J. Lynne Brown

Marital interactions in the process of dietary change for type 2 diabetes.

OBJECTIVE To explore how couples adjust to dietary management of type 2 diabetes. DESIGN Couples were interviewed, first together and then separately, during the first year after diagnosis and 1 year later. SETTING Qualitative interviews conducted in hospital classrooms using a semistructured interview guide. PARTICIPANTS Couples (N = 20) with a recently diagnosed spouse who met the study criteria were purposefully selected from volunteers solicited from hospital-based diabetes classes. PHENOMENON OF INTEREST Processes used by the couple to address the prescribed diet. ANALYSIS Thematic analysis of interview transcripts using grounded theory to identify patterns of adaptation processes used over time. RESULTS Three couple categories emerged (cohesive, enmeshed, and disengaged), representing adaptation to the diabetic diet. Initially, 5 couples were cohesive (teamwork approach), 7 were enmeshed (nondiabetic spouse responsible for the diet; spouse was dependent), and 8 were disengaged (spouses functionally separate; spouse was solely responsible for the diet management). A year later, the majority of couples were disengaged (n = 14), 1 couple remained cohesive, and 4 couples remained enmeshed. Themes of flexibility, roles, rules, and communication varied across categories. CONCLUSIONS AND IMPLICATIONS Understanding categories of marital adjustment to the diabetic diet may improve nutrition-based diabetes interventions. Further study is needed to verify these findings in larger and more diverse populations.

Couples' Gender Role Preferences and Management of Family Food Preferences

OBJECTIVE To learn how couples stratified by gender role preference (GRP) manage food preferences. DESIGN One-time individual semistructured qualitative interview with each partner in a couple representing 1 of 3 GRP pairings. SETTINGS/PARTICIPANTS Volunteers were recruited using advertising and snowball sampling and met the criteria of both parents living at home, wife no older than 40 years, and at least one child under age 6 years and, if present, all others under age 18 years. Both partners in volunteer couples completed a 31-item GRP scale, and the scores of each partner were categorized as traditional (lowest 25% of possible scores), transitional (middle 50%), or egalitarian (top 25%). No traditional couples volunteered. A purposeful sample of 10 transitional and 10 egalitarian wives representing 20 couples was interviewed. VARIABLES MEASURED Each partner was asked how food preference patterns were established and how family member food preferences affect foods served at evening meals now. ANALYSIS Thematic content analysis, constant comparison, and consensus produced the final thematic analysis. RESULTS Transitional wives married to transitional husbands established a pattern of deference to the husbands preferences that could make alteration of food choices difficult. Egalitarian wives married to egalitarian husbands established a fairer pattern of balancing partners food preferences. CONCLUSIONS AND IMPLICATIONS Nutrition education for transitional and egalitarian couples should use different approaches.

Reliability of a short and long version of the Block food frequency form for assessing changes in calcium intake

We tested the reliability of a modified version of the Block 98-item food frequency questionnaire (FFQ) and a short 40-item FFQ derived from the Block form to estimate usual calcium intake. Ninety-eight female volunteers completed both forms three times during a 6-month period; forms were initially completed by participants at a group meeting (T1) and, subsequently, 2 months (T2) and 4 months (T3) later, by mail. Both mean total energy intake in kilocalories and mean calcium intake derived from the long FFQ dropped significantly between T1 and T2. The nutrient density variable, calcium per 1,000 kcal, did not vary significantly between administrations. Pearson correlation coefficients were most uniform for pairwise comparisons of calcium per 1,000 kcal at the three times. Mean calcium intake derived from the short FFQ did not vary significantly between administrations, and Pearson correlation coefficients ranged from .70 to .77 for paired comparisons. When using the long FFQ, the nutrient density variable, calcium per 1,000 kcal, was a more reliable measure of usual calcium intake than was calcium in milligrams. The short FFQ provided reliable estimates of usual calcium intake in milligrams and captured more than 75% of the calcium intake measured by the long FFQ.

