Demographic and Psychosocial Predictors of Fruit and Vegetable Intakes Differ: Implications for Dietary Interventions

Objective The National Cancer Institute (Rockville, Md) has launched a nationwide initiative—5 A Day for Better Health—to encourage consumption of fruits and vegetables. Because the tastes and culinary uses of fruits and vegetables differ, however, it is not known whether a general 5-A-Day message is an effective intervention strategy. This study examined whether there are differences between the demographic and psychosocial correlates of fruit and vegetable intakes.

Design Data are from the Washington State Cancer Risk Behavior Survey (1995-1996), a cross-sectional, random-digit-dial telephone survey representative of the adult population of Washington State.

Subjects/setting Interviews were completed with 1,450 adults. Data were collected about demographic characteristics, health status, health-related behavior, fruit and vegetable intakes, and the following diet-related psychosocial factors: beliefs, motives, barriers, attitudes, and stages of dietary change.

Statistical analyses Multivariate linear regression analysis was used to test whether the associations of demographic characteristics and psychosocial factors with fruit intake differed from associations with vegetable intake.

Results In general, health status, health-related behavior, and psychosocial factors were more strongly associated with fruit intakes than vegetable intakes. For example, regular exercisers consumed 0.44 more daily servings of fruits and 0.36 more servings of vegetables than nonexercisers. Compared with those in the preaction stage of dietary change, adults in the maintenance stage consumed 0.99 more daily servings of fruits and 0.68 more servings of vegetables. Intrinsic motivations for eating a healthful diet (eg, to feel better) were strongly associated with both fruit and vegetable intakes, and these associations were stronger for fruit. Extrinsic motivations were not associated with either fruit or vegetable intakes.

Applications Dietary interventions based on a general 5-A-Day message may be more effective in increasing fruit intakes than vegetable intakes. Targeted interventions that focus specifically on vegetables are probably necessary. Intrinsic motives for eating a healthful diet should be key components of interventions to increase fruit and vegetable intakes. J Am Diet Assoc. 1998;98:1412-1417.     

中国9省(自治区)1991－2011年18～44岁人群蔬菜水果摄入状况及变化趋势

目的 研究1991－2011年中国9省(自治区)18～44岁人群蔬菜、水果的摄入状况及变化趋势。方法 以“中国健康与营养调查”(CHNS)1991－2011年调查数据为基础,选择连续3天24 小时有完整膳食数据的18～44岁健康人群作为研究对象,计算该人群平均每天蔬菜、水果的摄入率及摄入量,并与《中国居民膳食指南》蔬菜、水果推荐摄入量进行比较。结果 1991－2011年中国9省(自治区)18～44岁人群蔬菜摄入率变化不大、摄入量下降明显;水果摄入率及摄入量不断提高,2011年调查人群蔬菜、水果摄入率及摄入量分别为99.7%、48.0%、321.6 g/d、90.1 g/d。蔬菜摄入量达到《中国居民膳食指南》推荐摄入量的人群比例显著下降,至2011年为50.2%;水果摄入量达到《中国居民膳食指南》推荐摄入量的人群比例显著上升,至2011年为17.4%。结论 中国9省(自治区)18～44岁人群蔬菜、水果平均摄入量仍低于《中国居民膳食指南》的推荐摄入量,应采取措施进一步促进该人群蔬菜和水果的摄入。     

Life-course events and experiences: association with fruit and vegetable consumption in 3 ethnic groups

