults.

METHODS

A cross-sectional survey of a population-based sample of 658 African-Americans, aged 18-70 years, in North Carolina. Information was collected on diet-related psychosocial (predisposing, reinforcing and enabling) factors based on the PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation) planning framework; demographic, lifestyle and behavioural characteristics, and fruit and vegetable intake.

RESULTS

The mean participant age was 43.9 years (standard deviation 11.6), 57% were female and 76% were overweight/obese. Participants expressed healthy beliefs regarding many of, but not all, the psychosocial factors. For example, although half of the respondents believed it is important to eat a diet high in fruits/vegetables, only 26% knew that >or=5 daily servings are recommended. The strongest associations of the psychosocial factors with fruit/vegetable intake were for predisposing factors (e.g. belief in the importance of a high fruit/vegetable diet and knowledge of fruit/vegetable recommendations) and one reinforcing factor (social support), with differences between the healthiest and least healthy responses of 0.5-1.0 servings per day. There was evidence of effect modification by gender in associations between psychosocial factors and fruit/vegetable consumption (e.g. self-efficacy was only significant in women), with higher intakes and generally healthier responses to the psychosocial variables in women than men.

CONCLUSIONS

Interventions to increase fruit/vegetable intake in African-Americans may be more effective if they focus primarily on predisposing factors, such as knowledge, self-efficacy and attitudes, but not to the exclusion of reinforcing and enabling factors. The psychosocial factors that are targeted may also need to be somewhat different for African-American men and women.

Past food habit change is related to obesity, lifestyle and socio-economic factors in the Malmo Diet and Cancer Cohort

Objectives

To examine if obesity status and socio-economic and lifestyle factors are associated with self-reported past food habit change, and also whether the level of obesity depends on the reason for change.

Design

Cross-sectional analysis within the Malmo Diet and Cancer (MDC) study using data from the baseline examination and the extensive socio-economic and lifestyle questionnaire including questions of past food habit change. The risk of having changed food habits in the past was examined using logistic regression. Mean differences in obesity status across categories of reasons for past food habit change were examined using analysis of variance.

Setting

Malmö, the third largest city in Sweden.

Subjects

A sub-sample (15 282 women and 9867 men) from the MDC cohort recruited from 1992 to 1996.

Results

Individuals with body mass index (BMI) >30 kg m−2 had an increased risk of having reported past food habit change compared with individuals with BMI <25 kg m−2 (odds ratio (OR) = 1.63, 95% confidence interval (CI) = 1.48–1.83 for women; OR = 1.53, 95% CI = 1.32–1.76 for men). The highest level of obesity was observed among individuals who had changed their diet due to reasons related to the metabolic syndrome. Changers were more likely to be highly educated and to live alone, be retired, ex-smokers and non-drinkers at baseline.

Conclusions

Because past food habit change is related to obesity and other lifestyle and socio-economic factors, a complex confounding situation may exist that could seriously influence observed relationships between diet and disease. Studies need to collect information on past food habit change and take this information into account in the analysis and when interpreting study outcomes.

Correlates of fat intake behaviors in participants in the eating for a healthy life study

OBJECTIVE

This study identified socioeconomic correlates of total dietary fat intake in the Eating for a Healthy Life Study, a community-based dietary intervention study involving religious organizations.

SUBJECTS/DESIGN

To create our sampling frame for the Eating for a Healthy Life Study, a pool of religious organizations was identified from a list of religious faith organizations provided by the Church Council of Greater Seattle. Individual members were randomly selected from recruited religious organizations to complete a telephone-administered, baseline, cross-sectional survey. There were 2,507 respondents who were eligible, consenting participants. Dietary behavior was assessed using a modified version of the Fat- and Fiber-Related Diet Behavior Questionnaire. Socioeconomic status was assessed using individual demographic variables.

MAIN OUTCOME MEASURES

Fat-related behaviors indicated by fat summary score and stage of change.

STATISTICAL ANALYSES

A multivariable linear regression model was used to examine the association of individual demographic variables with the Fat- and Fiber-Related Diet Behavior Questionnaire-derived measure of dietary fat intake. The same individual variables were used in a multivariable logistic regression model of dietary stage of change.

RESULTS

Age, race, sex, education, and self-assessed health status were found to be statistically significant correlates of fat intake. Variables associated with stage of dietary fat change included sex, education, and religious organization cohesion.

CONCLUSIONS

Demographic variance is an important factor in understanding dietary fat intake.

