Benefits, barriers, self-efficacy and knowledge regarding healthy foods; perception of African Americans living in eastern North Carolina

African Americans in the United States suffer from many health disparities such as obesity, diabetes or hypertension. Lifestyle factors including diet and physical activity play an important role in prevention of these health conditions. The purpose of this research project was to assess beliefs, barriers and self-efficacy of eating a healthy diet and self efficacy of shopping for foods such as whole grains or foods designated as low fat or low sodium. Additionally, the objective was to assess beliefs about healthfulness, appropriate consumption, and protective aspect of specific foods including fruits, vegetables, and whole grains. The assessment was done using a survey instrument developed for this study. Data collection took place at two church locations. Data were obtained from 57 African Americans, mean age 50 years old (SD 12.70) completed the survey. The majority of respondents (58.1%) were females and most (75%) had at least some college education. Generally, benefits of eating healthy foods received considerably higher scores compared to barriers of eating healthy. A belief that healthy foods would help to take care of one''s body received the highest mean score while a belief that healthy foods are too expensive had the highest score from all barriers. The results showed high self-efficacy of eating and purchasing healthy foods, high awareness of knowledge regarding foods associated with disease prevention but low awareness of recommendations for fruits and vegetables. The high scores for benefits, self-efficacy and knowledge regarding eating healthy foods did not translate into the perception of intake of such foods. Most participants believed that they do not eat enough of healthy foods. Interventions design to help African Americans make dietary changes should be culturally relevant and should involved working on a community level utilizing messages that are familiar and relevant to African Americans.     

Cultural aspects of African American eating patterns

The high mortality from diet‐related diseases among African Americans strongly suggests a need to adopt diets lower in total fat, saturated fat and salt and higher in fiber. However, such changes would be contrary to some traditional African American cultural practices. Focus group interviews were used to explore cultural aspects of eating patterns among low‐ and middle‐income African Americans recruited from an urban community in Pennsylvania. In total, 21 males and 32 females, aged 13–65 + years were recruited using a networking technique. Participants identified eating practices commonly attributed to African Americans and felt that these were largely independent of socioeconomic status. They were uncertain about links between African American eating patterns and African origins but clear about influences of slavery and economic disadvantage. The perception that African American food patterns were characteristically adaptive to external conditions, suggest that, for effective dietary change in African American communities, changes in the food availability will need to precede or take place in parallel with changes recommended to individuals. Cultural attitudes about where and with whom food is eaten emerged as being equivalent in importance to attitudes about specific foods. These findings emphasize the importance of continued efforts to identify ways to increase the relevance of cultural context and meanings in dietary counseling so that health and nutrition interventions are anchored in values as perceived, in this case, by African Americans.     

Key Focus Group Themes to Inform Weight Management Interventions in Deep South African Americans

ObjectiveTo understand African Americans’ perceptions, barriers, and facilitators to recruitment, enrollment, adoption, maintenance, and retention in a nutrition and physical activity promotion program.DesignFour focus groups were conducted.SettingTwo community settings located in Jackson and Hattiesburg, Mississippi.ParticipantsParticipants (n = 28) were aged 18–50 years.Main Outcome Measure(s)Barriers and facilitators associated with healthy eating, physical activity, achieving a healthy weight, and participation in a health behavior change program.AnalysisA conventional thematic content analysis approach includes data familiarization, initial code generation, initial theme generation, themes review, and team review for finalization of themes.ResultsMajor themes related to health behaviors and participation in a behavior change program were identified by participants, including time constraints, costs, social support, consistency and self-efficacy, motivation for longevity and disease prevention, physical appearance, fear of injury/pain, social norms/stigma associated with outdoor physical activity, body criticism from family members, and having empathic and validating program staff support.Conclusions and ImplicationsSeveral social determinants of health were identified as essential considerations for promoting healthy nutrition and physical activity behaviors among African American adult Mississippians. Cultural and spiritual implications were also identified. Study insights inform policy approaches for designing culturally appropriate health behavior change programs in the Deep South.     