OBJECTIVE: To examine how life-course experiences and events are associated with current fruit and vegetable consumption in 3 ethnic groups. DESIGN: A theoretic model developed from previous qualitative research guided the development of a telephone survey. Data were collected on fruit and vegetable consumption, sociodemographic characteristics, ethnic identity, and life-course events and experiences, including food upbringing, social roles, food skills, dietary changes for health, and practice of food traditions. SUBJECTS/SETTING: Low- to moderate-income adults living in a northeastern US city were selected randomly from 3 ethnic groups: black (n = 201), Hispanic (n = 191), and white (n = 200). STATISTICAL ANALYSES: Bivariate and multiple linear regression analysis of associations between life-course variables and fruit and vegetable consumption. RESULTS: Black, Hispanic, and white respondents differed significantly in life-course experiences, family roles, socio-demographic characteristics, and place of birth. Explanatory models for fruit and vegetable consumption differed among ethnic groups and between fruits and vegetables. Among black respondents, a college education was positively associated with fruit consumption; education and family roles contributed most to differences in fruit (R2 = .16) and vegetable (R2 = .09) consumption. Among Hispanic respondents, life-course experiences such as liking fruits and vegetables in youth, making dietary changes for health, and food skills were positively associated with fruit (R2 = .25) and vegetable (R2 = .35) consumption. Among white respondents, socio-demographic characteristics, such as being married with a young child or single with no child and having a garden as an adult, were positively associated with fruit (R2 = .20) and vegetable (R2 = .22) consumption. APPLICATIONS/CONCLUSIONS: An understanding of the determinants of food choice in different subcultural groups can be used to design effective nutrition interventions to increase fruit and vegetable consumption. Experiences such as eating fresh-picked fruits and vegetables while growing up or vegetable gardening as an adult may enhance fruit and vegetable consumption among members of some ethnic groups.     

Dietary Characteristics and Influencing Factors on Chinese Immigrants in Canada and the United States: A Scoping Review

Background: Chinese immigrants are an integral part of Canadian and American society. Chinese immigrants believe diet to be an important aspect of health, and dietary behaviours in this population have been associated with changes in disease risk factors and disease incidence. This review aims to summarize the characteristics of the dietary behaviours of Chinese immigrants and the associated influencing factors to better inform individual, clinical, and policy decisions. Methods: This scoping review was written in accordance with PRISMA guidelines. MEDLINE, PsychINFO, CINAHL, AgeLine, ERIC, ProQuest, Nursing and Allied Health Database, PsychARTICLES, and Sociology Database were utilized for the literature search. Articles were included if they explored dietary or nutritional intake or its influencing factors for Chinese immigrants to Canada or the United States. Results: A total of 51 papers were included in this review. Among Chinese immigrants in Canada and the United States, the intake of fruits and vegetables, milk and alternatives, and fiber were inadequate against national recommendations. Chinese immigrants showed increased total consumption of food across all food groups and adoption of Western food items. Total caloric intake, meat and alternatives intake, and carbohydrate intake increased with acculturation. Individual factors (demographics, individual preferences, and nutritional awareness), familial factors (familial preferences and values, having young children in the family, and household food environment), and community factors (accessibility and cultural conceptualizations of health and eating) influenced dietary behaviours of Chinese immigrants. Discussion and Conclusion: Efforts should be undertaken to increase fruit, vegetable, and fibre consumption in this population. As dietary acculturation is inevitable, efforts must also be undertaken to ensure that healthy Western foods are adopted. It is important for healthcare providers to remain culturally sensitive when providing dietary recommendations. This can be achieved through encouragement of healthy ethnocultural foods and acknowledgement and incorporation of traditional health beliefs and values into Western evidence-based principles where possible.     

A Preliminary Study of Potential Dietary Risk Factors for Coronary Heart Disease Among Chinese American Adolescents

ABSTRACT: This study investigated dietary knowledge, attitudes toward diet, behavioral factors affecting diet, and dietary patterns between American Chinese middle school students and Chinese middle school students living in China. Significant differences occurred in these variables between the two groups of students. Chinese students living in China had less knowledge and a less favorable attitude. However, they exhibited more positive behavioral factors affecting diet which include culture, religion, customs, economic factors, beliefs, and values. As for the dietary pattern. Chinese student living in China consumed less meat, dairy products, fat, sweets and snacks, and fast foods, and consumed more fruits, vegetables, and starch. (J Sch Health. 1994; 64(9): 368–371)     

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.     

