Peer Reviewed: Improving Fruit and Vegetable Consumption: Use of Farm-to-Consumer Venues Among US Adults

Improvements to the food environment including new store development and more farm-to-consumer approaches (ie, farmers'' markets, roadside stands, pick-your-own produce farms, or community-supported agriculture programs) may aid Americans in making healthier dietary choices. We analyzed data from a subset of respondents (N = 1,994) in the National Cancer Institute''s Food Attitudes and Behaviors Survey, a mail survey of US adults. We determined associations between primary grocery shoppers'' region and sociodemographic characteristics and frequency of purchasing fruits and vegetables in the summer from farm-to-consumer venues. A little more than one-quarter (27%) of grocery shoppers reported a frequency of at least weekly use of farm-to-consumer approaches. Older adults and respondents who live in the Northeast were most likely to shop farm-to-consumer venues at least weekly, and no differences were found by sex, race/ethnicity, education, or annual household income. These findings suggest that farm-to-consumer venues are used by many Americans and could be expanded to increase access to fruits and vegetables.     

Peer Reviewed: Fruit and Vegetable Pricing by Demographic Factors in the Birmingham,Alabama, Metropolitan Area, 2004-2005

Introduction

Fruit and vegetable cost may influence consumption. Because the contextual environment influences food outlet type and availability, we wanted to determine whether neighborhood demographics were associated with prices of fruits and vegetables.

Methods

We surveyed 44 grocery stores in the Birmingham, Alabama, metropolitan area to determine prices of 20 fruits and vegetables. Stores were geocoded and linked to the corresponding Census 2000 block group to obtain data for the independent variables — percentage African American, percentage with at least a high school diploma, and percentage of households below the poverty level. We conducted multiple linear regressions to estimate these predictors for each fruit and vegetable''s mean price per serving during 2 seasons (fall/winter 2004, spring/summer 2005).

Results

In the fall, we found no significant relationships between the predictors and prices of any fruits and vegetables in the survey. In the spring, the percentage who had at least a high school diploma was a predictor of price per serving for potatoes (β = 0.001, P = .046).

Conclusion

Neighborhood demographics have little consistent influence on fruit and vegetable prices in Birmingham, Alabama, which may be a function of grocery store density, transportation patterns, and shopping patterns. The regional setting of the food environment has implications for food availability, variety, and price.     

Peer Reviewed: Assessing Retail Fruit and Vegetable Availability in Urban and Rural Underserved Communities

Introduction

Fruits and vegetables (F&Vs) are important parts of a healthy, balanced diet. Consumption of F&Vs is low among residents of socioeconomically disadvantaged communities. We investigated and compared retail F&V availability in urban and rural underserved communities in New York State.

Methods

All food retail stores and farmers'' markets (N = 263) in downtown Albany and in Columbia and Greene counties in New York State were visited and surveyed. Food stores were classified as F&V stores if they stocked more than the minimum varieties of fresh F&Vs defined by this study and as fruit-for-snack stores if they had ready-to-eat fruits only. Store density per 10,000 residents was calculated as a standardized measure of F&V availability. Adjustment weights were created to incorporate store size and business hours into the analysis.

Results

The weight-adjusted density (per 10,000 residents) of F&V stores was 4.6 in Albany''s minority neighborhood (reference category), 11.4 in Albany''s racially mixed neighborhood (P = .01), 7.8 in Columbia and Greene counties'' rural community (P = .10), and 9.8 in Columbia and Greene counties'' small-town community (P = .02). Significant differences were not found in fruit-for-snack stores, which ranged from 2.0 per 10,000 in the mixed neighborhood to 3.4 per 10,000 in the rural community.

Conclusion

The urban minority neighborhood had the most barriers to fresh F&Vs in retail outlets, even when compared with the rural community. The low availability of retail F&Vs in the minority neighborhood was attributed to the lack of supermarkets and not the absolute lack of food stores. Public health intervention strategies to increase retail F&V availability in urban minority neighborhoods may aid in mitigating these disparities.     

