Linda Nebeling

Psychosocial predictors of fruit and vegetable consumption in adults a review of the literature.

BACKGROUND Adequate fruit and vegetable intake has been found to promote health and reduce the risk of several cancers and chronic diseases. Understanding the psychological determinants of fruit and vegetable intake is needed to design effective intervention programs. METHODS Papers published in English from 1994 to 2006 that described the relationship between psychosocial predictors and fruit and vegetable intake in adults were reviewed. Studies and their constructs were independently rated based on the direction of significant effects, quality of execution, design suitability, and frequency. Methodology from the Guide to Community Preventive Services was used to systematically review and synthesize findings. RESULTS Twenty-five psychosocial constructs spanning 35 studies were reviewed (14 prospective and 21 cross-sectional/descriptive studies). Strong evidence was found for self-efficacy, social support, and knowledge as predictors of adult fruit and vegetable intake. Weaker evidence was found for variables including barriers, intentions, attitudes/beliefs, stages of change, and autonomous motivation. CONCLUSIONS The findings underscore the need to design future behavioral interventions that use strong experimental designs with efficacious constructs and to conduct formal mediation analyses to determine the strength of these potential predictors of fruit and vegetable intake.

Changes in vegetable and fruit consumption and awareness among US adults: Results of the 1991 and 1997 5 A Day for Better Health Program surveys

OBJECTIVE The purpose of this study is to assess population-based changes in vegetable and fruit consumption and psychosocial correlates. DESIGN Two nationally representative random digit dial surveys conducted in 1991 and 1997; respondents were queried regarding consumption of and attitudes and knowledge about vegetables and fruit. SUBJECTS/SETTING Respondents were 2,755 and 2,544 adults (in 1991 and 1997, respectively) older than 18 years. STATISTICAL ANALYSIS PERFORMED Vegetable and fruit consumption and message awareness were measured using weighted-only and regression model-adjusted analyses to assess changes. RESULTS Mean vegetable and fruit consumption was significantly (P=.007) higher in 1997 than in 1991 using weighted-only analyses, but remained significant only for Hispanic (P=.03) and nonsmoker (P=.004) subgroups when adjusted for demographic shifts. Significantly higher percentages were found in the model-adjusted analyses for those consuming 5 or more (daily servings (23.4% to 25.8%), message awareness (7.7% to 19.2%), and knowledge of the 5 A Day Program (2.0% to 17.8%). APPLICATIONS/CONCLUSIONS A significantly positive change in vegetable and fruit consumption occurred between 1991 and 1997 according to traditional methods of survey data analysis, but null findings resulted when the data were adjusted for demographic shifts. Nutrition professionals should continue targeting specific demographic subgroups with tailored interventions to move all Americans toward achievement of dietary guidelines for vegetable and fruit consumption.

Association of Awareness, Intrapersonal and Interpersonal Factors, and Stage of Dietary Change with Fruit and Vegetable Consumption: A National Survey.

Purpose. To examine associations of awareness, intrapersonal and interpersonal factors, and stage of change with consumption of fruits and vegetables. Design. Nationally representative, random digit dial survey conducted in 1997 with a response rate of 44.5%. Psychosocial correlates of fruit and vegetable consumption were assessed using regression analyses. Setting. United States. Subjects. A total of 2605 adults who were 18 years and older. Measures. Awareness of the “5 A Day for Better Health” program and its message, along with stage of change; taste preferences; self-efficacy; and perceived benefits, barriers, threats, social support, and norms related to fruit and vegetable consumption. Results. Awareness and intrapersonal and interpersonal factors explained 24% of the variance in fruit and vegetable consumption beyond the 9% explained by demographic characteristics. Knowledge of the 5 A Day message was associated with a 22% increase in fruit and vegetable consumption. Self-efficacy for eating fruits and vegetables and taste preferences (affect) were the factors most consistently and strongly associated with both higher consumption and higher likelihood of being in action or maintenance stages of change. Affect and perceived barriers were more strongly associated with increased vegetables and salad than fruit. Conclusions. Dietary intervention programs to increase fruit and vegetable consumption should emphasize the 5 A Day message, increased self-efficacy, and ways to make vegetables more palatable and easily accessible. Understanding the factors that influence dietary choices should be used when designing dietary interventions.

The Role of Obesity in Cancer Survival and Recurrence

Obesity and components of energy imbalance, that is, excessive energy intake and suboptimal levels of physical activity, are established risk factors for cancer incidence. Accumulating evidence suggests that these factors also may be important after the diagnosis of cancer and influence the course of disease, as well as overall health, well-being, and survival. Lifestyle and medical interventions that effectively modify these factors could potentially be harnessed as a means of cancer control. However, for such interventions to be maximally effective and sustainable, broad sweeping scientific discoveries ranging from molecular and cellular advances, to developments in delivering interventions on both individual and societal levels are needed. This review summarizes key discussion topics that were addressed in a recent Institute of Medicine Workshop entitled, “The Role of Obesity in Cancer Survival and Recurrence”; discussions included (i) mechanisms associated with obesity and energy balance that influence cancer progression; (ii) complexities of studying and interpreting energy balance in relation to cancer recurrence and survival; (iii) associations between obesity and cancer risk, recurrence, and mortality; (iv) interventions that promote weight loss, increased physical activity, and negative energy balance as a means of cancer control; and (v) future directions. Cancer Epidemiol Biomarkers Prev; 21(8); 1244–59. ©2012 AACR.

