Jennifer Di Noia

Application of the transtheoretical model to fruit and vegetable consumption among economically disadvantaged African-American adolescents: preliminary findings.

Purpose. To examine the application of the transtheoretical model (TTM) to fruit and vegetable consumption among economically disadvantaged African-American adolescents. Methods. Scales for measuring decisional balance, situational self-efficacy, and processes of change for fruit and vegetable consumption were developed and pretested with 57 economically disadvantaged African-American adolescents. The scales and measures for assessing stages of change, demographic variables, and fruit and vegetable consumption were administered to a separate sample of 262 participants. t-tests for independent samples and analysis of variance were used to examine differences in TTM variables and fruit and vegetable consumption across stages of change. Results. Two-factor solutions for decisional balance and processes of change and a three-factor solution for situational self-efficacy provided the best fit to the data. Alpha coefficients of reliability for the scales ranged from .77 (experiential change processes) to .91 (pros). Participants in action-maintenance stages evidenced higher pros, self-efficacy, and fruit and vegetable consumption and significantly lower cons than did participants in precontemplation and contemplation-preparation stages. Also, participants in action-maintenance stages used processes of change more frequently than did those in precontemplation-contemplation-preparation stages. The use of experiential and behavioral processes within these stages did not differ significantly, as posited. Discussion. Observed differences in TTM variables and fruit and vegetable consumption by stage of change in this sample of economically disadvantaged African-American adolescents were consistent with theory and previous applications of the model to fruit and vegetable consumption in adults. With replication studies, the TTM may be appropriate for designing interventions to increase fruit and vegetable consumption among this population.

Computer-Mediated Intervention Tailored on Transtheoretical Model Stages and Processes of Change Increases Fruit and Vegetable Consumption Among Urban African-American Adolescents

Purpose. To examine the efficacy of an intervention based on the transtheoretical model (TTM) for increasing fruit and vegetable consumption among economically disadvantaged African-American adolescents. Design. Pretest-posttest quasi-experimental study. Setting. Youth services agencies located in New York, New Jersey, and Pennsylvania. Agencies were assigned to computer intervention (CIN) and nonintervention control study arms. Subjects. A total of 507 African-American adolescents ages 11 to 14 years. Intervention. Youths in the CIN arm completed four 30-minute intervention sessions tailored on TTM stages and processes of change. Measures. Self-reported fruit and vegetable consumption and stages, pros, cons, and self-efficacy for consumption. Analysis. Intervention effects were examined with analysis of covariance models that were controlled for demographic variables and baseline measures of each outcome. Chi-square analyses were used to examine between-arm differences in youths stage progressions. Results. After adjustment by covariates, pros (p < .025) and fruit and vegetable consumption (p < .001) varied significantly with study arm. Youths in the CIN arm had higher pro scores and fruit and vegetable consumption than controls. More youths in the CIN arm than in the control arm progressed to later stages and maintained recommended intake levels (p < .05). Conclusions. A TTM-based intervention can increase fruit and vegetable intake and effect positive changes in TTM variables related to intake among economically disadvantaged African-American adolescents.

GENDER-SPECIFIC HIV PREVENTION WITH URBAN EARLY-ADOLESCENT GIRLS: OUTCOMES OF THE KEEPIN' IT SAFE PROGRAM

This study evaluates the efficacy of Keepin It Safe, a theory-based, gender-specific, CD-ROM-mediated HIV prevention program for urban, early adolescent girls. Intervention effects were examined in a randomized, pretest-posttest wait-list control-group design. Changes in HIV/AIDS knowledge, protective attitudes, and skills for reducing HIV risk-related sexual behaviors were tested using linear regression models that were controlled for baseline values of each outcome. Recruited through youth services agencies located in the greater New York City area, study participants comprised 204 adolescent girls aged 11-14 years. Girls exposed to Keepin It Safe, relative to wait-list control girls, increased their HIV/AIDS knowledge, perceived efficacy and enjoyment of abstinence, perceived efficacy and enjoyment of condoms, and sexual assertiveness, suggesting that a theory-based, gender-specific, CD-ROM-mediated HIV prevention program can enhance knowledge, protective attitudes, and skills for reducing HIV risk-related sexual behaviors among urban early-adolescent girls.