Household Supplemental Nutrition Assistance Program Participation is Associated With Higher Fruit and Vegetable Consumption

ObjectiveExamine whether differences were present by Supplemental Nutrition Assistance Program (SNAP) participation in dietary patterns, achievement of dietary recommendations, and food security for children (aged 7–18 years) receiving free/reduced-price school meals.MethodsCross-sectional study. Caregiver–child dyads at a pediatric clinic completed validated surveys. Food security, dietary patterns, and achievement of dietary recommendations were compared between child SNAP participants/nonparticipants.ResultsAmong 205 caregivers, 128 (62.4%) reported SNAP participation. Percentages of child SNAP participants/nonparticipants meeting recommendations were largely nonsignificantly different and overwhelmingly low. Supplemental Nutrition Assistance Program participants reported higher mean daily servings of vegetables (P = 0.01) and fruits (P = 0.01) than nonparticipants. Caregiver-reported household food security was not significantly different between SNAP participants and nonparticipants (P = 0.44).Conclusions and ImplicationsIn this study, child-reported fruit/vegetable intakes were significantly higher among SNAP participants than nonparticipants, suggesting child SNAP participants may experience small but noteworthy benefits related to fruit/vegetable consumption. Additional supports are needed to achieve dietary recommendations.     

Peer Reviewed: Factors Associated With Cervical Cancer Screening in Puerto Rico

Introduction

Racial/ethnic disparities in cervical cancer screening exist in the United States; rates are lowest among women who live in Puerto Rico. We identified factors associated with cervical cancer screening among women aged 18 years or older living in Puerto Rico.

Methods

We included women who participated in the Puerto Rico Behavioral Risk Factor Surveillance System in 2006 who had not had a hysterectomy (n = 2,206). We calculated the weighted population prevalence estimates of Papanicolaou (Pap) test screening in the past 3 years and used logistic regression models to assess factors associated with screening.

Results

Most participants (71.9% [95% confidence interval (CI)Most participants (71.9% [95% confidence interval (CI) = 69.4%-74.4%]) reported having had a Pap test in the preceding 3 years. Factors associated with screening in multivariate analysis included routine checkup in the past year and leisure-time physical activity. Compared with women with a household income less than $15,000, those with higher incomes were more likely to have had a Pap test. Similarly, divorced or separated women were more likely to have been screened (odds ratio [OR] = 1.13; 95% CI = 1.12-1.15) than those who were married/living together. We did not find associations between screening behavior and education, health care coverage, body mass index, or smoking status.

Conclusion

The prevalence of cervical cancer screening in Puerto Rico is below the 90% recommendation established by Healthy People 2010. Our findings regarding factors associated with Pap screening behavior identified population subgroups who are underscreened and who may benefit from targeted interventions and screening programs.     

Peer Reviewed: Behavioral Risk Factors Associated With Overweight and Obesity Among Older Adults: the 2005 National Health Interview Survey

Introduction

Obesity is associated with coronary heart disease, stroke, certain cancers, hypertension, and type 2 diabetes. Concern about obesity among older adults is growing, and research to examine behaviors associated with risk for increased weight in this population is needed. We examined differences by sex in behaviors associated with overweight and obesity among older adults (aged ≥50 years).

Methods

We analyzed data from the 2005 National Health Interview Survey using logistic regression to predict the likelihood of overweight (body mass index [BMI], 25.0-29.9 kg/m²) and obesity (BMI ≥30.0 kg/m²) relative to healthy weight (BMI, 18.5-24.9 kg/m²) among older adults. We used self-reported weights and heights. Correlates were risk behaviors for chronic disease (smoking status, alcohol intake, consumption of fruits and vegetables, leisure-time physical activity, walking for leisure, walking for transportation, and strength training).

Results

Among older men, the prevalence of overweight was 46.3%, and the prevalence of obesity was 25.1%. Among older women, the prevalence of overweight was 33.4%, and the prevalence of obesity was 28.8%. In adjusted logistic regression models, sex differences were observed in the significance of most risk factors for overweight and obesity. Men who were occasional, light, or moderate drinkers were 28% more likely to be obese than men who were nondrinkers; women who were heavy drinkers were 55% less likely to be obese than women who were nondrinkers. Compared with men and women who were regularly active during leisure time, inactive men were 39% more likely to be obese, and inactive women were 28% more likely to be obese.