The collaboration readiness of transdisciplinary research teams and centers findings from the National Cancer Institute's TREC Year-One evaluation study.

Growing interest in promoting cross-disciplinary collaboration among health scientists has prompted several federal agencies, including the NIH, to establish large, multicenter initiatives intended to foster collaborative research and training. In order to assess whether these initiatives are effective in promoting scientific collaboration that ultimately results in public health improvements, it is necessary to develop new strategies for evaluating research processes and products as well as the longer-term societal outcomes associated with these programs. Ideally, evaluative measures should be administered over the entire course of large initiatives, including their near-term and later phases. The present study focuses on the development of new tools for assessing the readiness for collaboration among health scientists at the outset (during the first year) of their participation in the National Cancer Institutes Transdisciplinary Research on Energetics and Cancer (TREC) initiative. Indexes of collaborative readiness, along with additional measures of near-term collaborative processes, were administered as part of the TREC Year-One evaluation survey. Additionally, early progress toward scientific collaboration and integration was assessed, using a protocol for evaluating written research products. Results from the Year-One survey and the ratings of written products provide evidence of cross-disciplinary collaboration among participants during the first year of the initiative, and also reveal opportunities for enhancing collaborative processes and outcomes during subsequent phases of the project. The implications of these findings for future evaluations of team science initiatives are discussed.

Changes in Carotenoid Intake in the United States: The 1987 and 1992 National Health Interview Surveys

OBJECTIVES To assess the changes in carotenoid intake between 1987 and 1992 among US adults by sociodemographic characteristics and high-risk groups for chronic disease; and to identify the dietary sources of specific carotenoid intake. DESIGN A food frequency questionnaire (FFQ) was collected from a representative sample of respondents to the 1987 and 1992 National Health Interview Surveys throughout two calendar quarters. Black and white adults, 18 to 69 years old, participated in 1987 (n = 8,161) and 1992 (n = 8,341). METHOD FFQ data were matched and linked to the US Department of Agriculture-National Cancer Institute carotenoid food composition database for analysis. STATISTICAL ANALYSIS Mean differences in carotenoid intake over time were compared by sociodemographic characteristics and region of the country, after adjustment for sampling weights in a multiple linear regression model. RESULTS Mean intake of the carotenoid lutein declined among white women (18%), among adults aged 40 to 69 years (16%), among persons with 9 to 12 years of education (11%), among nondrinkers (18%), among drinkers of 1 to 6 alcoholic drinks/ week (7%), among smokers (former smokers by 11%, current smokers by 7%, and never smokers by 9%), among income groups (<

Evaluation of Three Short Dietary Instruments to Assess Fruit and Vegetable Intake: The National Cancer Institute's Food Attitudes and Behaviors Survey

20,000 by 7%, > or =

Influence of Using Different Sources of Carotenoid Data in Epidemiologic Studies

20,000 by 9%), and residents in the south and northeast (by 13% each, respectively). Mean intake of the carotenoid lycopene increased among white men (9%), among adults aged 18 to 39 years and aged 40 to 69 years (by 5% and 6%, respectively), among those with 13 years of education or more (12.5%), among alcohol drinkers (by 10% and 7% for 1 to 6 vs 7 or more drinks/week, respectively), among former and current smokers (by 6% each), among those with incomes > or =

ResearchOriginal ResearchEvaluation of Three Short Dietary Instruments to Assess Fruit and Vegetable Intake: The National Cancer Institute's Food Attitudes and Behaviors Survey

20,000 (8%), and among residents in the west (16%) and midwest (5%). All differences described were statistically significant (P < .01). APPLICATION The decline in lutein intake (from dark green leafy vegetables), particularly in white women, may have public health implications as a result of the recognized inverse association between carotenoid intake and disease risk.

The impact of lifestyle characteristics on carotenoid intake in the United States: the 1987 National Health Interview Survey.

BACKGROUND Fruit and vegetable (F/V) intake assessment tools that are valid, reliable, brief, and easy to administer and code are vital to the field of public health nutrition. OBJECTIVE To evaluate three short F/V intake screeners (ie, a 2-item serving tool, a 2-item cup tool, and a 16-item F/V intake screener) among adults using multiple 24-hour dietary recalls (24-hour recalls) as the reference instrument and evaluate test-retest reliability of the screeners across a 2- to 3-week time period. DESIGN Validity and reliability study. PARTICIPANTS/SETTING Two hundred forty-four adults for the validity study and 335 adults for test-retest reliability. STATISTICAL ANALYSES PERFORMED Median values for F/V intakes were calculated for the screeners and 24-hour recalls. The Wilcoxon signed rank test was used to compare screeners with the 24-hour recalls. Deattenuated Pearson correlations were reported for validity and intraclass correlation coefficient used for reliability. RESULTS The estimated median daily servings/cups of F/V for the 2-item serving screener was lower, for the 2-item cup screener was equivalent for men but higher for women, and for the 16-item F/V intake screener were about the same when compared with 24-hour recall values. The deattenuated correlations comparing the 24-hour recalls with the screeners were positive but weak for the 2-item serving screener, and were positive and moderate in strength for the 2-item cup and 16-item F/V intake screeners. The test-retest intraclass correlation coefficients were all positive and fairly strong for all of the screeners. CONCLUSIONS Although dietary screeners offer a more cost-effective, less burdensome way to obtain gross estimates to rank individuals with regard to F/V intake, these methods are not recommended for assessing precise intake levels.