Implication of socio-economic status on the prevalence of overweight and obesity in Greek adults: the ATTICA study

BACKGROUND

Although ooverweight and obesity are considered as a health problem that affects millions of people worldwide, the implication of socio-economic status (SES) in these healthy conditions have rarely been investigated. We evaluated the associations of overweight and obesity with SES, in a population based sample of Greek adults.

METHODS

During 2001-2002 we randomly enrolled 1514 men (18-87 years old) and 1528 women (18-89 years old), stratified by the age-sex distribution (census 2001) of the Attica area, Greece. We studied several demographic, anthropometric, lifestyle, dietary and bio-clinical factors of the participants. SES (low, middle and high) was defined through the education and economical level of the participants.

RESULTS

The prevalence of overweight and obesity was 53 and 20% in men, and 31 and 15% in women, respectively, while an increase in the prevalence of obesity was observed with progressing age. Both men and women in the higher SES group had significantly lower prevalence of obesity as compared to the middle and lower SES group (p<0.001). However, multivariate analysis showed that the observed associations between SES and obesity were mainly explained by differences in physical activity status and energy intake of the participants.

CONCLUSION

Overweight and obesity seems to be a serious health problem, affecting more prominently people in the lower SES. However, eating and other lifestyle habits mainly explained the association between SES and obesity.

Correlates of Soy Food Consumption in Women at Increased Risk for Breast Cancer

OBJECTIVES

The objectives of the present study were to examine sociodemographic correlates of soy food consumption among women at increased risk of breast cancer, describe factors influencing soy food consumption or nonconsumption, and identify women's sources of information about soy foods.

DESIGN

A cross-sectional, self-report survey was used to assess frequency of and factors influencing soy food consumption. Soy food intake was reported for the past year.

SUBJECTS/SETTING

Participants were 452 women with family histories of breast cancer who were enrolled in a cancer risk assessment program.

STATISTICAL ANALYSES PERFORMED

Comparisons between consumers and nonconsumers of soy foods were performed using multivariate logistic regression and chi(2) analyses.

RESULTS

Thirty-two percent reported soy food consumption. Commonly consumed soy foods were vegetable burgers, tofu, and soymilk. Consumers of soy foods were more likely to have higher levels of education and report eating five or more daily servings of fruits and vegetables. The primary reason for consumption of soy foods was eating a healthful diet, whereas insufficient knowledge about soy food preparation was the primary reason stated for nonconsumption. Both consumers and nonconsumers reported obtaining information about soy foods from magazines, friends, and newspapers. Consumers also indicated using the Internet to seek information.

CONCLUSIONS

These findings contribute to our understanding of the level of soy intake among women at increased risk for breast cancer and highlight potential factors that may influence women's decisions regarding soy food consumption. Women, particularly in this vulnerable population, would benefit from clear messages regarding the health effects of soy.

Qualitative comparison of dietary choices and dietary supplement use among older adults with and without a history of colorectal cancer

OBJECTIVE

To explore colorectal cancer survivors' beliefs about diet, dietary supplements, health, and cancer in relation to beliefs of a similar group without colorectal cancer.

DESIGN

In-depth, semistructured, open-ended interviews were used to examine perceptions.

PARTICIPANTS

Twenty-two participants (10 colorectal cancer survivors and 12 from a comparison group) from the North Carolina Strategies for Improving Diet, Exercise, and Screening Study.

ANALYSIS

Verbatim interview transcripts were coded and analyzed. Comparisons were made between colorectal cancer survivors and the comparison group.

RESULTS

Three main themes emerged: the influence of significant life events on dietary change, concerns about contaminants in the food supply, and a lack of physician guidance in dietary supplement selection.

CONCLUSION AND IMPLICATIONS

The experience of colorectal cancer is significant and may lead to dietary change among some survivors, but these findings do not suggest that it is necessarily more influential than other life events. Participants sought to control diet (for coping or survival) and also felt that diet cannot be controlled (due to the contamination of the food supply). Although many lacked guidance from physicians about dietary supplements, they were comfortable making their own decisions to self-treat. Enhanced understanding of the themes that guide selection of diet and dietary supplements can provide a context for dietitians in practice and researchers conducting behavioral interventions.

Psychosocial predictors of eating habits among adults in their mid-30s: the Oslo Youth Study follow-up 1991-1999

Background

The predictive value of the psychosocial constructs of Theory of Planned Behaviour (TPB) on subsequent dietary habits has not been previously investigated in a multivariate approach that includes demographic factors and past dietary behaviour among adults. The aim of this study was to investigate to what extent TPB constructs, including intention, attitudes, subjective norms, perceived behavioural control, and perceived social norms, measured at age 25 predicted four eating behaviours (intake of fruits and vegetables, whole grains, total fat and added sugar) eight years later.

