Elizabeth Fries

Development and Reproducibility of a Brief Food Frequency Questionnaire for Assessing the Fat, Fiber, and Fruit and Vegetable Intakes of Rural Adolescents

OBJECTIVE To describe the systematic development and reproducibility of a food frequency questionnaire (FFQ) designed to meet the specific research requirements of the Goals for Health cancer prevention intervention program for rural middle school children. DESIGN A 4-step process was used to develop a brief FFQ for scoring intakes of total fat, fiber, and fruits and vegetables. The resulting questionnaire consisted of 25 food frequency items and 10 supplemental questions. Reproducibility of the questionnaire was determined by comparing responses at the beginning and end of a 4-month interval. SUBJECTS Study subjects were sixth- and seventh-grade students attending middle schools in rural areas of Virginia and upstate New York. Seventh-grade students participated in the pilot study, and sixth-grade students participated in the reproducibility study. The final version of the FFQ was completed twice by 539 sixth graders. After exclusions for missing and unreliable data, the usable sample size was 415. Boys were somewhat more likely than girls to be excluded for missing data. African-American students comprised 32% of the population. STATISTICAL ANALYSES PERFORMED Each food frequency item was associated with 3 scores--a fat score, a fiber score, and a combined score for the number of servings of fruits and vegetables. Means and standard deviations were determined for nutrient variables, differences between repeat administrations were tested for significance by paired t test, and Pearson correlation coefficients were calculated for nutrients and for individual food items. RESULTS Correlation coefficients for nutrient scores were 0.58 for fat, 0.49 for fiber, and 0.51 for fruits and vegetables. For individual food items, correlations ranged from 0.24 to 0.59 (mean=0.41). APPLICATIONS/CONCLUSIONS Using a systematic approach to developing a study-specific FFQ for rural adolescents is feasible. Further, the reproducibility of the Goals for Health questionnaire was demonstrated for the 3 nutrient scores it was designed to measure. This developmental approach may be readily adapted to other populations, study designs, and nutrients of interest. The validity of the questionnaire remains to be tested.

Stereotypes associated with a low-fat diet and their relevance to nutrition education

Two experiments and one correlational study were conducted to examine the nature and consequences of stereotypes of persons who eat either low-fat or high-fat diets. In Study 1, 132 college students were asked to describe the personal characteristics of a typical male or female peer who was associated with one of three diet characteristics (high-fat diet, low-fat diet, or no diet description). For Study 2, personal characteristics attributed to persons who eat either a low-fat or a high-fat diet that were obtained in Study 1 were converted into rating scales. In the second study, 164 participants were asked to rate one of six target personalities that were created by combining the three diet and two gender conditions (eg, a man who eats high-fat foods). These two studies revealed that both desirable and undesirable personal characteristics are attributed to individuals who eat high-fat diets and to those who eat low-fat diets. Persons eating low-fat diets were described and rated as being self-centered and fastidious students, whereas persons eating high-fat diets were described as being more easy going and more likely to attend parties. However, persons who eat low-fat foods were also described more favorably as being physically fit and attractive. In Study 3, we examined the relationship between stereotypes of persons who eat low-fat diets and reactions to a widely used cancer prevention booklet in a group of 177 undergraduates.(ABSTRACT TRUNCATED AT 250 WORDS)

Results of a rural school-based peer-led intervention for youth: goals for health.

BACKGROUND School-based interventions are critical for enhancing the health of youth. The Goals for Health (GFH) school-based project was a goal-setting and life-skills intervention conducted in rural areas to increase self-efficacy, knowledge, and positive behaviors related to healthy eating. The intervention was peer-led with high school students teaching health and life skills to sixth-grade students. The purpose of this study was to examine the impact of the GFH school-based program on healthy eating outcomes related to self-efficacy, attitudes, knowledge, and behavior, and to examine the impact of quality of program implementation on the above outcomes. METHODS Twenty-three rural schools in Virginia (15) and New York (8) participated in the study. Twelve of the schools were intervention schools that received the 12-week GFH program. The remaining 11 were wait-list control schools. Sixth graders (n = 2120 baseline) from all schools were surveyed at 4 time points (preintervention, postintervention, 1 and 2 year follow-up). RESULTS Results included significant change patterns across the 4 assessment points in the predicted direction for healthy eating-related self-efficacy and fat and fiber knowledge. No significant change patterns were found at follow-up for fat, fiber, or fruit and vegetable intake. Results also indicated differences across gender and ethnicity and significant findings related to quality of implementation. CONCLUSIONS Future interventions need to provide opportunities to practice healthy living skills over an extended period of time, include components that focus on contextual change in the school and the family, and monitor program implementation.

Effects of dietary fat feedback on behavioral and psychological variables

This paper reports on the immediate and delayed reactions to dietary fat consumption feedback. Subjects in our study received (1) personalized dietary fat feedback and (2) information about how to alter their fat consumption. Fat consumption was measured using a brief fat assessment instrument. Subjects were categorized into three risk groups: at or below, above, and significantly above the recommended level. Emotional, cognitive, and behavioral reactions were measured immediately after receiving feedback and at 1 month postfeedback. Subjects who received high fat feedback showed greater negative emotional distress in response to the feedback and stated that they knew less about high-fat foods than subjects receiving lower feedback. By the 1-month follow-up, subjects in the highest feedback condition were least likely to report intentions to lower their dietary fat. Interventions designed to alter dietary fat consumption should take into account the emotional and cognitive consequences of risk factor feedback.

Gail model risk assessment and risk perceptions.