Public reactions to information about genetically engineered foods: effects of information formats and male/female differences

Developing effective communication strategies to inform the public about genetic engineering applications in food production is critical for the successful commercialization and future development of the technology. However, few existing studies in the United States have examined how communication materials affect public understanding of new technologies. Our survey study examined the effect of two information formats developed according to public issue education principles on the public understanding of, interest in and attitude towards genetically engineered salmon. In addition, we examined male/female differences in attitude. Our results indicated that participants who read the “consequence” information learned more, expressed more interest, and indicated higher level of actual confidence in judgment than those who read the “perspective” information. Women were less approving of genetically engineered salmon than men were both before and after reading the information. Reading information led to a positive change in attitude although the effect size was not different between sexes. The male/female difference was likely due to womens higher level of concern about effects on humans and greater trust of environmental groups compared to mens. Suggestions for designing an effective print communication about a specific genetic engineering application are presented.

Family members' influence on family meal vegetable choices

OBJECTIVE Characterize the process of family vegetable selection (especially cruciferous, deep orange, and dark green leafy vegetables); demonstrate the usefulness of Exchange Theory (how family norms and experiences interact with rewards and costs) for interpreting the data. DESIGN Eight focus groups, 2 with each segment (men/women vegetable likers/dislikers based on a screening form). Participants completed a vegetable intake form. SETTING Rural Appalachian Pennsylvania. PARTICIPANTS Sixty-one low-income, married/cohabiting men (n = 28) and women (n = 33). ANALYSIS Thematic analysis within Exchange Theory framework for qualitative data. Descriptive analysis, t tests and chi-square tests for quantitative data. RESULTS Exchange Theory proved useful for understanding that regardless of sex or vegetable liker/disliker status, meal preparers see more costs than rewards to serving vegetables. Experience plus expectations of food preparer role and of deference to family member preferences supported a family norm of serving only vegetables acceptable to everyone. Emphasized vegetables are largely ignored because of unfamiliarity; family norms prevented experimentation and learning through exposure. CONCLUSIONS AND IMPLICATIONS Interventions to increase vegetable consumption of this audience could (1) alter family norms about vegetables served, (2) change perceptions of experiences, (3) reduce social and personal costs of serving vegetables, and (4) increase tangible and social rewards of serving vegetables.

Impact of a Nutrition Education Program to Increase Intake of Calcium-Rich Foods by Chinese-American Women

Chinese-American women have a high risk of osteoporosis. However, their calcium intake has been reported previously as considerably below the Dietary Reference Intake. Increasing consumption of calcium-rich foods, many of which are also fortified with vitamin D, is a safe way to increase their calcium and vitamin D intake. This studys objective was to pilot-test an intervention to help Chinese-American women incorporate calcium-rich foods into their diet. This intervention was evaluated using a quasi-experimental study with a nested design and pre-, immediate post-, and 3-month follow-up assessments. Calcium and vitamin D intake, Theory of Planned Behavior constructs, and knowledge were measured at three time points. First-generation Chinese-American mothers between 35 and 55 years old (n=141) were recruited from six weekend Chinese schools. Three Chinese schools each were randomly assigned to the experimental (n=71) or control group (n=70). The experimental group received a free heel scan and six weekly interactive lessons designed based on the Theory of Planned Behavior. The control group received six weekly nonrelated financial lessons by mail. Changes for each measure were assessed by linear mixed model with repeated measures adjusted for confounding variables. Compared to the control group, the experimental group improved all measures considerably, except two subjective norm constructs (normative belief and motivation to comply) at post-assessments. The experimental group significantly increased its baseline calcium (t=7.898, P<0.001) and vitamin D intake (t=6.609; P<0.001) at posttest and this increase was retained at follow-up. Results suggest that this theory-based intervention is effective for increasing the dietary calcium and vitamin D intake of Chinese-American women.

Gender role preference and family food chores.