<Emphasis Type="Italic">Healthy Eating and Harambee</Emphasis>: Curriculum Development for a Culturally-Centered Bio-Medically Oriented Nutrition Education Program to Reach African American Women of Childbearing Age

The purpose was to develop, implement and evaluate a peer-led nutrition curriculum Healthy Eating and Harambee that addresses established objectives of maternal and infant health and to shift the stage for African American women of childbearing age in Genesee County toward healthier dietary patterns using a socio-cultural and biomedical orientation. The PEN-3 model, which frames culture in the context of health promotion interventions, was integrated with the Transtheoretical Model to guide this 13-week pre-test/post-test curriculum. Materials developed included soul food plate visuals, a micronutrient availability worksheet, a fruit stand, and gardening kits. Learning activities included affirmations, stories, case-scenarios, point-of-purchase product recognition, church health teams, and community health fairs. We investigated health-promoting dietary behaviors (consumption of more fruits and vegetables (F&V), serving more F&V to their families, and moderating dietary sodium and fat intakes), and biomedical behaviors (self-monitoring blood pressure and exercising) across five stages of change. Session attendance and program satisfaction were assessed. N = 102 women participated (mean age = 27.5 years). A majority (77%) reported adopting at least one healthy eating behavior (moderating sodium, serving more F&V to their families), 23% adopted at least two such behaviors (reading food labels for sodium; using culinary herbs/spices; serving more F&V to their families), and 45% adopted both dietary (moderating sodium; eating more fruits) and biomedical behaviors. Participants and facilitators favorably evaluated the curriculum and suggested improvements. A multi-conceptual approach coupled with cultural and biomedical tailoring has potential to promote young African American women’s movement to more advanced stages of change and improve self-efficacy for fruit and vegetable intake, dietary sodium moderation, and self-monitoring blood pressure and physical activity.     

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.     

Position of The American Dietetic Association: Nutrition Standards For Child-Care Programs

It is the position of The American Dietetic Association (ADA) that all child care programs should achieve recommended standards for meeting children's nutrition and nutrition education needs in a safe, sanitary, supportive environment that promotes healthy growth and development. Over the past 3 decades there has been steady growth in the use of center-based child care arrangements. At the same time, trends in child health have shifted the emphasis in child nutrition programs from the prevention of dietary deficiencies to the promotion of healthful food practices for prevention of chronic diseases. Therefore, the implementation of high standards for nutrition and nutrition education in child care settings today will have major impact on the health of Americans in the future. This position provides guidance to health care practitioners, day-care providers, and parents regarding menu adequacy and planning, food preparation, foodservice, food safety, and nutrition education for children in day care centers. The provision of a safe and pleasant environment will promote the acquisition of healthful eating habits for children that will prevent disease and enable growth and development. J Am Diet Assoc. 1999;99:981–988.     

Using a cultural framework to assess the nutrition influences in relation to birth outcomes among African American women of childbearing age: application of the PEN-3 theoretical model

The purpose is to present the process and results of focus groups conducted to access information for the design of a healthy eating curriculum to reduce maternal nutritional risks and enhance protective factors among African American women in relation to birth outcomes. Sixteen younger (19 to 25 years) and 20 older African American women (45 to 60 years), respectively, participated. The PEN-3 model, (Airhihenbuwa, 1995, 1999) guided the focus groups. Most women stated that culture and family relationships impacted their food choices. Younger women expressed creativity with recipes and presented a desire to be more involved with preparing foods. Older women expressed eagerness to teach family-centered culinary skill-building classes. Both groups of women acknowledged time and budget barriers, identified the prevalence of lactose intolerance, and recognized that large grocery stores that offered food variety were not located in their community. Health professionals are encouraged to consider these findings while designing interventions targeting young African American women's nutrition in relation to birth outcomes.     

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.     