Conclusion

Several risk behaviors for chronic disease appear to be associated with overweight and obesity among older adults. Modification of these behaviors has the potential to reduce weight.     

Peer Reviewed: Perceptions of Individual and Community Environmental Influences on Fruit and Vegetable Intake, North Carolina, 2004

Introduction

Increases in obesity and other chronic conditions continue to fuel efforts for lifestyle behavior changes. However, many strategies do not address the impact of environment on lifestyle behaviors, particularly healthy dietary intake. This study explored the perceptions of environment on intake of fruits and vegetables in a cohort of 2,479 people recruited from 22 family practices in North Carolina.

Methods

Participants were administered a health and social demographic survey. Formative assessment was conducted on a subsample of 32 people by using focus groups, semistructured individual interviews, community mapping, and photographs. Interviews and discussions were transcribed and content was analyzed using ATLAS.ti version 5. Survey data were evaluated for means, frequencies, and group differences.

Results

The 2,479 participants had a mean age of 52.8 years, mean body mass index (BMI) of 29.4, and were predominantly female, white, married, and high school graduates. The 32 subsample participants were older, heavier, and less educated. Some prevalent perceptions about contextual factors related to dietary intake included taste-bud fatigue (boredom with commonly eaten foods), life stresses, lack of forethought in meal planning, current health status, economic status, the ability to garden, lifetime dietary exposure, concerns about food safety, contradictory nutrition messages from the media, and variable work schedules.

Conclusion

Perceptions about intake of fruits and vegetables intake are influenced by individual (intrinsic) and community (extrinsic) environmental factors. We suggest approaches for influencing behavior and changing perceptions using available resources.     

Peer Reviewed: Sociodemographic and Health Characteristics Associated With Attempting Weight Loss During Pregnancy

Introduction

Approximately 40% of women of childbearing age report that they are attempting to lose weight. No professional medical organization recommends attempting to lose weight during pregnancy because of the possible risks to both mother and baby. Since half of all pregnancies are unintended, women may attempt to lose weight before they know they are pregnant, and some women may continue or initiate weight loss attempts even after they know they are pregnant. This study examines the extent to which pregnant women report attempting to lose weight and associated sociodemographic and health characteristics.

Methods

We used aggregated multiple-year data (1996-2003) from the Behavioral Risk Factor Surveillance System to assess the prevalence of attempting to lose weight among pregnant women and the extent to which sociodemographic and health characteristics are associated with the behavior.

Results

The prevalence of attempting to lose weight during pregnancy was 8.1%. Attempting to lose weight during pregnancy was associated with age 35-44 years, Hispanic ethnicity, obesity, alcohol consumption, and mental distress during the previous month.

Conclusion

A substantial proportion of pregnant women attempt to lose weight. Preconception and prenatal care should include counseling women to achieve a healthy weight before becoming pregnant, to maintain healthy weight during pregnancy, and not to attempt weight loss during pregnancy. Further research should be conducted to understand how attempting weight loss during pregnancy translates into dietary change and weight loss and associated maternal and fetal outcomes.     

Peer Reviewed: Lay Representations of Cancer Prevention and Early Detection: Associations With Prevention Behaviors

Introduction

The Common Sense Model of illness representations posits that how people think about an illness affects how they try to prevent the illness. The purpose of this study was to determine whether prevention representations vary by cancer type (colon, lung, and skin cancer) and whether representations are associated with relevant behaviors.

Methods

We analyzed data from the Health Information National Trends Survey (HINTS 2005), a nationally representative survey of American adults (N = 5,586) conducted by telephone interview.

Results

Respondents reported that all 3 types of cancer can be prevented through healthy behaviors; however, fewer did so for colon cancer. More respondents reported screening as a prevention strategy for colon cancer than did so for lung or skin cancer. Representations were associated with colon cancer screening, smoking status, and sunscreen use.

Conclusion

Representations of cancer were associated with relevant health behaviors, providing a target for health messages and interventions.     