Mixed Method Approaches to Understanding Cancer-Related Dietary Risk Reduction among Public Housing Residents

Improving diet is one important pathway for addressing cancer disparities. We conducted mixed-method analyses of 468 24-h dietary recalls from 156 African–American women residents of Washington DC public housing to better understand dietary patterns. Recalls were rated for five cancer-related preventive characteristics (adequate fruits/vegetables, moderate fat, moderate calories, no alcohol, and adequate Healthy Eating Index score), combined as a scale. Bivariate and multivariate analyses identified psychosocial and dietary characteristics associated with scale scores. Qualitative analyses of dietary records identified contextual aspects of food patterns within and across score groups. Sixty-one percent of respondents met zero or one dietary goal; alcohol abstention was most common (64%). Only 12% achieve either three (6%), four (4%), or all five (<1%) goals; five fruit and vegetable servings were least common (15%). The underlying scalar structure of responses suggests that fruit and vegetable consumption is seldom achieved in this population without other scale components. Poorer scores were associated with younger age, depressive symptoms, stressful life events, smoking, and food-purchasing practices. Qualitative analyses identified eight themes related to differences between dietary patterns. Findings reinforce the value of nonreductionist approaches to cancer-related nutrition intervention.     

Associations Between Dietary Patterns and Longitudinal Quality of Life Changes in Colorectal Cancer Patients: The ColoCare Study

Quality of life (QoL) is an important clinical outcome in cancer patients. We investigated associations between dietary patterns and QoL changes in colorectal cancer (CRC) patients. The study included 192 CRC patients with available EORTC QLQ-C30 data before and 12 months post-surgery and food frequency questionnaire data at 12 months post-surgery. Principal component analysis was used to identify dietary patterns. Multivariate regression models assessed associations between dietary patterns and QoL changes over time. We identified four major dietary patterns: “Western” dietary pattern characterized by high consumption of potatoes, red and processed meat, poultry, and cakes, “fruit&vegetable” pattern: high intake of vegetables, fruits, vegetable oils, and soy products, “bread&butter” pattern: high intake of bread, butter and margarine, and “high-carb” pattern: high consumption of pasta, grains, nonalcoholic beverages, sauces and condiments. Patients following a “Western” diet had lower chances to improve in physical functioning (OR = 0.45 [0.21–0.99]), constipation (OR = 0.30 [0.13–0.72]) and diarrhea (OR: 0.44 [0.20–0.98]) over time. Patients following a “fruit&vegetable” diet showed improving diarrhea scores (OR: 2.52 [1.21–5.34]. A “Western” dietary pattern after surgery is inversely associated with QoL in CRC patients, whereas a diet rich in fruits and vegetables may be beneficial for patients' QoL over time.     

Psychosocial factors and dietary habits associated with vegetable consumption

OBJECTIVE: We assessed scales of psychosocial factors and dietary habits related to vegetable consumption and examined associations of these scales with vegetable intake. METHODS: Data are from 838 adults who participated in a 1997 to 1998 Washington State random digital-dial survey designed to monitor attitudes and behavior related to cancer risk and prevention. Information was collected on psychosocial factors related to vegetable consumption, vegetable-related dietary habits, demographic (participant) characteristics, and vegetable intake. Factor analyses were used to identify the underlying dimensions in the psychosocial and dietary habits scales. Analyses of variance, linear regression, and Pearson's correlations examined associations among participant characteristics, psychosocial factors, dietary habits, and vegetable consumption. RESULTS: Factor analyses of the psychosocial scale suggested four coherent dimensions or subscales--importance of eating vegetables, health benefits, convenience and taste of raw vegetables, and taste of cooked vegetables--with good internal consistency reliability (Cronbach's alpha = 0.67-0.77). There were four subscales within the dietary habits scale--add vegetables to mixed dishes, include vegetables at lunch and dinner, eat raw vegetables, and eat salads--with fair internal consistency reliability (Cronbach's alpha = 0.37-0.61). The psychosocial factors and dietary habits were strongly correlated (summary scales Pearson's r = 0.55), and after adjustment for participant characteristics, both scales were significantly and positively associated with vegetable intake (Pearson's r = 0.45 and 0.54, respectively, for summary scales; all Ps < 0.001). Further, the scales explained between 14% and 23% of the variance in vegetable intake. CONCLUSIONS: These scales of psychosocial factors and dietary habits related to vegetable consumption could be used to target intervention messages and evaluate intervention effects.     