Methods

Two hundred and forty men and 279 women that participated in the Oslo Youth Study were followed from 1991 to 1999 (mean age 25 and 33 years, respectively). Questionnaires at baseline (1991) included the constructs of the TPB and dietary habits, and at follow-up (1999) questionnaires included demographic factors and diet. For the assessment of diet, a food frequency questionnaire (FFQ) with a few food items was used at baseline while an extensive semi-quantitative FFQ was used at follow-up.

Results

Among men, attitudes, subjective norms and previous eating behaviour were significant predictors of fruit and vegetable intake, while education and past eating behaviour were predictive of whole grain intake in multivariate analyses predicting dietary intake at follow-up. For women, perceived behavioural control, perceived social norms and past behaviour were predictive of fruit and vegetable intake, while subjective norms, education and past eating behaviour were predictive of whole grain intake. For total fat intake, intention was predictive for men and perceived behavioural control for women. Household income and past consumption of sugar-rich foods were significant predictors of added sugar intake among men, while past intake of sugar-rich foods was a significant predictor of added sugar intake among women.

Conclusion

After adjusting for potential confounding factors, all psychosocial factors assessed among young adults appeared predictive of one or more eating behaviours reported eight years later. Results point to the influence of psychosocial factors on future eating behaviours and the potential for interventions targeting such factors.

Eating at fast-food restaurants is associated with dietary intake, demographic, psychosocial and behavioural factors among African Americans in North Carolina

OBJECTIVE

To examine associations of the frequency of eating at fast-food restaurants with demographic, behavioural and psychosocial factors and dietary intake in African American adults.

METHODS

Self-reported data from a population-based cross-sectional survey of 658 African Americans, aged 20-70 years, in North Carolina. An 11-page questionnaire assessed eating at fast-food restaurants, demographic, behavioural and diet-related psychosocial factors, and dietary intake (fruit, vegetable, total fat and saturated fat intakes, and fat-related dietary behaviours).

RESULTS

The participants were aged 43.9+/-11.6 years (mean+/-standard deviation), 41% were male, 37% were college graduates and 75% were overweight or obese. Seventy-six per cent reported eating at fast-food restaurants during the previous 3 months: 4% usually, 22% often and 50% sometimes. Frequency of eating at fast-food restaurants was positively associated with total fat and saturated fat intakes and fat-related dietary behaviours (P<0.0001) and inversely associated with vegetable intake (P<0.05). For example, mean daily fat intake was 39.0 g for usually/often respondents and 28.3 g for those reporting rare/never eating at fast-food restaurants. Participants who reported usual/often eating at fast-food restaurants were younger, never married, obese, physically inactive and multivitamin non-users (all P<0.01). Frequency of eating at fast-food restaurants was positively associated with fair/poor self-rated health, weak belief in a diet-cancer relationship, low self-efficacy for healthy eating, weight dissatisfaction, and perceived difficulties of preparing healthy meals and ordering healthy foods in restaurants (all P<0.05). Frequency of eating at fast-food restaurants did not differ significantly by sex, education, smoking, ability to purchase healthy foods or knowledge of the Food Guide Pyramid.

CONCLUSIONS

Eating at fast-food restaurants is associated with higher fat and lower vegetable intakes in African Americans. Interventions to reduce fast-food consumption and obesity in African Americans should consider demographic and behavioural characteristics and address attitudes about diet-disease relationships and convenience barriers to healthy eating.

Food nutrition label use is associated with demographic, behavioral, and psychosocial factors and dietary intake among African Americans in North Carolina

OBJECTIVE

Reading nutrition labels on food packages may improve food choices and enable healthful dietary practices. This report describes the prevalence of nutrition label use and its association with demographic, behavioral, and psychological factors and diet among African-American adults.

DESIGN/SUBJECTS

Self-reported data from a population-based cross-sectional survey of 658 African Americans, aged 20 to 70 years, in North Carolina. An 11-page questionnaire assessed nutrition label use, fruit and vegetable consumption, total and saturated fat intakes, fat-related dietary behaviors, diet-related psychosocial factors, and demographic and behavioral characteristics.

STATISTICAL ANALYSIS

Chi2 tests and logistic regression analyses examined associations of demographic, psychosocial, and behavioral factors with nutrition label use. Linear regression was used to estimate the variation in diet explained by label use.