Peer Reviewed: Risky Behaviors Among Ohio Appalachian Adults

This article describes the prevalence of risky behaviors known to be associated with increased cancer morbidity and mortality among Ohio Appalachian adults. These behaviors, or risk factors, include: 1) tobacco use; 2) energy imbalance (involving poor diet, obesity, and physical inactivity); and 3) sexual behaviors. We report current estimates of the prevalence of these behaviors among Ohio Appalachian adult residents and review social, psychological, and biological variables associated with these risky behaviors. We also present recent empirical studies that have been completed or are in progress in Ohio Appalachia. Finally, we discuss how these studies help bridge well-documented gaps in the literature.     

Agricultural Experiences Are Positively Associated With High School Students' Fruit and Vegetable Perceptions and Consumption

Objective

To examine the relationship between high school students' agricultural experiences and their (1) attitudes about consuming local fruits and vegetables, (2) willingness to try new fruits and vegetables, and (3) fruit and vegetable consumption.

Peer Reviewed: School Lunch Source and Adolescent Dietary Behavior

Introduction

As rates of childhood obesity rise, the nutritional content of lunches eaten at school is more heavily scrutinized. We examined the association between dietary behaviors and the number of days that adolescents bring lunch to school.

Methods

We analyzed cross-sectional data for 2,774 adolescents who responded to the 2005 California Health Interview Survey and reported dietary behaviors for a weekday.

Results

In bivariate analyses, adolescents who typically brought their lunch from home 5 days per week ate fast food on fewer occasions; consumed fewer servings of soda, fried potatoes, and high-sugar foods; and ate more fruit and vegetables compared with adolescents who never brought their lunch to school. In linear regressions controlling for demographics, body mass index, desire to change weight, parent education, and adult presence after school, students who typically brought their lunch to school 5 days per week ate fast food 0.35 fewer times and consumed 0.35 fewer servings of soda, 0.10 fewer servings of fried potatoes, 0.25 fewer servings of high-sugar foods, and 0.95 more servings of fruit and vegetables per day compared with students who never brought their lunch to school.

Conclusion

These findings suggest that adolescents who bring lunch to school from home have more positive dietary behaviors than do adolescents who get their lunches from other sources. Improving the nutritional quality of foods offered from other sources, such as the National School Lunch Program and competitive foods, could help improve adolescent dietary behaviors.     

Peer Reviewed: Fast-Food Consumption and Obesity Among Michigan Adults

Introduction

Consumption of meals eaten away from home, especially from fast-food restaurants, has increased in the United States since the 1970s. The main objective of this study was to examine the frequency and characteristics of fast-food consumption among adults in Michigan and obesity prevalence.

Methods

We analyzed data from 12 questions about fast-food consumption that were included on the 2005 Michigan Behavioral Risk Factor Survey, a population-based telephone survey of Michigan adults, using univariate and bivariate analyses and multivariate logistic regression, and compared these data with data on Michigan obesity prevalence.

Results

Approximately 80% of Michigan adults went to fast-food restaurants at least once per month and 28% went regularly (≥2 times/wk). Regular fast-food consumption was higher among younger adults (mostly men) but was not significantly associated with household income, education, race, or urbanicity (in a multivariate framework). The prevalence of obesity increased consistently with frequenting fast-food restaurants, from 24% of those going less than once a week to 33% of those going 3 or more times per week. The predominant reason for choosing fast food was convenience. Although hypothetically 68% of adults who go to fast-food restaurants would choose healthier fast-food items when available, only 16% said they ever use nutritional information when ordering.

Conclusion

The prevalence of fast-food consumption is high in Michigan across education, income, and racial groups and is strongly associated with obesity. Making nutritional information at fast-food restaurants more readily available and easier to use may help consumers to order more healthful or lower-calorie items.     

Peer Reviewed: Intention to Seek Care for Symptoms Associated With Gynecologic Cancers, HealthStyles Survey, 2008

Introduction

Women with ovarian cancer typically experience symptoms before diagnosis; such symptoms for other gynecologic cancers have not been systematically studied. We investigated which symptoms of gynecologic cancers prompt intention to seek care among women and whether demographic differences in intention exist. This study was undertaken, in part, to inform development of the Centers for Disease Control and Prevention''s campaign, Inside Knowledge: Get the Facts About Gynecologic Cancer.

