Cancer Prevention-Related Nutrition Knowledge,Beliefs, and Attitudes of U.S. Adults: 1992 NHIS Cancer Epidemiology Supplement

The objective of this study was to describe the cancer prevention-related nutrition knowledge, beliefs, and attitudes of U.S. adults. Data collected for the 1992 National Health Interview Survey Cancer Epidemiology Supplement were ana-lyzed.The Supplement was completed by 12,005 adults aged 18 years and older. Frequency distributions were calculated. Logistic regression analyses were conducted to explore differences in knowledge, beliefs, and attitudes according to selected factors. Most adults (83%) believe that good eating habits may reduce their chances of developing major diseases. Of those who held this belief, 66% named cancer as a disease that might be related to what people eat or drink. Among those who believed cancer to be related to what people eat or drink, eating more fiber (72%), more fruits and vegetables (66%), and less fat (60%) were mentioned most frequently as foods/nutrients that affect cancer risk. Conflicting dietary advice, cost of eating a healthy diet, and social support were the most salient perceived barriers to having a healthful diet. Knowledge, beliefs, and attitudes were found to vary by age, sex, ethnicity, poverty, and education. Findings suggest that, although a moderate majority are aware of the relationship between diet and cancer, fewer are knowledgeable about nutrients/foods that influence risk. Differences found in knowledge, beliefs, and attitudes by various socioeconomic factors suggest that nutrition intervention strategies may need to be targeted and tailored to various population subgroups.     

Barriers and Facilitators for Consumer Adherence to the Dietary Guidelines for Americans: The HEALTH Study

The majority of the US population does not meet recommendations for consumption of milk, whole grains, fruit, and vegetables. The goal of our study was to understand barriers and facilitators to adherence to the Dietary Guidelines for Americans for four nutrient-rich food groups in fifth-grade children and unrelated adult caregivers across six sites in a multistate study. A total of 281 unrelated adult caregivers (32% African American, 33% European American, and 35% Hispanic American) and 321 children (33% African American, 33% European American, and 34% Hispanic American) participated in 97 Nominal Group Technique sessions. Nominal Group Technique is a qualitative method of data collection that enables a group to generate and prioritize a large number of issues within a structure that gives everyone an equal voice. The core barriers specific to unrelated adult caregivers were lack of meal preparation skills or recipes (whole grains, fruit, vegetables); difficulty in changing eating habits (whole grains, fruit, vegetables), cost (milk, whole grains, fruit, vegetables), lack of knowledge of recommendation/portion/health benefits (milk, vegetables), and taste (milk, whole grains, vegetables). Specific to children, the core barriers were competing foods (ie, soda, junk foods, sugary foods [whole grains, milk, fruit, vegetables]), health concerns (ie, milk allergy/upset stomach [milk]), taste/flavor/smell (milk, whole grains, fruit, vegetables), forget to eat them (vegetables, fruit), and hard to consume or figure out the recommended amount (milk, fruit). For both unrelated adult caregivers and children, reported facilitators closely coincided with the barriers, highlighting modifiable conditions that could help individuals to meet the Dietary Guidelines for Americans.     

An Exploratory study of compliance with dietary recommendations among college students majoring in health-related disciplines: application of the transtheoretical model

Compliance with food group and nutrient recommendations, and self-efficacy, stage of change, perceived barriers and benefits for healthy eating were assessed among a convenience sample of college students majoring in health-related disciplines. Dietary and psychosocial data were collected using three-day food records and scales, respectively. Means (SD), frequencies, and percents were calculated on all data, and logistic regressions were used to determine whether any of the psychosocial correlates predicted the stage of change for healthy eating. Noncompliance with food group recommendations ranged from 53% for the meat/meat alternates group to 93% for the vegetables/juice group, whereas noncompliance with nutrient recommendations ranged from 26% for cholesterol to 99% for potassium. A majority of students (57%) self-classified in the preaction and 40% in the action stages of change for eating healthy. The students'' self-efficacy to eat healthy was highest in positive/social situations and lowest when experiencing emotional upset. The most important perceived barrier to healthy eating was that friends/roommates do not like to eat healthy foods, and the most important perceived benefit was that eating healthy foods provides the body with adequate nutrients. The difficult/inconvenient self-efficacy subscale predicted the stage of change for healthy eating. These students would benefit from interactive learning opportunities that teach how to purchase and prepare more whole grain foods, fruits, and vegetables, enhance their self-efficacy for making healthy food choices when experiencing negative emotions, and overcome perceived barriers to healthy eating.     