Novel diet for patients with impaired mastication evaluated by consumption rate,nutrition intake,and questionnaire

Objective“iEat^®” (EN Otsuka Pharmaceutical Co. Ltd.; study diet), a food product that resembles an ordinary meal in appearance but is cooked to soften, was compared with foods provided to patients with impaired mastication (modified traditional diet) to investigate the influence of the appearance of foods on the consumption rate, dietary nutrition intake, and satisfaction level.MethodsAfter serving the study participants the modified traditional diet on days 1 and 2, the study diet on days 3, 4, and 5, and the modified traditional diet on days 6 and 7, the consumption rates were measured by weight difference. The amounts of dietary nutrition intake were calculated from the consumption rates. Satisfaction levels were evaluated by a questionnaire completed by the participants and their health care professionals after each meal.ResultsNo significant difference in consumption rates was observed between the study diet and the modified traditional diet. The amounts of dietary nutrition intake of energy and protein were significantly higher for the study diet than for the modified traditional diet. The study diet showed higher satisfaction levels in terms of “appearance” when evaluated by the participants, and “joy of eating” and “overall satisfaction level” when evaluated by the health care professionals.ConclusionThe study diet has potential to become a new dietary option for patients with impaired mastication.     

Evaluation of dietary behaviors of preschool children in Seoul and Gyeonggi-do associated with the level of parents' health consciousness: using nutrition quotient for preschoolers (NQ-P)

BACKGROUND/OBJECTIVESThis study aimed to assess the dietary behaviors of preschool children using the nutrition quotient for preschoolers (NQ-P) and analyzed the difference in the scores of the children''s dietary behaviors in regards to the parents'' health consciousness.SUBJECTS/METHODSThe subjects were 257 children aged 3–5 years and their parents residing in Seoul and Gyeonggi-do, South Korea. The questionnaire is composed of demographic characteristics, the NQ-P questions, and health consciousness. All data were statistically analyzed by SPSS program (ver. 25.0) and the statistical differences in variables were evaluated by χ² test, Fisher''s exact test, t-test, 1-way analysis of variance and Tukey''s multiple comparison test.RESULTSThere was a significant difference on the intake frequency of processed meat by region and fast foods by age, region, and weight status (P < 0.05). There was also a significant difference in not moving around while eating by weight status and parents'' effort to have healthy eating habits by sex (P < 0.05). The mean score of NQ-P of the total subjects was 59.47, which was within the medium-low grade. The mean score of balance was 61.62, and the boys were significantly higher than girls (P < 0.05). As the age of children increased, the mean score of the moderation was significantly decreased (P < 0.05). The scores of NQ-P (P < 0.05), balance (P < 0.01), and environment (P < 0.05) were significantly higher in the high group of parents'' health consciousness than the low group.CONCLUSIONSAccording to the results of the evaluation by NQ-P, the dietary behaviors of preschoolers residing in Seoul and Gyeonggi-do need to be improved. For improving their eating behavior and nutritional health status, parents and children need customized nutrition education programs based on sex, age, region and weight status of preschool children as well as the degree of parents'' health consciousness.     

Nahrungsmittelnachfrage, Ernährungsqualität und die rolle von ernährungsbezogenen Einstellungen und Wissen

The determinants of eating behavior in Germany are analysed, using the National Food Consumption Survey. In addition to income and sociodemographic variables, attitude and knowledge variables related to nutrition and health are included. First, the relationship between these variables and the demand for selected foods is investigated. Based on the consumption of various foods, indicators of dietary quality are established and the impact of the above mentioned variables on dietary quality is analysed. The results reveal a significant influence of sociodemographic as well as attitude and knowledge variables. Among others the educational attainment and attitudes towards a healthy nutrition were significant determinants of the eating behavior. The results are helpful in identifying sociodemographic groups whose eating patterns are of special concern and they also give some indications where nutrition education programs could be aimed at.     