Use of a Brief Food Frequency Questionnaire for Estimating Daily Number of Servings of Fruits and Vegetables in a Minority Adolescent Population

The validity of the 5 A Day for Better Health Program food frequency questionnaire (5 A Day FFQ) for estimating fruit and vegetable consumption was examined in a sample of 156 African-American adolescents aged 10 to 14 years. To determine validity, the correlation between 5 A Day FFQ fruit, juice, and vegetable intake and 3-day intake measured by direct observation was assessed. Correlations were calculated separately by food type (ie, fruits, juices, and vegetables) and sex and age to determine whether the accuracy of youths recording differed based on these factors. Paired-samples t tests were used to test for differences between 5 A Day FFQ and observed intake estimates. The ability of the 5 A Day FFQ to correctly classify youths according to intake level (ie, intake of five or more daily servings) was also examined. The 5 A Day FFQ intake was significantly correlated with observed intake (r=0.39; P<0.01). Correlations were weaker by food type (r=0.15 to r=0.28) and did not differ based on youths sex or age. Mean 5 A Day FFQ intake (6.74+/-6.00 servings) was considerably higher than mean observed intake (5.41+/-1.51 servings), and this was a result of the overestimation of vegetable intake. Sensitivity, specificity, and positive and negative predictive values of the 5 A Day FFQ were 67.1%, 68.6%, 63.5%, and 71.9%, respectively. Findings suggest that the 5 A Day FFQ may be more useful as a screening tool for identifying African-American adolescents most in need of intervention than for estimating youths mean intake in dietary intervention programs.

Dietary fat intake among urban, African American adolescents

This study examined commonly consumed high-fat food sources to estimate dietary fat intake among 314 urban, African American adolescents (mean age (SD)=12.57 (.98) years; 66% female; 91% African American non-Hispanic; and 9% African American Hispanic). Youths fat intake was measured using the Block Fat Screener. Most (77%) participants had diets very high in fat (i.e., 40% to 50% of energy). Mean frequencies of consumption revealed youths preferences for the following high-fat food items: corn chips, potato chips, popcorn, and crackers; fried chicken; and doughnuts, pastries, cake, and cookies. Total fat intake differed based on youths age. Urban, African American adolescents can benefit from intervention to lower their fat intake. Programs that target and address the food preferences and eating habits of this population are clearly needed.

Indicators of Gender Equality for American States and Regions: An Update

This paper describes the methods and datasources used to update state-level indicatorsof economic, political, and legal genderequality originally developed by Sugarman andStraus (1987). Indicators were combined tocreate an updated version of the GenderEquality Index and relevant subscales. Preliminary evidence of the internalconsistency reliability and construct validityof the updated measure is presented. Acomparison of state rankings for the originaland updated versions of the Gender EqualityIndex reveal that there continue to bestatistically significant differences betweenU.S. states and regions in the degree of genderequality observed but there is evidence of atrend toward greater homogeneity among states. Scores on the overall index have not increasedsubstantially in states identified as having ahigh degree of gender equality previously. Instead, the most dramatic increases areoccurring in states characterized by lowerlevels of gender equality previously. Despiteincreases observed among states, the medianscore of 62 on the Updated Gender EqualityIndex reveals that in the typical Americanstate, women have achieved less than two-thirdsof what is needed to have equality with men.This paper describes the methods and datasources used to update state-level indicatorsof economic, political, and legal genderequality originally developed by Sugarman andStraus (1987). Indicators were combined tocreate an updated version of the GenderEquality Index and relevant subscales. Preliminary evidence of the internalconsistency reliability and construct validityof the updated measure is presented. Acomparison of state rankings for the originaland updated versions of the Gender EqualityIndex reveal that there continue to bestatistically significant differences betweenU.S. states and regions in the degree of genderequality observed but there is evidence of atrend toward greater homogeneity among states. Scores on the overall index have not increasedsubstantially in states identified as having ahigh degree of gender equality previously. Instead, the most dramatic increases areoccurring in states characterized by lowerlevels of gender equality previously. Despiteincreases observed among states, the medianscore of 62 on the Updated Gender EqualityIndex reveals that in the typical Americanstate, women have achieved less than two-thirdsof what is needed to have equality with men.