RESULTS

The mean age of participants was 43.9+/-11.6 years, 41% were men, 37% were college graduates, and 75% were overweight/obese. Seventy-eight percent of respondents read nutrition labels when they purchased packaged foods. Nutrition label use was significantly higher among participants who were women, older, educated beyond high school, and obese (P <.05). After adjusting for demographic characteristics, the strongest psychosocial predictors of nutrition label use were healthful eating self-efficacy, strong belief in a diet-cancer relationship, and trying to lose weight. Usual/often label users had higher fruit and vegetable consumption and lower fat intakes (P <.001), and nutrition labels explained 2% to 17% of the variance in dietary intake.

CONCLUSIONS

Nutrition information on packaged foods appears to be a useful way to conduct point-of-purchase nutrition education among African Americans in North Carolina. Most respondents used food labels at least sometimes, but only about half usually or often did so. Efforts should be made to determine how all consumers could use nutrition labels effectively.

Eating after breast cancer: influences on women's actions

OBJECTIVE

To explore women's dietary actions after a breast cancer diagnosis and the factors influencing those actions.

DESIGN

Individual interviews exploring women's perceptions.

SETTING

Vancouver, British Columbia, Canada.

PARTICIPANTS

A culturally diverse convenience sample of women (N = 30) aged 40 to 60 years diagnosed with breast cancer 6 months to 15 years previously.

PHENOMENON OF INTEREST

Social and personal factors that influence dietary actions.

ANALYSIS

Verbatim interview transcripts were coded and themes developed by sorting and summarizing coded transcript segments.

RESULTS

Women held a wide range of beliefs concerning the relationship between diet and breast cancer, particularly their own cancer occurrence. Actions were not always consistent with professed beliefs. Some women believed that diet contributes to breast cancer, even their own cancer, yet made no diet changes; others did not believe in such a relationship but did change their diets postdiagnosis. Family support, employment, financial resources, cultural food patterns, and other health concerns were strong influences.

CONCLUSIONS AND IMPLICATIONS

Although beliefs about diet-cancer connections affect actions concerning diet change, the relationship is not consistent. Diet change is also affected by social, cultural, and economic concerns that are at least as important as a woman's beliefs. Nutrient supplements appear to be a common, although perhaps temporary, response to diagnosis. Future research should explore the possibilities for nutrition professionals to help women think critically about the range of influences on their diets.

Demographic and health-related correlates of herbal and specialty supplement use

BACKGROUND

By broadening the definition of a dietary supplement, the 1994 Dietary Supplements Health and Education Act opened the market to many herbals, botanicals, and other food ingredients that would have otherwise needed safety testing before being sold. Information regarding patterns and correlates of herbal and specialty supplement use can help nutritionists understand which compounds are most commonly used, who are likely to use these supplements, and whether the choice of herbal supplements appears motivated by specific health concerns.

METHODS

Data are from 61,587 participants, aged 50 to 76 years, who completed a self-administered mailed questionnaire in 2000-2002 on current dietary supplement use (20 herbal/specialty supplements, multivitamins, and 17 individual vitamins or minerals), demographic and lifestyle characteristics, and medical history.

RESULTS

When compared with no supplement use, herbal/specialty supplement use was significantly higher among respondents who were older, female, educated, had a normal body mass index, were nonsmokers, engaged in exercise, and ate a diet lower in fat and higher in fruits and vegetables (all P<.001). Similar trends were observed when herbal/specialty supplement users were compared with vitamin/mineral users. For specific supplements and medical conditions, the strongest associations were cranberry pills and multiple bladder infections (odds ratio [OR], 4.66; 95% confidence interval [CI], 4.03-5.38), acidophilus pills and lactose intolerance (OR, 3.37; 95% CI, 2.96-3.84), and saw palmetto and enlarged prostate (OR, 3.33; 95% CI, 3.00-3.72).

CONCLUSIONS

Odds of supplement use are high for certain demographic and lifestyle characteristics. Additionally, persons with specific medical conditions are using supplements promoted to reduce risk for their particular conditions.