Development of scales to measure dietary acculturation among Chinese-Americans and Chinese-Canadians

OBJECTIVE: To develop simple scales to measure a Chinese immigrant's adoption of Western eating patterns (dietary acculturation). STUDY DESIGN AND PARTICIPANTS: Data are from 244 less-acculturated women of Chinese ethnicity living in Seattle, Wash, and Vancouver, British Columbia, Canada. Interviewers collected information on sociodemographic characteristics, acculturation indices, items that reflect Western and Chinese dietary behavior, and consumption of fruits, vegetables, and fat. STATISTICAL ANALYSES: Analysis of variance and linear regression analyses examined associations among dietary measures and acculturation variables, controlling for age, education, and city of residence. RESULTS: We developed 2 scales to assess dietary acculturation: the Western Dietary Acculturation Scale and the Chinese Dietary Acculturation Scale, measuring Western and Chinese eating behavior, respectively. Although the population in this study was a less-acculturated sample, most participants reported some Western dietary practices, such as drinking milk (78%), eating cheese (78%), eating at Western fast-food restaurants (56%), and eating between meals (72%). Younger, highly educated women employed outside the home had the highest Western dietary acculturation scores (P < .001). Women with high scores on the Western scale reported higher-fat dietary behaviors and had increased fruit and vegetable intake since immigration compared to those with lower scores (P < .001). There was good agreement between the dietary acculturation scales and traditional acculturation indicators (P < .001). APPLICATIONS: Nutrition programs for immigrant/minority groups may be more effective if they are tailored to level of dietary acculturation. Therefore, the ability to accurately assess dietary acculturation is an important component of nutrition education, interventions, and counseling in these populations.     

Peer Reviewed: Dietary Behaviors Associated With Fruit and Vegetable Consumption, Marion County, Indiana, 2005

Introduction

Eating inadequate amounts of fruits and vegetables is associated with diminished health, and most Americans fall short of the Centers for Disease Control and Prevention''s recommendation to eat at least 2 servings of fruit and 3 servings of vegetables each day. This study assessed behaviors associated with fruit and vegetable consumption in adults.

Methods

A cross-sectional, random-digit–dialed telephone survey of 4,784 adults living in Marion County (Indianapolis), Indiana, measured demographic characteristics, personal health data, food consumption, food label use, and other eating habits. Multivariate logistic regressions were used to assess the association between selected dietary behaviors and fruit and vegetable consumption, controlling for demographic characteristics.

Results

Behaviors associated with adequate versus inadequate consumption of fruits and vegetables were frequent snacking on healthy foods (odds ratio [OR], 2.54), eating meals at home (OR, 2.09), using nutrition labels when making purchases (OR, 1.52), and using "heart healthy" symbols and other food information labels when ordering from restaurants (OR, 1.41). Frequent red meat consumption was negatively associated with adequate consumption of fruits and vegetables (OR, 0.64).

Conclusions

Healthful snacking, food label use, and eating meals prepared at home may improve dietary quality. Our measure of adequacy may also be useful in future studies assessing dietary behavior and diet composition.     