OBJECTIVE To learn how couples stratified by gender role preference (GRP) manage food chores. DESIGN One-time, individual semistructured qualitative interview with each partner in a couple representing 1 of 3 GRP pairings. SUBJECTS/SETTINGS Volunteers were recruited using advertising and snowball sampling and met the criteria of (1) both parents living at home, (2) wife no older than 40, and (3) at least one child under age 6 and, if present, all others under age 18. Both partners in volunteer couples completed a 31-item GRP scale, and the scores of each partner were categorized as traditional (lowest 25% of possible scores), transitional (middle 50%), or egalitarian (top 25%). No traditional couples volunteered. A purposeful sample of 10 transitional and 10 egalitarian wives representing 20 couples were interviewed. VARIABLES MEASURED Each partner was asked to describe their current food chore responsibility, their opinion of the balance of responsibility, and how this role assignment had changed since first married. ANALYSIS METHODS USED: Thematic content analysis, constant comparison, and consensus produced the final thematic analysis. RESULTS Couples in which both partners were transitional assigned food chore responsibility primarily to accommodate the breadwinners role. Couples in which both partners were egalitarian used three different strategies to handle food chores. IMPLICATIONS Educators should consider the differences found when designing interventions for recently married couples and parents of young children.

Assessing the subsequent effect of a formative evaluation on a program

The literature on formative evaluation focuses on its conceptual framework, methodology and use. Permeating this work is a consensus that a program will be strengthened as a result of a formative evaluation although little empirical evidence exists in the literature to demonstrate the subsequent effects of a formative evaluation on a program. This study begins to fill that gap. To do this, we outline the initial program and formative evaluation, present key findings of the formative evaluation, describe how these findings influenced the final program and summative evaluation, and then compare the findings to those of the formative. The study demonstrates that formative evaluation can strengthen the implementation and some impacts of a program, i.e. knowledge and some behaviors. The findings also suggest that when researchers are faced with negative feedback about program components in a formative evaluation, they need to exercise care in interpreting and using this feedback.

Place of Dairy Products in the Chinese-American Family Food System

Chinese Americans have a high risk of osteoporosis and their calcium intake is substantially below the daily recommendation. However, little has been done to reduce the risk of this hard-to-reach population. This theory-based qualitative study explored how first-generation Chinese American couples with children view dairy products, how they use them in their family food system, and how these uses influence their dietary behavior or intake. Twenty couples, recruited from weekend Chinese schools at three locations in Pennsylvania, were interviewed. Taste, texture, and use of additives and growth hormones appeared to be more important influences on dairy choice than lactose intolerance. In these families, parental use of food rules and power to influence food patterns affected family flexibility about dairy use. Fathers power, his views of dairy products, and his preference for Chinese-based dinners had a greater influence than those of his wife or children on the use of dairy-based dinner dishes. In contrast, choices at breakfast or lunch and for snacks were more flexible and could include dairy products. Nutrition educators can encourage introduction of dairy products into the traditional dietary pattern of Chinese Americans by offering opportunities to taste unfamiliar dairy products, demonstrating use of dairy products to prepare familiar foods, including both parents in any intervention or at least in tasting recipes, and providing information on importance of calcium to bone health and amount of calcium needed from reputable sources.

Impact of a community-based intervention on serving and intake of vegetables among low-income, rural Appalachian families.

OBJECTIVE To evaluate the effectiveness of a community-based intervention promoting the serving and eating of deep-orange, cruciferous, and dark-green leafy vegetables. DESIGN Randomized, parallel-group, community-based intervention with a baseline/postintervention/3-month follow-up design. SETTING AND PARTICIPANTS Low-income food preparers (n = 50) and their partners (n = 50) in rural Appalachia Pennsylvania. INTERVENTION Experimental food preparers attended 8 weekly interactive lessons; control food preparers received 8 weekly mailings that included similar recipes and handouts. MAIN OUTCOME MEASURES Target vegetable intake and frequency of serving by experimental and control treatment groups and by high and low meal diary scores, a measure of recipe acceptability. ANALYSIS Linear mixed-model analysis with repeated measures. RESULTS No significant differences resulted between the original experimental and control treatment groups. When grouped by high and low meal diary scores, more experimental families had high scores than in controls. High scores were associated with significant changes in frequency of serving and intake of the target vegetables. CONCLUSIONS AND IMPLICATIONS Meal diary use may foster food preparer negotiation with partners and children to become involved in vegetable dish evaluation. Tools to help the trained food preparer draw family members into recipe evaluation, such as the meal diary, are useful and needed.