Alexandra E. Evans

Designing Effective Nutrition Interventions for Adolescents

By altering dietary behaviors, nutrition interventions during adolescence have the potential of affecting children at that time and later in life. The majority of interventions implemented in the teen years have occurred in schools, but other intervention sites have included after-school programs, summer camps, community centers, libraries, and grocery stores. Programs with successful outcomes have tended to be behaviorally based, using theories for the developmental framework; included an environmental component; delivered an adequate number of lessons; and emphasized developmentally appropriate strategies. One planning method that can be used in the development of nutrition interventions is Intervention Mapping. The steps of Intervention Mapping include conducting a needs assessment, developing proximal program objectives, mapping appropriate strategies and methods to address the objectives, planning the program design, planning program adoption and implementation, and evaluation. The use of intervention-planning techniques, coordination of nutrition and physical education interventions, using technological advances such as CD-ROMs, incorporation of policy changes into intervention efforts, and dissemination of effective programs are all trends that will influence the future development of effective nutrition programs for adolescents.

Factors of Fruit and Vegetable Intake by Race, Gender, and Age among Young Adolescents

OBJECTIVEnTo explore demographic differences in individual, social, and environmental factors potentially related to fruit and vegetable intake.nnnDESIGNnSelf-report questionnaires administered to a convenience sample of middle school students during regular classes.nnnPARTICIPANTSnBlack and white adolescents, 11 to 15 years of age (N = 736).nnnVARIABLES MEASUREDnMeasures included self-efficacy, family dinner frequency, normative beliefs, outcome expectations, modeling, availability, preferences, snack choice, and demographics.nnnANALYSISnChi-square, general linear models, and Poisson and linear regressions as appropriate.nnnRESULTSnBlack participants reported greater social influences than did white participants, whereas white adolescents reported greater family environmental influences on fruit and vegetable intake. The oldest adolescents reported lower self-efficacy, peer modeling, family dinner frequency, and fruit and vegetable preferences compared with younger adolescents. White participants and females reported a higher preference for vegetables than did black participants and males. Regression models for self-efficacy and snack choice explained 41% and 34% of the variance, respectively. Preferences for vegetables and parental modeling were the strongest correlates of self-efficacy. Self-efficacy was the strongest correlate of snack choice.nnnCONCLUSIONS AND IMPLICATIONSnDecreases in several factors with age highlight the importance of intervention for this age group. Future research is needed for a better understanding of the formation and modification of self-efficacy and snack choice.

Examining the Theory of Planned Behavior and the Construct of Self-Efficacy to Predict Mammography Intention:

This article examines the applicability of the Theory of Planned Behavior (TPB) with the addition of the selfefficacy construct in the understanding of the motivation to obtain an initial screeningmammogramamong Cypriot women. The study sample consisted of 293women aged 40 to 65 years, asymptomatic of breast cancer, and with no previous mammography experience. The study took place at the General Hospital of Nicosia in Cyprus. The results of the study provided support of the TPB with the addition of self-efficacy in an international setting. Self-efficacy was the strongest predictor of intention. Other predictors of intention included educational level, time of last clinical breast examination, and age. The study also provided some empirical support of the distinction between self-efficacy and perceived behavioral control. Researchers may want to include self-efficacy in addition to the TPB and other demographic characteristics in future applications to more fully explain behavioral outcomes.

Changing the home nutrition environment: Effects of a nutrition and media literacy pilot intervention

The specific aim for this pilot study was to evaluate the effectiveness of a nutrition and media literacy intervention targeting elementary students and their parents. The purpose of the intervention was to increase child fruit and vegetables (FV) consumption and change the home nutrition environment (measured with FV availability and accessibility and parental social support). During the intervention, students learned about nutrition, the role media plays in shaping values concerning nutrition, and developed a media campaign for their parents. A quasi-experimental research design was used to evaluate the effectiveness of the intervention. The media intervention was effective in changing the home environment.

Outcome expectations, barriers, and strategies for healthful eating: a perspective from adolescents from low-income families.