Methods

We analyzed the 2008 HealthStyles dataset (n = 2,991 women), an annual, cross-sectional, national mail survey. We calculated weighted percentages of women who indicated an intention to seek care for symptoms (defined as intention to call or see a doctor) by demographic characteristics and level of concern about developing a gynecologic cancer. We evaluated independent predictors of intention to seek care for each symptom.

Results

For most symptoms, more than 50% of women reported an intention to seek care. Greater percentages of women indicated an intention to seek care for symptoms clearly gynecologic (eg, 91%, postmenopausal bleeding) than for symptoms not clearly gynecologic (eg, 37%, feeling full after eating a small amount). For most symptoms, after adjustment, black women, postmenopausal women, and women with greater concern about developing gynecologic cancers were more likely than their counterparts to intend to seek care.

Conclusion

Intention to seek care differed by race, menopausal status, and level of concern about developing a gynecologic cancer. These findings will help in developing messages to educate women about the array of gynecologic and nongynecologic cancer symptoms.     

Factors Associated with Fruit and Vegetable Consumption among Women Participating in WIC

Objective The purpose of this analysis was to assess to what extent sociodemographic and psychosocial characteristics predict consumption of fruits and vegetables in women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).Design Baseline survey data were analyzed for women enrolled in the Maryland WIC 5 A Day Promotion Program, a study sponsored by the National Cancer Institute. Sociodemographic variables included age, race, education, marital status, working status, pregnancy status, and smoking status. Psychosocial variables included self-efficacy, knowledge, attitudes, social support, and perceived barriers to consuming 5 or more servings daily of fruits and vegetables.Subjects/setting Analyses are based on 3,122 women enrolled at 15 WIC sites in Baltimore and 6 counties in Maryland.Statistical analyses performed Because psychosocial characteristics were measured on different scales and varied in dispersion, we standardized scores for these variables. Multiple regression analyses were then performed to assess contributions of the sociodemographic variables and the standardized psychosocial variable scores to the variance in consumption of fruits and vegetables.Results Sociodemographic variables were not powerful predictors of fruit and vegetable consumption. In contrast, an increase of 1 standard deviation in self-efficacy resulted in a mean increase of 0.76 servings, and an increase of 1 standard deviation in perceived barriers resulted in a decrease of 0.50 servings. About 21% of the variance in consumption was explained by all of the variables examined.Applications Dietitians and intervention programs should focus on increasing clients’ self-efficacy, positive attitudes, and knowledge relating to fruits and vegetables while trying to reduce perceived barriers to consumption of fruits and vegetables. J Am Diet Assoc. 1998;98:1141-1148.     

Dietary Intake of Phytonutrients in Relation to Fruit and Vegetable Consumption in Korea

The purpose of this study was to provide baseline data for health policy creation by estimating phytonutrient intake and identifying major food sources of phytonutrients. Dietary recall data collected in the 2008 Korea National Health and Nutrition Examination Survey and phytonutrient database of the Korea National Academy of Agricultural Science were used in this study. The proportions of the population satisfying recommended dietary guidelines for fruits and vegetables were estimated, and phytonutrient intake was compared between populations who consumed the recommended intake and those who did not. The study found that 5.3% of subjects satisfied the recommended fruit and vegetable intake. In particular, the proportions of adolescents (13 to 18 years of age) and young adults (19 to 39 years of age) meeting the recommended fruit and vegetable intake were lower than other age groups (P<0.001). Intakes of major carotenoids (alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein/zeaxanthin, and lycopene), flavonoids (anthocyanidins, hesperitin, quercetin, catechin, and isoflavones), and one phenolic compound (gallic acid) were significantly higher (P<0.001) among subjects who met the recommendations for fruit and vegetable consumption compared with those who did not. Carrots, sweet potatoes, squash, tomatoes, and watermelons were found to be major sources of carotenoids. Flavonoids were mainly obtained from persimmons, mandarins, apples, grapes, onions, soybeans, and chestnuts. However, one or two food items contributed to nearly all intake of each phytonutrient, suggesting a lack of variety. In conclusion, the Korean population needs to consume a larger quantity and variety of fruits and vegetables.