Concepts of Healthy Diet Among Urban, Low-Income, African Americans

We sought to explore concepts of healthy diet and to elicit recommendations to support healthier eating among urban, low-income, African Americans. We conducted semi-structured interviews with 33 self-identified African American adults (18-81 years of age, 15 male participants) from a low-income neighborhood in west Philadelphia, PA, during summer and fall 2008. Our qualitative approach was continuous, iterative and thematic considering gender, age category, and participants' "mentions" of fast-food and fruit-and-vegetable intake from the preceding day. We found that participants shared concepts about broad nutritional principles consistent with national dietary recommendations, but disagreed about the healthfulness of specific foods-e.g. meat. On average-with little variation-participants reported eating >2 "mentions" more of fast foods the preceding day than fruits and vegetables (P < 0.001). Suggested strategies to help promote eating more produce included increasing exposure, advertising, affordability, and local availability (vice versa to limit fast-food consumption), and more education on the health effects of diet and how to find and prepare healthy foods. Women's ideas reflected their roles in food shopping and food preparation; otherwise, participants' ideas did not differ appreciably by gender or age. Overall, participants generally expressed sufficient understanding of nutritional principles to eat healthfully, but disagreed about the healthfulness of specific foods and described largely unhealthy dietary consumption from the preceding day. If poor dietary intake results from barriers to recognizing, purchasing, and preparing healthy foods, then participants' suggestions to increase education and modify the environment may lead to improved diets and better health in the community.     

Choose a variety of grains daily, especially whole grains: a challenge for consumers

The 2000 edition of Nutrition and Your Health: Dietary Guidelines for Americans is the first to include a specific guideline for grain foods, separate from fruits and vegetables, and recognize the unique health benefits of whole grains. This paper describes and evaluates major tools for assessing intakes of total grains and whole grains, reviews current data on who consumes grain foods and where, and describes individual- and market-level factors that may influence grain consumption. Aggregate food supply data show that U.S. consumers have increased their intake of grain foods from record low levels in the 1970s, but consumption of whole-grain foods remains low. Data on individual intakes show that consumption of total grains was above the recommended 6 serving minimum in 1994-1996, but consumption of whole grains was only one third of the 3 daily servings many nutritionists recommend. Increased intake of whole-grain foods may be limited by a lack of consumer awareness of the health benefits of whole grains, difficulty in identifying whole-grain foods in the marketplace, higher prices for some whole-grain foods, consumer perceptions of inferior taste and palatability, and lack of familiarity with preparation methods. In July 1999, the U.S. Food and Drug Administration authorized a health claim that should both make it easier for consumers to identify and select whole-grain foods and have a positive effect on the availability of these foods in the marketplace.     

Predictors of changes in adolescents' consumption of fruits, vegetables and energy-dense snacks

Understanding the predictors of developmental changes in adolescent eating behaviours is important for the design of nutrition interventions. The present study examined associations between individual, social and physical environmental factors and changes in adolescent eating behaviours over 2 years. Consumption of fruits, vegetables and energy-dense snacks was assessed using a Web-based survey completed by 1850 adolescents from years 7 and 9 of secondary schools in Victoria, Australia, at baseline and 2 years later. Perceived value of healthy eating, self-efficacy for healthy eating, social modelling and support, and home availability and accessibility of foods were assessed at baseline. Self-efficacy for increasing fruit consumption was positively associated with the change in fruit and vegetable consumption, while self-efficacy for decreasing junk food consumption was inversely associated with the change in energy-dense snack consumption. Home availability of energy-dense foods was inversely associated with the change in fruit consumption and positively associated with the change in energy-dense snack consumption, while home availability of fruits and vegetables was positively associated with the change in vegetable consumption. Perceived value of healthy eating and modelling of healthy eating by mothers were positively associated with the change in fruit consumption. Support of best friends for healthy eating was positively associated with the change in vegetable consumption. Self-efficacy and home availability of foods appear to be consistent predictors of change in fruit, vegetable and energy-dense snack consumption. Future study should assess the effectiveness of methods to increase self-efficacy for healthy eating and to improve home availability of healthy food options in programmes promoting healthy eating among adolescents.     