Overview of the health benefits of fruit and vegetable consumption for the dietetics professional: selected literature

Epidemiologic evidence of a protective role for fruits and vegetables in cancer prevention is substantial. The strength of this scientific base guides US national policymaking in diet and health issues and facilitates community and local programs that address national dietary goals to increase fruit and vegetable consumption. Current scientific evidence also suggests a protective role for fruits and vegetables in prevention of coronary heart disease, and evidence is accumulating for a protective role in stroke. In addition, a new scientific base is emerging to support a protective role for fruits and vegetables in prevention of cataract formation, chronic obstructive pulmonary disease, diverticulosis, and possibly, hypertension. This article provides an overview of the health benefits associated with fruit and vegetable consumption for each of these conditions, including brief discussions of underlying protective mechanisms, identifies key scientific findings regarding the health benefits of fruit and vegetable consumption, and outlines applications of these findings for dietetics professionals. The evidence reviewed provides additional support for increased consumption of a wide variety of vegetables, in particular, dark-green leafy, cruciferous, and deep-yellow-orange ones, and a wide variety of fruits, in particular, citrus and deep-yellow-orange ones. Continued attention to increasing fruit and vegetable consumption is a practical and important way to optimize nutrition to reduce disease risk and maximize good health. J Am Diet Assoc. 2000; 100:1511-1521.     

The Relationship between Food Security Status and Fruit and Vegetable Intake during the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has drastically altered food shopping behaviors, and the resulting economic recession has caused a spike in food insecurity. Since food insecurity is associated with poor diet, especially low intake of fruits and vegetables, food-insecure individuals may disproportionately experience negative health impacts related to poor diet during the pandemic. To assess the relationship between food security status and fruit and vegetable intake during the COVID-19 pandemic, we conducted an online survey of adult residents of the US state of Michigan in June of 2020. Among the 484 survey respondents, 36.2% were classified as food-insecure. Food-insecure respondents consumed fruits and vegetables fewer times per day than food-secure respondents and were more likely to report decreasing their consumption of any type of fruits and vegetables (total, fresh, frozen, and canned) since the pandemic started. For those who reduced their purchase of fresh fruit and vegetable, reasons included poor quality, poor availability, high price, reduced store trips, and concerns of contamination. These findings highlight the need for adequate food assistance during the COVID-19 pandemic and in future pandemics, as well as public health messages that promote healthy eating.     

Predictors of self-initiated, healthful dietary change

OBJECTIVE: To examine demographic and psychosocial factors that predict healthful dietary change. DESIGN: A cohort study, examining how factors assessed at baseline predicted change in fat-related dietary habits and fruit and vegetable intakes 2 years later. PARTICIPANTS: Participants were recruited in 1995 and 1996 by random-digit dialing (response rate 0.63), and followed-up in 1997 and 1998 (follow-up rate 0.82). The final sample included 336 men and 502 women. MAIN OUTCOME MEASURES: Fruit and vegetable intake and fat-related dietary patterns, measured by telephone-administered surveys. STATISTICAL ANALYSES: Chi2 tests and linear regression were used to test associations of baseline characteristics with dietary change. RESULTS: Fat intake (energy from fat) decreased by approximately 2 percentage points and fruits and vegetables intake increased by 0.17 servings per day (both P<.001). Changes were significantly larger among women and persons who were well educated. Persons in the maintenance stage of change and persons who believed there was a strong relationship between diet and cancer made the largest dietary changes. Use of food labels was strongly associated with fat reduction, but not with increases in fruits and vegetables. APPLICATIONS: These results suggest that food labels are useful for helping people reduce fat intake, that interventions should target persons at all stages of dietary change, and that new efforts are needed to reach men and persons who are less well educated.     

Dietary pattern change and acculturation of Chinese Americans in Pennsylvania

Objective

To obtain information about dietary pattern change of Chinese Americans in Pennsylvania and its relationship with demographic characteristics and acculturation indicators.

Design

A cross-sectional self-administered survey.

Subjects

A convenience sample of 399 Chinese Americans.

Statistical analyses performed

t Tests, analysis of variance with Tukey post-hoc tests, Spearman rank correlation, and χ² test.

