Edward T. Sheehan

A Stage-of-Change Classification System Based on Actions and Beliefs Regarding Dietary Fat and Fiber

Purpose. The objectives of this study were to develop a stage-of-change classification system and to determine the degree to which various adult subgroups have adopted the behavioral changes necessary to achieve a low-fat and/or high-fiber diet as recommended by the Dietary Guidelines for Americans. Design. The study used a mail survey randomly sent to 7110 adults. Setting. The survey was conducted in 11 states and the District of Columbia. Subjects. The random sample included males and females over age 18. Of the eligible respondents, 3198 (51.5%) were included in this analysis, with 2004 and 2066 unambiguously classified into stages of change for fat and fiber, respectively. Measures. Stage of change was defined by an algorithm based on self-reported intent and behaviors to limit fat and/or increase fiber. Results. 45% of the respondents were classified as being in action/maintenance for fat and 38% for fiber. Women, older adults, individuals with advanced education, persons with diet-related chronic disease, people with higher levels of relevant nutrition knowledge and attitudes, and persons who indicated that health concerns were a primary influence on their diet were more likely to be in action/maintenance than other respondents. Conclusions. The algorithm in this study presents a model that more closely reflects the proportions of the adult population that have achieved low-fat diets and classifies a greater proportion in the preparation stage than classification systems in previous studies.

Food supplement use and related beliefs: survey of community college students

Abstract Food supplement use and related health beliefs were evaluated in 502 community college students from Arizona. Regular users (37%) were students who reported using supplements weekly or daily, while sporadic users (25%) reported taking supplements less than once per week; the remaining 38% were nonusers. The most popular supplements were vitamin C, multiple vitamins, multivitamins plus minerals, calcium, and vitamin E. Amino acids, garlic, aloe vera, yeast, and fish oil were the most popular unconventional supplements reported. Significantly more users than nonusers believed that food supplements increased pep and energy, reduced stress, were necessary to ensure proper nutrition, were needed if people felt tired and run down, and that vitamin C could prevent colds. The findings revealed that supplement use was prevalent among young adults and that supplement users perceived more health benefits of food supplements than nonusers.

Reported Adoption of Dietary Fat and Finer Recommendations Among Consumers

OBJECTIVE To identify constraints in adopting dietary fat and fiber recommendations. DESIGN A questionnaire was mailed to a sample of the general population, a convenience sample of persons with heart disease and cancer in 11 states, and registered dietitians in 5 states. The survey included questions on demographic and attitudinal factors that were correlated with specific practices to reduce fat intake and increase fiber intake. SETTING From the general population sample of 6,206 eligible respondents (return rate of 51.5%), those selected were respondents who indicated that they would adopt a dietary recommendation if it were good for them (n = 2,682). Subsamples from the general population were matched to 362 registered dietitians and 147 persons with cancer or heart disease on selected demographic variables. Factors associated with adoption of specific behaviors were identified. STATISTICAL ANALYSIS PERFORMED Statistical analysis included chi 2, factor analysis, and analysis of variance. RESULTS The majority of persons who said they would adopt a fat-reducing behavior if it were good for their health reported practicing that behavior often or usually. More than 60% reported consuming whole grains; however, only 15% reported eating fruits and vegetables frequently. Among the general population sample, those more likely to practice a behavior had the following characteristics: female, college educated, older than 60 years, white, higher income, no children younger than 18 years, perceived health status as excellent, and absence of chronic disease. Registered dietitians and those with chronic disease were also more likely to follow dietary fat and fiber recommendations. APPLICATIONS Nutrition education messages that lead to increased consumption of dietary fiber need to be developed. Nutrition educators should provide strategies for consumers for increasing use of fruits and vegetables in all meals. Good taste and convenience are critical components. The food industry may assist by providing a wider array of convenience entrees or side dishes that feature produce and whole grains.

Diet fat and fiber knowledge, beliefs and practices are minimally influenced by health status

Over 2700 subjects were surveyed to determine if a particular disease condition resulted in better knowledge, beliefs and dietary practices in relation to fat and fiber intakes. Using discriminant analysis, it appeared that the presence of disease conditions could affect these aspects of fat and fiber intake, but the contribution was minimal. General overall nutrition knowledge was lower for subjects reporting osteoporosis, and knowledge of specific facts about fiber was significantly lower in hypertensive and heart disease subjects. Dietary practices related to selection of high fat food was poorer in hypertensives than normotensives. Those with heart disease and hypercholesterolemia had better knowledge about fat than those without this condition. Only subjects with heart disease had more appropriate beliefs toward diet fat and health than did other subjects. Dietary practices appeared to be a factor for only two disease conditions. Subjects self-reporting elevated blood cholesterol levels had more appropriate fiber and fat practices, and diabetics had better diet fiber practices than others. Using multiple regression analysis, older subjects had lower fat and higher fiber intakes, whereas those with greater BMI had poorer diet practices with respect to fat and fiber. Furthermore, the analysis indicated that individuals with the belief that fat or fiber intake could affect health and well-being, and those with better nutrition knowledge, had better dietary practices.