Predictors of nutritional adequacy in mother-toddler dyads from rural families with limited incomes

OBJECTIVE: To predict the mean adequacy ratio (MAR) scores of mothers and toddlers from intakes of fruits, vegetables, and dairy group foods and being seated during mealtimes. DESIGN/SUBJECTS: This was a regression analysis of cross-sectional data of the diet quality and being seated during mealtimes of 100 rural mother-toddler dyads from limited-income families using two 24-hour dietary recalls. Children were 11 to 25 months of age and at or below 100% of the poverty index. MEASURES OF OUTCOME: Dietary quality for mothers and toddlers was assessed using a MAR score for eight different nutrients (vitamin A, vitamin C, vitamin D, folate, calcium, zinc, iron, and magnesium), and a score of 85 or above was considered nutritionally adequate. The main food groups of interest were servings from the fruits, vegetables, and dairy group foods. Mealtime sitting behavior was the percentage of times the toddler remained seated while eating. RESULTS: Servings of fruits, vegetables, and dairy foods predicted 0.62 of the variance in the mother's MAR score, whereas vegetable and dairy intakes along with being seated while eating indicated nutritional adequacy for toddlers. Mothers with low MAR scores were most likely to have toddlers with poor diets, although few toddlers had poor diet quality. CONCLUSIONS: Adequate intakes of dairy, vegetables, and whole fruits along with being seated while eating could be quick assessment tools to screen toddlers for nutritional risk. Mothers with poor diet quality were likely to have toddlers with poor diets; low intakes of fruits, vegetables, and dairy foods were markers for poor diet quality in mothers.     

Factors influencing food choices of adolescents: findings from focus-group discussions with adolescents.

OBJECTIVE: To assess adolescents' perceptions about factors influencing their food choices and eating behaviors. DESIGN: Data were collected in focus-group discussions. SUBJECTS/SETTING: The study population included 141 adolescents in 7th and 10th grade from 2 urban schools in St Paul, Minn, who participated in 21 focus groups. ANALYSIS: Data were analyzed using qualitative research methodology, specifically, the constant comparative method. RESULTS: Factors perceived as influencing food choices included hunger and food cravings, appeal of food, time considerations of adolescents and parents, convenience of food, food availability, parental influence on eating behaviors (including the culture or religion of the family), benefits of foods (including health), situation-specific factors, mood, body image, habit, cost, media, and vegetarian beliefs. Major barriers to eating more fruits, vegetables, and dairy products and eating fewer high-fat foods included a lack of sense of urgency about personal health in relation to other concerns, and taste preferences for other foods. Suggestions for helping adolescents eat a more healthful diet include making healthful food taste and look better, limiting the availability of unhealthful options, making healthful food more available and convenient, teaching children good eating habits at an early age, and changing social norms to make it "cool" to eat healthfully. APPLICATIONS/CONCLUSIONS: The findings suggest that if programs to improve adolescent nutrition are to be effective, they need to address a broad range of factors, in particular environmental factors (e.g., the increased availability and promotion of appealing, convenient foods within homes schools, and restaurants).     

Australian adult consumers' beliefs about plant foods: a qualitative study.

This exploratory qualitative study examined consumers' perceived barriers and benefits of plant food (fruits, vegetables, grains, legumes, nuts, seeds) consumption and views on the promotion of these foods. Ten focus groups were conducted in Melbourne, Australia. Groups consisted of employees of various workplaces, community group members, university students, and inner-city residents. Health-related benefits predominated, particularly relating to the properties of plant foods (e.g., vitamins). Taste, variety, versatility, and environmental benefits were also considered important. The main barriers to eating plant foods were lack of knowledge and skills and length of preparation time. The poor quality of plant foods was also an issue for consumers. Awareness of the promotion of plant foods was generally high. Participants noted that promotions require a stronger practical emphasis with a focus on quick, easy-to-prepare foods and meals. These findings provide insight into effective ways to promote a higher consumption of plant foods.     

Use of the Grade of Membership method to identify consumption patterns and eating behaviors among adolescents in Rio de Janeiro, Brazil

To identify food patterns and eating behaviors among adolescents and to describe the prevalence rates, this study applied the Grade of Membership method to data from a survey on health risk factors among adolescent students in Rio de Janeiro, Brazil (N = 1,632). The four profiles generated were: "A" (12.1%) more frequent consumption of all foods labeled as healthy, less frequent consumption of unhealthy foods, and healthy eating behaviors; "B" (45.8%) breakfast and three meals a day as a habit, less frequent consumption of fruits and vegetables and of five markers of unhealthy diet; "C" (22.8%) lack of healthy eating behaviors, less frequent consumption of vegetables, fruit, milk, cold cuts, cookies, and soft drinks; and "D" (19.3%) more frequent consumption of all unhealthy foods and less frequent consumption of fruits and vegetables. The results indicate the need for interventions to promote healthy eating in this age group.     

Nutrition and cancer prevention knowledge, beliefs, attitudes, and practices: the 1987 National Health Interview Survey.