To better understand outcome expectations, barriers, and strategies for healthful eating, 5 structured focus groups were conducted with adolescents from low-income families (n = 48; 83% Black students; 10–14 years old). The focus group questions dealt with healthful eating in different settings: home, school, and other eating establishments. Results suggested that healthful eating is important to this population, but perceived barriers prevent the consistent consumption of healthful foods. Strategies suggested by participants to increase healthful eating (eg, parents and schools making healthy foods that look and taste good more available) should be considered when developing nutrition interventions for adolescents from low-income families.

Predicting adolescent risk behaviors based on an ecological framework and assets.

OBJECTIVESnTo examine the relationship between an aggregate risk score (smoking, drinking, and number of sex partners) and measures of youth assets in a sample of 3439 youth aged 14-18 years.nnnMETHODSnLinear regression models for African American and white males and females predicted an aggregate risk score.nnnRESULTSnAfter adjustments, the youth asset most predictive of risk was self/peer values regarding risk behaviors. Perceived school support was also predictive.nnnCONCLUSIONSnTaking an ecological approach to the measurement of adolescent health behaviors contributes to our understanding of these risk behaviors.

Cognitive motivations associated with screening mammography in Cyprus

BACKGROUNDnThis study examined the relationship between cognitive motivations, demographic characteristics, related preventive health behaviors, and intention to obtain a first screening mammogram among Greek Cypriot women.nnnMETHODSnThis cross-sectional study took place at the outpatient clinics of the General Hospital of Nicosia during the fall of 1999. The participants were 293 women asymptomatic of breast cancer and with no previous mammographic experience. The Theory of Planned Behavior in conjunction with the construct of self-efficacy was used in the development of the questionnaire. The assessment also included demographic information, practice of other preventive health behaviors, and knowledge of breast cancer screening.nnnRESULTSnSelf-efficacy was the most significant determinant of initial screening mammography, followed by normative beliefs associated with the physician, family and close friends, and perceived behavioral control beliefs related to barriers to obtaining a mammogram. Educational level, time of last clinical breast examination, and status of breast self-examination were also strongly implicated in the explanation of initial screening mammography.nnnCONCLUSIONSnInsights into specific salient motivational cognitions and certain demographic characteristics or related preventive health behaviors are crucial to the development and implementation of effective intervention strategies.

Increasing access to healthful foods: a qualitative study with residents of low-income communities

BackgroundInadequate access to healthful foods has been identified as a significant barrier to healthful dietary behaviors among individuals who live in low-income communities. The purpose of this study was to gather low-income community members’ opinions about their food purchasing choices and their perceptions of the most effective ways to increase access to healthful foods in their communities.MethodsSpanish and English focus groups were conducted in low-income, ethnically-diverse communities. Participants were asked about their knowledge, factors influencing their food purchasing decisions, and their perceptions regarding solutions to increase access to healthful foods.ResultsA total of 148 people participated in 13 focus groups. The majority of participants were female and ethnically diverse (63% Hispanic, 17% African American, 16% Caucasian, and 4% “other”). More than 75% of the participants reported making less than

Dietary practices of South Carolina adolescents and their parents.

1999 USD per month. Participants reported high levels of knowledge and preference for healthful foods. The most important barriers influencing healthful shopping behaviors included high price of healthful food, inadequate geographical access to healthful food, poor quality of available healthful food, and lack of overall quality of the proximate retail stores. Suggested solutions to inadequate access included placement of new chain supermarkets in their communities. Strategies implemented in convenience stores were not seen as effective. Farmers’ markets, with specific stipulations, and community gardens were regarded as beneficial supplementary solutions.ConclusionThe results from the focus groups provide important input from a needs assessment perspective from the community, identify gaps in access, and offer potential effective solutions to provide direction for the future.

Variables associated with fruit and vegetable intake in adolescents.

OBJECTIVEnTo assess and identify correlates of adolescents and parents compliance with food guide pyramid recommendations (FGPR) and weight-control behaviors (WCB).nnnMETHODSnData were collected from a random sample of adolescents (2,021) and parents (1,231) and were analyzed using multiple and logistic regression.nnnRESULTSnOnly 7% eight graders, 4% eleventh graders, and 3% parents met all FGPR. The most significant predictors of FGPR and WCB include knowledge, attitudes, and eating concerns. Extreme dieters were less likely and moderate dieters were more likely to meet recommendations.nnnCONCLUSIONnResults have relevance for developing nutritional programs for adolescents.