Criterion validity and user acceptability of a CD-ROM-mediated food record for measuring fruit and vegetable consumption among black adolescents

OBJECTIVESnTo determine the criterion validity and user acceptability of the Healthy Eating Self-Monitoring Tool (HEST), a CD-ROM-mediated food record for measuring fruit and vegetable consumption among economically disadvantaged black adolescents.nnnDESIGNnItem intakes, daily intake measures of fruit, vegetables and juices, and daily and total fruit and vegetable intake assessed with the HEST over a 3 d interval were compared with observed intake using Spearman correlations and Wilcoxon signed ranks tests. Mean ratings of participants interest in, enjoyment of and likelihood of recommending the HEST to peers were compared with an a priori criterion rating for establishing user acceptability of the HEST.nnnSETTINGnYouth services agencies in New York City.nnnSUBJECTSnEighty-nine black adolescents aged 11 to 14 years.nnnRESULTSnSpearman correlations were significant for 67 % of items, for daily intake measures of fruit (days 1 and 3), vegetables and juices (days 1 and 2), and for fruit and vegetable intake (all three days). Wilcoxon signed ranks tests found non-significant intake differences for 78 % of these items, for daily intake measures of fruit and vegetables, and for fruit and vegetable intake (days 2 and 3). HEST-recorded 3 d intake of 14.65 servings was significantly correlated with and did not differ significantly from observed 3 d intake of 15.21 servings. Youths HEST-recorded intake was accurate to within 0.56 of a serving of their observed intake. Mean ratings of the HEST were above the criterion rating across user acceptability dimensions assessed.nnnCONCLUSIONSnThe HEST is a promising food record approach that is acceptable to youths.

Drug abuse risk and protective factors among black urban adolescent girls : A group-randomized trial of computer-delivered mother-daughter intervention

A group-randomized design tested a mother-daughter intervention in which researchers aimed to increase protective factors in a community sample of Black urban adolescent girls. Girls and their mothers at 2 community agencies were pretested and, by agency, were randomized to either an intervention arm or a control arm. Intervention arm girls and their mothers received a program for improving mother- daughter rapport. Posttest data collected 3 weeks after program delivery revealed that intervention arm mothers and daughters improved more than did control arm mothers and daughters on measures of communication and closeness. At 3-month follow-up, intervention arm mothers, relative to control arm mothers, continued to report better communication with and closeness to their daughters. Girls and mothers in the intervention arm rated the computer program favorably on parameters of enjoyment, comfort, relevance, usefulness of information, improvements to their relationship with one another, and whether they would recommend the computer program to friends.

Fat avoidance and replacement behaviors predict low-fat intake among urban African American adolescents

Using measures of behaviors shown to predict low-fat intake in previous research, this study examined whether the behaviors would predict low-fat intake among urban African American adolescents. Recruited through youth services agencies in Philadelphia, Pa, participants were 399 African American adolescents (67% female subjects) with a mean age of 13.09 years (range, 10-15 years). Fat-related dietary behaviors were measured using items that were adapted from the Food Habits Questionnaire. Fat intake was measured using the Block Fat Screener. Spearman correlations examined the relationships between fat-related dietary behaviors and fat intake. Seven behaviors were significantly associated with low-fat intake: had chicken that was baked or broiled instead of fried; ordered pasta or pizza served without meat sauce or meat toppings; had a vegetarian dinner; used low-calorie instead of regular salad dressing; ate at least 2 vegetables (not green salad) at dinner; ate bread, rolls, or muffins without butter or margarine; and avoided foods that were fried in oil, shortening, or lard. Using multiple regression, fat intake was regressed on the linear combination of demographic variables and these fat-related dietary behaviors. The regression equation accounted for 17% of the variance in fat intake (adjusted R(2) = 0.13). Fat avoidance (ate bread, rolls, or muffins without butter or margarine) and replacement (ordered pasta or pizza served without meat sauce or meat toppings) behaviors were significant predictors of low-fat intake. Dietary interventions to lower fat intake among urban African American adolescents should promote the adoption of these behaviors.