A community-based feasibility study using wheat bran fiber supplementation to lower colon cancer risk.

METHODS In this feasibility study, free-living older adults (n = 180; means = 67.5 years old) were randomly assigned to one of three levels of a 3-month standardized compliance enhancement program. RESULTS Regarding subject compliance with the 18 g/day wheat bran fiber supplement, the high compliance enhancement group had a superior regimen compliance rate (88%) versus the medium and low groups, (66 and 29%, respectively) (P = 0.01), with similar attrition rates. CONCLUSION No significant gastrointestinal side effects and changes in body weight were reported. For similar efficacy, the comprehensive compliance enhancement group had the greatest cost effectiveness.

Vitamin and food supplement practices and nutrition beliefs of the elderly in seven Western states

Abstract A mail survey of 2,451 non-institutionalized subjects, including 595 sixty years or older living in seven Western state (Arizona, California, Colorado, Hawaii, New Mexico, Nevada and Washington) reported frequencies and factors associated with vitamin and mineral supplementation. Sixty percent of subjects over 60 years reported using one or more supplements with multiple vitamin, vitamin D and vitamin E being most frequently used (>50%). Reasons for use ranged from lack of vitamin in food to energy and/or tiredness. Sources of nutrition information cited most frequently were newspapers and books. The level of usage in the elderly is a major concern for health providers as well as the lack of information from professional resources.

Mineral supplementation practices of adults in seven western states

Seven western states (Arizona, California, Idaho, Nevada, New Mexico, Oregon, and Wyoming) were surveyed in 1986 to determine the extent of vitamin/mineral supplementation and dosage levels of single supplements. Questionnaires were mailed to 3,500 individuals. A 57.8% response rate was obtained from the deliverable surveys, with a sample size of 1,730. The sample consisted of 54% women and 46% men and was predominantly white (88.9%). Fifty-four percent of the sample consumed some type of supplement; multiple vitamin/minerals were consumed with the greatest frequency. For single supplements, vitamin C was reported with the greatest frequency (23.1%), followed by some type of calcium supplement (22.5%) and vitamin E (11.1%). More than 80% of the vitamin C users indicated a dosage of 250 mg/day. Most respondents consumed calcium dosages of less than 1,000 mg/day. For vitamin E, 75% of the users consumed more than 200 IU/day. The data suggest that the potential for toxicity due to excess supplementation levels exists in the western states studied.

Acceptability, Satisfaction and Cost of a Model-Based Newsletter for Elders in a Cancer Prevention Adherence Promotion Strategy

Though widely used by business, industry, academia, and social service agencies as a mass communication vehicle, the effectiveness of newsletters has received limited critical review. The sound research base needed to support the use of newsletters in cancer prevention interventions was not found in the literature. This article details the development, design, use and evaluation of a health behavior model-based monthly newsletter for participants in three community-oriented cancer prevention studies. Depending on the extent of behavior change asked of them, participants reported reading 60-100% of the content. Participants in the three different cancer prevention interventions perceived the newsletters to be informative, accurate, and interesting. Costing as little as

Prediction of calcium supplement use among college students: Application of the theory of reasoned action

0.36 per participant per issue, this strategy has implications for other types offield studies with similarly educated participants. The adherencepromotion strategy, of which the newsletters were a part, kept the participants in field studies long enough to test the study hypotheses and potentially improve their health, and reduce morbidity and mortality.

Contribution of diet versus supplements to selected nutrient intake in the western region

Abstract As part of a survey on vitamin and mineral food supplement use at Pima Community College (Tucson, AZ), 247 students were exposed to a pamphlet emphasizing the need for calcium throughout life. The Theory of Reasoned Action was then used as a model to predict intention to consume supplemental calcium. Attitudes were found to be significant predictors of behavioral intention. Normative influences (family, friends and physicians) were much less strong. The beliefs most predictive of attitude were that calcium would improve disease resistance and that it provided good value for the money. Other beliefs of importance to the students were that calciums use was scientifically based and that it contributed to a good diet. Intention to take supplemental calcium was highly correlated with user status: food supplement users were significantly more likely than non-users to report intention to take calcium. The findings indicate the utility of theory-driven research in nutrition. Using a model such as the Theory of Reasoned Action, individual beliefs and normative influences can be identified for target populations, facilitating the development of more appropriate nutrition education materials.