Patients can benefit from accessible breast cancer risk information. The Gail model is a well-known means of providing risk information to patients and for guiding clinical decisions. Risk presentation often includes 5-year and lifetime percent chances for a woman to develop breast cancer. How do women perceive their risks after Gail model risk assessment? This exploratory study used a randomized clinical trial design to address this question among women not previously selected for breast cancer risk. Results suggest a brief risk assessment intervention changes quantitative and comparative risk perceptions and improves accuracy. This study improves our understanding of risk perceptions by evaluating an intervention in a population not previously selected for high-risk status and measuring perceptions in a variety of formats.

Racial and gender differences in the diets of rural youth and their mothers.

OBJECTIVE To examine mother-child dietary concordance that may contribute to healthy eating practices critical to cancer prevention in underserved rural families. METHODS A brief food frequency questionnaire was administered to 404 sixth-graders and their mothers in rural Virginia and New York. RESULTS Significant dietary fat concordance rates were indicated for mother-daughter dyads only. A 3-way interaction revealed that African American girls with mothers who report high fat intake are at highest risk for health-compromis ing dietary behaviors. CONCLUSIONS Interventions may need to differ entially motivate male and female adolescents and incorporate familial and cultural influences to pro mote healthy eating in rural youth.

Fruit and Vegetable Dietary Behavior in Response to a Low-Intensity Dietary Intervention: The Rural Physician Cancer Prevention Project

CONTEXT Increased fruit and vegetable intake can reduce cancer risk. Information from this study contributes to research exploring health disparities in high-risk dietary behavior. PURPOSE Changes in fruit and vegetable behavior were evaluated to assess the effects of a low-intensity, physician-endorsed dietary intervention in a rural population. METHODS The study was a randomized trial of 754 patients from 3 physician practices in rural Virginia. Low-literacy nutrition education materials and personalized dietary feedback were administered by mail and telephone. Mixed model analysis of variance was used to determine the effect of the intervention on fruit and vegetable intake behavior, knowledge, intentions, and self-efficacy at 1, 6, and 12 months. FINDINGS The intervention effect was moderated by age, race, sex, and education. Intake at 1 and 6 months was increased for older and younger participants and those with some college, and further maintained at 12 months by those who did not complete high school. African Americans in the intervention group displayed significantly greater intentions to increase fruit/vegetable intake than whites/others. Knowledge of fruit/vegetable recommendations significantly increased in the intervention group at 12 months, particularly for men. CONCLUSIONS For the rural population, a low-intensity physician-endorsed self-help dietary intervention was successful in initiating fruit and vegetable dietary changes at 1 and 6 months post-intervention, and increasing intentions to change in African Americans. The relationship of the moderating effects of age, race, sex and education need to be further explored in relation to dietary intervention and dietary behavior change for the rural population.

Rural adolescent attitudes toward smoking and weight loss : Relationship to smoking status

Perceptions that smoking contributes to weight loss are widespread among youth. We examined the association between weight loss and smoking to determine whether supportive attitudes were associated with smoking status and whether this is a particular problem in rural areas. High school students (N=730) completed a survey assessing smoking-related characteristics and behaviors. Attitudes assessed included perceptions of whether weight concerns were the reasons others smoke and personal beliefs about tobaccos effect on weight gain. Smoking status was categorized as never (44%), experimental (42%), and current (14%). Multinomial logistic regressions investigated relationships between attitudes and smoking, adjusting for weight goals, gender, ethnicity, parent/peer smoking, and body mass index. Both attitudinal measures were associated with smoking (p< .05). Nonsmokers and experimental smokers were more likely than current smokers to believe that people smoke to lose weight. Although current smokers were less likely to report that others smoke for weight control, they believed they would gain weight if they quit. Conversely, nonsmokers and experimental smokers were less likely to believe they would gain weight if they do not smoke compared with current smokers. Thus personal attitudes differ from attitudes toward others with respect to weight loss and smoking. Moreover, endorsement of these attitudes can reliably distinguish current versus experimental smokers and may help better clarify the transition to current smoker. Because weight concerns are a significant factor in youth smoking, these issues should be included in intervention efforts, particularly in rural communities where smoking rates are higher and age at initiation is earlier.

The effect of accuracy of perceptions of dietary-fat intake on perceived risk and intentions to change

Consumption of excess fat increases risk for many health problems and diseases. In the present study, 188 undergraduate students were studied to understand self-perceptions of dietary-fat intake and the impact of those perceptions. Findings indicated that the majority of participants had inaccurate perceptions about the amount of fat in their diets. Further, compared to people who overestimated dietary-fat intake, people who underestimated fat intake had lower perceived risk of cancer, had lower intentions to change, and demonstrated less knowledge about the dietary-fat content of many foods. Findings suggest that this unrealistic underestimation of fat intake is a cognitive barrier to dietary change and people who underestimate dietary fat intake may require more intensive intervention to change their diets.

Cancer prevention in rural youth: teaching goals for health: the pilot.

BACKGROUND The Goals for Health project is designed to change the cancer-related behaviors of tobacco use and dietary fat and fiber consumption. The intervention teaches health and life skills to rural, minority sixth and seventh graders in rural Virginia and New York. This article presents the results of the pilot. METHODS Participants were 129 sixth graders at one rural middle school who were surveyed prior to and following delivery of the pilot sixth-grade intervention. RESULTS Results include significant changes from pre- to post-intervention in several diet and smoking attitude and self-efficacy variables, dietary fat and fiber knowledge, high-fat snack consumption, and dietary fat scores. Multivariate analyses reveal important contributions of personal control over food choices and family and friend influence on change in dietary fat score from pre- to post-intervention. CONCLUSIONS These pilot program results suggest avenues for dietary and cancer prevention interventions in high-risk, rural adolescents.