Results

After immigration, Chinese Americans increased consumption frequency of all seven food groups (grains, vegetables, fruits, meat/meat alternatives, dairy products, fats/sweets, and beverages) and Western foods while consumption frequency of traditional Chinese foods decreased. Dietary variety also increased after immigration. Higher education and higher income levels were associated with a larger increase in consumption frequency of grains, vegetables, and fruits. Persons who resided in the United States for a longer period of time shared a greater increase in their consumption frequencies of vegetables, fats/sweets, and beverages. Persons with better English proficiency had a greater increase in their consumption frequency of grains, fruits, meat/meat alternatives, and fats/sweets.

Conclusions

This study can help nutrition educators design appropriate educational programs for first-generation Chinese Americans that can facilitate the adoption of more healthful dietary practices. Nutrition educators should consider the dietary changes of Chinese-American participants, such as skipping breakfast and increased consumption frequency of fats, sweets, and soft drinks, which were observed in this study. For example, acculturated first-generation Chinese Americans should be encouraged to decrease fats, sweets, and soft-drink consumption. Less-acculturated persons should be encouraged to maintain their healthful dietary pattern and increase consumption of vegetables and fruits.     

Associations of Soluble Fiber,Whole Fruits/Vegetables,and Juice with Plasma Beta-Carotene Concentrations in a Free-Living Population of Breast Cancer Survivors

Objective: Soluble fiber and the physical state of fruits/vegetables affect plasma ß-carotene concentrations; however, most of this research was conducted in laboratory-based settings. These analyses investigated the relationship between soluble fiber and juiced versus whole fruits/vegetables to plasma ß-carotene concentrations in a free-living population. Method: This cross-sectional analysis used 12-month follow-up data from the Women's Healthy Eating & Living Study (1995–2006), a study to improve diet in breast cancer survivors in the Western United States. The dietary nutrients considered in this analysis included intake of soluble fiber (g), ß-carotene from fruit/vegetable juice (mg), and ß-carotene from whole fruits/vegetables (mg). A linear regression model was used to assess the relationship of the variables to plasma ß-carotene concentrations. Results: Out of 3,088 women enrolled in the Women's Healthy Eating & Living Study, 2,397 women had complete data (mean age = 54). The final model accounted for approximately 49% of the explained variance in plasma ß-carotene concentrations. Fruit/vegetable juice had the largest positive relation to plasma ß-carotene concentrations (standardized parameter estimate = 0.23, p < 0.01), followed by whole fruits/vegetables (standardized parameter estimate = 0.09, p < 0.01). Conclusion: Soluble fiber may inhibit ß-carotene absorption; therefore, consumption of juice may increase plasma ß-carotene concentrations more than whole fruits/vegetables in free-living populations.     

Dietary beliefs and behaviour of a UK Somali population

Background:  Somalis comprise one of the largest asylum seeking populations in the UK, yet very little is known about how this migration has affected traditional attitudes towards food or eating habits. The present study was commissioned to examine the health behaviours (smoking, diet and exercise) of a Somali population in London; the study focuses on the dietary beliefs and self-reported eating behaviours of these subjects.
Methods:  Because of the documented difficulty of engaging black and minority ethnic groups in research, a mixed methodology was used, involving focus groups to elicit specific dietary themes and a questionnaire survey to attempt to quantify community concordance with these themes. Eight focus groups were held in London in 2006; there were two women's and six men's groups, with 62 participants in total. The questionnaire was developed following analysis of the focus group discussions and opportunistically distributed via local Somali community organisations (77 respondents).
Results:  The typical diet of focus group participants largely consisted of rice, pasta and red meat. There was low consumption of fruit and vegetables reported among the focus group participants: of survey respondents 97% reported eating less than two pieces of fruit, and 92% less than two portions of vegetables, a day.
Conclusions:  Fruit and vegetable consumption was low and there was uncertainty about what constituted a healthy diet and a stated desire for education around this. Cultural factors such as the traditional Somali diet, social associations of food and lack of appropriate information are issues that need to be addressed.     