Using the RE-AIM Framework in Formative Evaluation and Program Planning for a Nutrition Intervention in the Lower Mississippi Delta

ObjectiveIdentification of prominent themes to be considered when planning a nutrition intervention using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.DesignQualitative formative research.SettingWomen's social and civic organizations in the Lower Mississippi Delta.ParticipantsThirty-seven (5 white and 32 black) women with a college degree or higher.Phenomenon of InterestImpact of dietary and contextual factors related to the Lower Mississippi Delta culture on intervention planning.AnalysisCase analysis strategy using question-by-question coding.ResultsMajor themes that emerged were “healthy eating focus” and “promoting a healthy lifestyle” when recruiting organizations (Reach); “positive health changes” as a result of the intervention (Effectiveness); “logistics: time commitment, location, and schedule” to initiate a program (Adoption); “expense of healthy foods” and “cooking and meal planning” as barriers to participation (Implementation); and “resources and training” and “motivation” as necessary for program continuation (Maintenance). The “health of the Delta” theme was found across all dimensions, which reflected participants' compassion for their community.Conclusions and ImplicationsResults were used to develop an implementation plan promoting optimal reach, effectiveness, adoption, implementation, and maintenance of a nutrition intervention. This research emphasizes the benefits of formative research using a systematic process at organizational and individual levels.     

Life dissatisfaction and eating behaviors among older African Americans: The protective role of social support

Objectives

To examine (a) the influences of life dissatisfaction and dietary social support on eating behaviors (a high-fat diet and fruit/vegetable consumption) of older African Americans and (b) the moderating role of perceived dietary social support on the association between their life dissatisfaction and unhealthy eating behaviors.

Design

Baseline data from a larger intervention study of mid-life and older African Americans. The study incorporated a quasi-experimental design with random selection of participants, stratifying for age and gender.

Setting

Six churches in North Florida.

Participants

One hundred and seventy-eight (132 females and 46 males with a median age of 60) older African Americans.

Measurements

A structured questionnaire elicited personal data as well as information on eating behaviors, life dissatisfaction, and perceived dietary social support.

Results

Older African Americans with more cumulative life adversity, as reflected by high life dissatisfaction, had significantly poorer eating behaviors including the consumption of a high-fat diet and low intake of fruits and vegetables. Older African Americans?? dietary choices were also associated with their perceived social support. More importantly, perceived social support acted as a buffer to mitigate the influence of life dissatisfaction on older African Americans?? eating behaviors.

Conclusion

Life dissatisfaction places older African Americans at risk for unhealthy eating behaviors. However, high levels of dietary social support can protect older African Americans from the influence of life dissatisfaction on unhealthy eating behaviors. There are practical implications of this research for health interventions and programming.     

Position of the American Dietetic Association: local support for nutrition integrity in schools

It is the position of The American Dietetic Association that the school and community have a shared responsibility to provide all students with access to high-quality foods and nutrition services as an integral part of the total education program. Educational goals, including the nutrition goals of the National School Lunch Program and the School Breakfast Program, should be supported and extended through school district policies that create an overall school environment with learning experiences that enable students to develop lifelong, healthful eating habits. Local school policy, developed through a collaborative process that responds to community needs and priorities, should include the integration of the school nutrition program with education. Nutrition integrity policy provides a framework for the integration and coordination of all aspects of the school nutrition program. Nutrition integrity is defined as “a guaranteed level of performance that ensures that all foods available and consumed by children in schools are consistent with the Recommended Dietary Allowances and the Dietary Guidelines for Americans, and contribute to the development of lifelong, healthy eating habits.” Achieving nutrition integrity means taking a comprehensive approach to program planning, management, operations, and integration of nutrition into the total education program of the school. The community is a valuable resource for this effort. Collaboration between key school- and community-based constituents, including children and other stakeholders, will result in the most effective and relevant plans for local school nutrition programs. However, competing and profit-making food and beverage sales may create a conflicting environment and can contradict lessons taught in health and nutrition education. This position provides direction for the dietetics profession for addressing this issue along with providing a suggested action plan for local schools and their communities. J Am Diet Assoc. 2000;100:108-111.     