This article examines the nutrition and cancer prevention knowledge, beliefs, attitudes, and self-reported dietary changes of a US national probability sample. The data were drawn from the Cancer Control Supplement of the 1987 National Health Interview Survey, which was answered by 22,043 adults. Thirty-five percent of the sample reported that they had made dietary changes in the past 1 to 5 years for health reasons. Respondents reported eating more vegetables, fruit, lower-fat meats, and whole grains/fiber and less high-fat meats, fats, sweets/snacks, salty foods, refined grain products, alcohol, and dairy products. Those who did not make any dietary changes most often said the reason was that they enjoyed the food they were presently eating and did not want to make any changes. More than 90% of the sample agreed that diet and disease were related and 73% knew that diet and cancer were related, yet 44% believed there was nothing a person could do to reduce the risk of getting cancer or didn't know what could be done. In response to open-ended questions about foods that either increase or decrease cancer risk, vegetables, whole grains/fiber, fruit, and lower-fat meats were thought to decrease risk, and high-fat meats, fats, alcohol, sweets/snacks, and additives were thought to increase cancer risk. We found education and income levels to be the major demographic variables that have an impact on cancer prevention knowledge, attitudes, and beliefs. People with lower incomes and at lower educational levels should be targeted for education about cancer risk reduction.     

Health Attitudes and Behaviors of African American Adolescents

African Americans continue to die disproportionately from chronic diseases such as diabetes, hypertension and heart disease. Eating fruits and vegetables have been shown to reduce those risks yet little is known about the health attitudes of African American adolescents and their eating habits and engagement in physical activity. A survey was administered to African American adolescents in a Midwestern city to determine the health attitudes and behaviors related to dietary intake and physical activity. The total sample consisted of 448 African American adolescents aged 12-17. Forty-seven percent were males and 53% were females. The findings show that African American adolescents did have poor fruit and vegetable intake and fairly low rates of exercise. The study also showed there were statistically significant differences between males and females regarding eating a balanced diet, reducing the amount of fat in diets and engaging in physical activity. African American females were more likely to eat a balanced diet and have reduced the fat in their diets than males but African American males were more likely to engage in physical activity in the past 7 days than females. Findings suggest more efforts are needed to curb the poor eating and exercising habits of African American adolescents if a reduction in chronic disease is to be met for this population.     

Applying the theory of planned behavior to promotion of whole-grain foods by dietitians

The objective of this preliminary study was to apply the theory of planned behavior to explain dietitians’ intentions to promote whole-grain foods. Surveys were mailed to a random national sample of registered dietitians to assess knowledge and attitudinal, normative, and control beliefs regarding intention to promote whole-grain foods, with a 39% return rate (n=776, with 628 usable surveys from those working in direct patient care). About half of the respondents had a master’s degree, and 58% had substantial experience in the dietetics field. The theory of planned behavior explained intention to promote whole grains to a moderate extent (df=3, F=74.5, R²=0.278, P<.001). Most were positive about the health benefits, and few perceived barriers to promotion. However, many had low levels of knowledge and self-efficacy regarding ability to help clients consume more whole-grain foods. Continuing education for dietitians should use strategies that enhance self-efficacy regarding ability to promote whole-grain foods.     

Optimising women's diets. An examination of factors that promote healthy eating and reduce the likelihood of unhealthy eating

The majority of nutrition promotion research that has examined the determinants of unhealthy or healthy dietary behaviours has focused on factors that promote consumption of these foods, rather than factors that may both promote healthy eating and buffer or protect consumption of unhealthy foods. The purpose of this paper is to identify factors that both promote healthy eating and also reduce the likelihood of eating unhealthily amongst women. A community sample of 1013 Australian women participated in a cross-sectional self-report survey that assessed factors associated with diet and obesity. Multiple logistic regressions were used to examine the associations between a range of individual, social and environmental factors and aspects of both healthy and unhealthy eating, whilst controlling for key covariates. Results indicated that women with high self efficacy for healthy eating, taste preferences for fruit and vegetables, family support for healthy eating and the absence of perceived barriers to healthy eating (time and cost) were more likely to consume components of a healthy diet and less likely to consume components of a unhealthy diet. Optimal benefits in overall diet quality amongst women may be achieved by targeting factors associated with both healthy and unhealthy eating in nutrition promotion efforts.     