Measuring fruit and vegetable consumption: providing serving size information doubles estimated percent eating five per day

Measuring the extent to which individuals meet the 5 A Day dietary recommendation for fruits and vegetables can provide information on the effectiveness of public health efforts to increase consumption of these foods. However, dietary measurement is complicated by the issue of serving size. We compared two methods of measuring fruit and vegetable consumption using a random-digit-dialed telephone survey of 917 Washington state adults. The survey included two sets of questions about fruit and vegetable consumption, one providing and the other not providing standard definitions of serving size. The specific wording of questions had a large effect on the conclusions about levels of fruit and vegetable consumption. Although only 26% of respondents met the 5 A Day recommendations without serving size information, 50% met these recommendations when using a measure that included a definition of serving size.     

Relationship of Hunger and Food Insecurity to Food Availability and Consumption

Objective To describe the relationship of new measures of hunger and food insecurity to household food supplies and individual food and nutrient intake.Design and Setting A questionnaire containing the Radimer/Cornell hunger and food insecurity items and questions on eating patterns and the frequency of fruit and vegetable consumption was administered to subjects during a personal interview in their homes. A 24-hour diet recall and a household food inventory were conducted at the initial interview and at a follow-up visit.Subjects Participants were 193 women drawn from a random sample of 308 women who had completed a previous health census in a rural New York State county. Subjects’ ages ranged from 15 to 40 years. All had children living at home and less than 16 years of education.Statistical analyses Regression analysis was used to test for linear trends across food insecurity groups for the household food inventory scores and for the frequency of consumption of fruits and vegetables, t Tests were used to assess differences between the food secure and food insecure groups for nutrient and food group means. A χ² test for trend was used to examine differences in the distribution of nutrient and fruit and vegetable intake between the food secure and food insecure groups.Results A significant decrease in the frequency of consumption of fruits and vegetables and the amount of food in the household and a significant increase in scores indicative of disordered eating patterns were associated with a worsening of food insecurity status. Potassium and fiber intake and fruit consumption differed significantly between the food secure and food insecure groups. The percentage of respondents consuming less than the Recommended Dietary Allowance for vitamin C and fewer than five fruits and vegetables per day was significantly greater among food insecure respondents than food secure respondents.Applications/conclusions The quantity of food available in households and consumption of fruits and vegetables decreased with increasingly severe problems with food insecurity and hunger. In this rural population, the Radimer/Cornell measures were useful in identifying households experiencing food insecurity and providing information about the nature of the food supply and the dietary intake problems experienced by food insecure households and persons, suggesting that these measures may be useful on community surveys designed to examine food insecurity issues. J Am Diet Assoc. 1996; 96:1019-1024.     

The relationship between self-efficacy, attitudes, intake compared to others, consumption, and stages of change related to fruit and vegetables

PURPOSE: This study examined whether eating practices and psychosocial factors differed across stages of change for fruit and vegetables. DESIGN: Data were collected using a self-administered written survey among a convenience sample of 739 Dutch adults. Response rate was 92%. SETTING: Data were collected as part of the baseline assessment for a nutrition intervention study. MEASURES: Fruit and vegetable intake was measured as self-reported consumption with a validated eight-item food frequency questionnaire. Psychosocial variables were measured with six items on bipolar seven-point scales and stage-of-change classifications were based on separate four-item algorithms for fruits and vegetables. Differences in psychosocial factors and consumption were analyzed using one-way analysis of variance with Scheffé's multiple-comparison test. RESULTS: Significant differences were found between stages of change in dietary intake, attitudes, self-efficacy, and judgment of one's own intake compared to others. Attitudes were most positive in preparation and action and least positive in precontemplation. Intake and self-efficacy were more positive in action/maintenance than in pre-action stages. CONCLUSIONS: The findings suggest that nutrition education aimed at encouraging higher intake of fruits and vegetables might be most effective if it is stage-tailored. Messages to influence attitudes about fruits and vegetables are likely to affect people in precontemplation, and self-efficacy information to increase confidence in overcoming barriers to consumption is likely to be effective with persons in contemplation and preparation stages.