The food consumption patterns and perceptions of dietary advice of older people

Background Prevention policies do not have an upper age limit, and as the overwhelming majority of older people continue to reside in the community there is a growing role for community dietetics and primary care team members in the promotion of healthy eating.
Method The multi-method project ascertained the dietary beliefs and practices of older people residing in high-income, low-income and rural localities of Scotland. One hundred and fifty-two people aged 75 years and over were interviewed using a semistructured interview schedule and 24-h food recall questionnaire.
Results An analysis of the food recall questionnaire demonstrated that the diets of the elderly appear to differ little from the Scottish population as a whole. In all groups there was an under consumption of fruits and vegetables reported. Findings from the interviews demonstrated that dietary beliefs were found to be firmly rooted in childhood and lifetime experiences. Participants defined healthy eating as 'proper meals', 'proper foods', and a variety of foods eaten in moderation. These definitions were based upon the consumption of fresh foods which would be considered healthy. Changing and conflicting advice on health and nutrition was contrasted with personal experiences. Few knew of the role of the dietitian or community dietitian.
Conclusions This study demonstrates a contrast between stated beliefs and actual consumption patterns. Access to food, and the cost and quality of foods impacted upon food practices. The role of the community dietitian should be promoted. Advice on healthy eating must work with contemporary practices and beliefs building upon positive aspects of diet and eating and involving the food industry, retail sector and health services.     

A Qualitative Study: Perceived Barriers and Facilitators to Nutrition Standard Adherence by In-home Childcare Providers

BackgroundThe Child and Adult Care Food Program (CACFP) nutrition standards may present food purchasing, preparation, and feeding challenges for caregivers of young children.ObjectiveTo elucidate perceived barriers and facilitators faced by in-home childcare providers to following the CACFP food and beverage nutrition standards.DesignVirtual, semistructured individual interviews elicited perceptions from a cross section of low-income, in-home childcare providers in Michigan.Participants/settingsTwenty childcare providers of various races, ethnicity, urban and rural residence, and licensure status.AnalysisThematic coding analysis with NVivo (ver12.0) to organize and interpret data.ResultsFour primary barriers to adhering to the CACFP nutrition standards emerged including (1) noncompliant food preferences of children and providers; (2) higher cost and lower availability of CACFP-approved items; (3) celebrations and food rewards; (4) excessive time and effort needed to prepare foods and beverages, especially with dietary restrictions for some children. Ten perceived facilitators included (1) using nutrition education available through community organizations; (2) finding convenient and easy ways to prepare foods and beverages; (3) using CACFP and Special Supplemental Nutrition Program for Women, Infants, and Children guidelines and funding; (4) increasing variety of foods and beverages by using a menu or recalling items recently served; (5) modeling eating healthful foods and encouraging sampling of new foods and beverages; (6) mixing preferred foods/beverages with less preferred; (7) using nutrition information available from social media and from peers; (8) allowing children to choose foods and beverages; (9) serving the same eligible food and beverages to all children; and (10) provider concern about impact of foods and beverages on children’s health and behavior.ConclusionsResults from this study can inform nutrition education from community organizations that occurs in tandem with CACFP sponsor organizations. In addition, they can be utilized to address state-level licensure regulations and quality improvement rating systems that include nutrition standards childcare providers are encouraged or required to follow.     

Designing social marketing strategies to increase African Americans' access to health promotion programs

This qualitative study explored four key factors--source, message, channel, and target--for linking at-risk African Americans with health promotion programs. Among the findings from focus group discussions was that the use of the African American church to involve at-risk African Americans in health promotion programs may actually function as a barrier for some individuals. The study also suggests that use of a high profile person to deliver a message may be counterproductive to efforts to motivate people to use health promotion programs. The significance of these and other findings for designing more effective social marketing strategies to increase at-risk African Americans' access to health promotion programs are discussed.