Poverty and obesity: the role of energy density and energy costs

Many health disparities in the United States are linked to inequalities in education and income. This review focuses on the relation between obesity and diet quality, dietary energy density, and energy costs. Evidence is provided to support the following points. First, the highest rates of obesity occur among population groups with the highest poverty rates and the least education. Second, there is an inverse relation between energy density (MJ/kg) and energy cost (US dollars/MJ), such that energy-dense foods composed of refined grains, added sugars, or fats may represent the lowest-cost option to the consumer. Third, the high energy density and palatability of sweets and fats are associated with higher energy intakes, at least in clinical and laboratory studies. Fourth, poverty and food insecurity are associated with lower food expenditures, low fruit and vegetable consumption, and lower-quality diets. A reduction in diet costs in linear programming models leads to high-fat, energy-dense diets that are similar in composition to those consumed by low-income groups. Such diets are more affordable than are prudent diets based on lean meats, fish, fresh vegetables, and fruit. The association between poverty and obesity may be mediated, in part, by the low cost of energy-dense foods and may be reinforced by the high palatability of sugar and fat. This economic framework provides an explanation for the observed links between socioeconomic variables and obesity when taste, dietary energy density, and diet costs are used as intervening variables. More and more Americans are becoming overweight and obese while consuming more added sugars and fats and spending a lower percentage of their disposable income on food.

Parental nutrition knowledge and nutrient intake in an atherosclerosis prevention project: the impact of child-targeted nutrition counselling

Most of the counselling in health care targeted at child nutrition is delivered via the parents, but little is known about the effects of such counselling on the nutrition knowledge and dietary habits of the parents. In the Special Turku Coronary Risk Factor Intervention Project for Children (STRIP), we studied how 6.5 years of child-targeted nutrition counselling affected the knowledge, attitudes and dietary habits of the parent mainly responsible for food purchase and preparation. We used a questionnaire and a 24-h recall interview in a time-restricted cohort of 98 families belonging to the intervention group and 89 families belonging to the control group in the STRIP project. After controlling for background variables, the intervention parents had better knowledge than the control parents of causal relationships between food choices and coronary heart disease and of the nutritional composition of foods. Knowledge of nutrition concepts did not differ between the two groups. The quality of fat was better in the diet of the intervention parents, they consumed less salt and they also had more knowledge concerning these subjects compared to the control parents (higher behavioural capability scores). The behavioural capability scores of the total group correlated poorly with their nutrient intakes. Thus, child-targeted nutrition intervention delivered to the parents increased parental nutrition knowledge and improved the quality of the parents' diet. However, as nutrition knowledge of the parents correlated poorly with their nutrient intakes, other factors than knowledge appear to influence parental dietary decisions.

Changes in diet, physical activity, and supplement use among adults diagnosed with cancer

OBJECTIVE

To investigate the prevalence and predictors of changes in diet, physical activity, and dietary supplement use among cancer patients. Design/subjects Telephone interviews of a population-based sample of 126 breast, 114 prostate, and 116 colorectal cancer patients from the state of Washington.

ANALYSIS

Logistic regression was used to estimate the odds ratio as a measure of the association of participant characteristics with lifestyle changes in the 12 months before the interview.

RESULTS

Overall, 66.3% of patients reported making lifestyle changes: 40.4% made one or more dietary changes, 20.8% added new physical activity, and 48.0% started taking new dietary supplements. Compared with men, women were 2.2 times more likely to take new dietary supplements (P <.01). Compared with patients aged 35 to 59, those aged 60 to 69 and 70 or older were statistically significantly less likely to make dietary changes (odds ratio = 0.39 and 0.54, respectively) or to take new supplements (odds ratio = 0.42 and 0.69, respectively). Compared with patients who received only one medical treatment, those receiving three or more treatments were more likely to make dietary changes (odds ratio = 2.6) or to start new physical activity (odds ratio = 3.0). Patients diagnosed 12 to 24 months before the interview were as likely to report making lifestyle changes as those diagnosed within one year of the interview. Having a stronger desire for personal control or internal locus of control predicted use of new dietary supplements (P for trend <.05 for both). Applications/conclusions Cancer survivors are likely to be making lifestyle changes and represent a group that could benefit from counseling on diet and physical activity.

Intergenerational transmission of health: the role of intrapersonal, interpersonal, and communicative factors

A model of household dietary behaviors based on adults' and children's intrapersonal, interpersonal, and communicative factors is introduced and tested. To the extent that children's health behaviors are influenced by adults' health behaviors, it is hypothesized that children's behavioral determinants, including self-efficacy, knowledge, and use of health information, will be affected by household adults' behavioral determinants. Household communication is expected to affect the behaviors and the behavioral determinants of adults and children. Data come from the Stanford Five-City Project. Structural equation models revealed that adults' dietary behavior was influenced by their self-efficacy, knowledge, and discussion between adults and children. Children's dietary behavior was influenced by their self-efficacy, knowledge, and use of health information. Adults' intrapersonal determinants of dietary behavior predicted corresponding children's measures. Implications for health education efforts directed at children include encouraging household discussion about health and focusing on adults as agents of change as an integral campaign strategy.