Psychosocial correlates of fruit and vegetable consumption among African American men

OBJECTIVE: To determine the best predictors of fruit and vegetable consumption among African American men age 35 years and older. DESIGN: Data (n = 291) from a 2001 nationally representative mail survey commissioned by the American Cancer Society. PARTICIPANTS: 291 African American men age 35 years and older. MAIN OUTCOME MEASURES: Dependent variables: (1) total fruits and vegetables without fried potatoes, (2) total fruit with juice, and (3) total vegetables without fried potatoes. Independent variables included 3 blocks of predictors: (1) demographics, (2) a set of psychosocial scales, and (3) intent to change variables based on a theoretical algorithm. ANALYSIS: Linear regression models; analysis of variance for the intent to change group. Alpha = .05. RESULTS: Regression model for total fruits and vegetables, significant psychosocial predictors: social norms, benefits, tangible rewards, and barriers-other. Total fruit with juice: social norms, benefits, tangible rewards. Total vegetables, no fried potatoes: tangible rewards, barriers-other interests. CONCLUSIONS AND IMPLICATIONS: For African American men, fruit consumption appears to be motivated by perceived benefits and standards set by important people in their lives; vegetable consumption is a function of extrinsic rewards and preferences for high-calorie, fatty foods. The results suggest that communications to increase fruit and vegetable consumption should be crafted to reflect differences in sources of motivation for eating fruits versus eating vegetables.     

The Diet Quality of Rural Older Adults in the South as Measured by Healthy Eating Index-2005 Varies by Ethnicity

The 2005 Dietary Guidelines for Americans publication placed increased emphasis on the importance of consuming a wide range of healthful foods and further reducing the consumption of less healthful ones. These recommendations are challenging for rural elders whose functional limitations, fewer resources, and limited access to foods negatively affect the quality of their diets. The purpose of this study was to characterize the diet quality of a multiethnic population-based sample of older adults (N=635) in the southern United States. Data were collected via home visit; dietary intakes were assessed using a food frequency questionnaire and converted into Healthy Eating Index-2005 (HEI-2005) scores used to monitor adherence to dietary guidelines. The mean total HEI-2005 score was 61.9/100 with fewer than 2% meeting the recommended score of 80/100. After controlling for age, sex, marital status, poverty status, and education, African Americans (n=136) had higher total HEI-2005 scores compared to American Indians (n=195) and non-Hispanic whites (n=304) (64.5 vs 60.1 and 61.1 respectively, P=0.001). Certain HEI-2005 foods were consumed in greater amounts by particular groups, such as total fruit and meat and beans (African Americans), whole fruit and grains (African Americans and American Indians), milk (non-Hispanic whites), and energy from solid fat, alcohol, and added sugars (American Indians). The overall diet quality of these rural elders was not adequate as determined by the HEI-2005; however, intakes of dark green and orange vegetables were adequate, and many participants were in compliance with the added fat and sugar guidelines. Determination of factors that promote or prevent the consumption of healthful foods among rural elders may help tailor nutrition education programs for these vulnerable communities.     

An exploratory study of attitudes, beliefs and practices related to the interim dietary guidelines for reducing cancer in the elderly

In this pilot study, a self-administered questionnaire was used to assess the health attitudes, beliefs and practices related to each of the Interim Dietary Guidelines for Reducing Cancer Risk (I.D.G.R.C.R.) in a convenience sample of elderly Caucasian subjects (N = 30) over 60 years old. The questionnaire items included personal efficacy, perceived motivators and barriers, and current practices related to the compliance of each of the dietary guidelines. The distributions of responses to the questionnaire items show variations in the subjects' attitudes, beliefs and current dietary practices related to each of the dietary guidelines. Most subjects reported current practice of most guidelines except the guideline of a low fat diet. Most of the time, the subjects perceived one or more motivations to comply with the guidelines of eating fruits and vegetables high in vitamin C, and eating dark green or deep yellow vegetables. Taste and health benefits were shown to be important factors among motivators influencing the compliance to the dietary guidelines. The findings of this exploratory study have direct implications for planning nutrition intervention programs for cancer risk reduction in the elderly.     

Dietary Guidelines for Americans, 1990 edition

The Dietary Guidelines for Americans are the federal statement of dietary guidance policy. The small bulletin presenting the guidelines contains practical advice for healthy Americans about what constitutes a healthful diet and how such a diet is important to health. The guidelines bulletin was first published in 1980 and revised slightly in 1985. The third edition (1990) reflects new research on diet and health relationships and on the utility of the guidelines to the public. The 1990 guidelines are: Eat a variety of foods; maintain healthy weight; choose a diet low in fat, saturated fat, and cholesterol; choose a diet with plenty of vegetables, fruits, and grain products; use sugars only in moderation; use salt and sodium only in moderation; and if you drink alcoholic beverages, do so in moderation.