Marilyn S. Townsend

Goal Setting as a Strategy for Dietary and Physical Activity Behavior Change: A Review of the Literature

Objective. Estimate effectiveness of goal setting for nutrition and physical activity behavior change, review the effect of goal-setting characteristics on behavior change, and investigate effectiveness of interventions containing goal setting. Data source. For this review, a literature search was conducted for the period January 1977 through December 2003 that included a Current Contents, Biosis Previews, Medline, PubMed, PsycINFO, and ERIC search of databases and a reference list search. Key words were goal, goal setting, nutrition, diet, dietary, physical activity, exercise, behavior change, interventions, and fitness. Study inclusion and exclusion criteria. The search identified 144 studies, of which 28 met inclusion criteria for being published in a peer reviewed journal and using goal setting in an intervention to modify dietary or physical activity behaviors. Excluded from this review were those studies that (1) evaluated goal setting cross-sectionally without an intervention; (2) used goal setting for behavioral disorders, to improve academic achievement, or in sports performance; (3) were reviews. Data extraction and synthesis. The articles were categorized by target audience and secondarily by research focus. Data extracted included outcome measure, research rating, purpose, sample, sample description, assignment, findings, and goal-setting support. Results. Thirteen of the 23 adult studies used a goal-setting effectiveness study design and eight produced positive results supporting goal setting. No adolescent or child studies used this design. The results were inconclusive for the studies investigating goal-setting characteristics (n = 7). Four adult and four child intervention evaluation studies showed positive outcomes. No studies reported power calculations, and only 32% of the studies were rated as fully supporting goal setting. Conclusions. Goal setting has shown some promise in promoting dietary and physical activity behavior change among adults, but methodological issues still need to be resolved. The literature with adolescents and children is limited, and the authors are not aware of any published studies with this audience investigating the independent effect of goal setting on dietary or physical activity behavior. Although, goal setting is widely used with children and adolescents in nutrition interventions, its effectiveness has yet to be reported.

Food Insecurity and Food Supplies in Latino Households with Young Children

OBJECTIVE To examine the relationship between food insecurity and food supplies in Latino households. DESIGN Cross-sectional survey, conducted February to May 2001. SETTING Six California counties. PARTICIPANTS Convenience sampling was used to recruit 274 low-income Latino families with preschool children from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), Head Start, and other community-based organizations. Complete data were available for 256 families. VARIABLES MEASURED Food security, household food scores. ANALYSIS Pearson correlations, Kruskal-Wallis test, and logistics regression. Significance level at P <.05. RESULTS Controlling for maternal education, food insecurity over the past 3 months was associated with lower household food supplies: dairy, r = -.18, P <.01; fruit, r = -.36, P <.001; grains, r = -.27, P <.0001; meats, r = -.22, P <.001; snack foods, r = -.23, P <.001; and vegetables, r = -.29, P <.001. CONCLUSIONS AND IMPLICATIONS In Latino households, greater food insecurity is associated with a lower variety of most foods, particularly fruits and vegetables. Future research in Latino households should explore the effects of seasonal food insecurity and household food shortages on food intake of individual household members, especially young children.

Less-energy-dense diets of low-income women in California are associated with higher energy-adjusted diet costs

BACKGROUND US-based studies are needed to estimate the relation, if any, between diet quality and estimated diet costs. OBJECTIVE We hypothesized that lower cost diets among low-income women in California would be energy dense but nutrient poor. DESIGN Energy and nutrient intakes for 112 women aged 18-45 y living in California were obtained with a food-frequency instrument. Dietary energy density (in MJ/kg or kcal/g) and energy-adjusted diet costs (in

Selecting Items for a Food Behavior Checklist for a Limited-Resource Audience

/10 MJ or

Evaluation of validity of items for a food behavior checklist

/2000 kcal) were calculated with local food prices. Tertile splits of energy density and energy cost were analyzed with one-factor analysis of variance. RESULTS Mean daily energy intake excluding all beverages was 7.1 MJ (1699 kcal), and mean dietary energy density was 6.5 kJ/kg (1.54 kcal/g). Lower dietary energy density was associated with significantly higher intakes of dietary fiber (P = 0.004), vitamin A (P < 0.001), and vitamin C (P < 0.001) and with significantly lower intakes of total fat (P = 0.003) and saturated fat (P < 0.001). Higher diet cost was associated with significantly lower dietary energy density (P < 0.001), total fat (P = 0.024), and saturated fat (P = 0.025) and with significantly higher intakes of vitamins A (P = 0.003) and C (P < 0.001). Each additional dollar in estimated diet costs was associated with a drop in energy density of 0.94 MJ/kg (0.225 kcal/g). CONCLUSIONS The finding that higher quality diets were more costly for these low-income women has implications for the food assistance and education programs of the US Department of Agriculture. Policy interventions may be required to allow low-income families in the United States to improve the quality of their diets given their food budget constraints.

Improving Readability of an Evaluation Tool for Low-income Clients Using Visual Information Processing Theories

OBJECTIVE To report 6 psychometric properties of food behavior checklist (FBC) items and then to use these properties to systematically reduce the number of items on this evaluation tool. DESIGN Random assignment to the intervention and control groups. SETTING Low-income communities. PARTICIPANTS Women (N = 132) from limited-resource families. MAIN OUTCOME MEASURES Reliability, internal consistency, baseline differences by ethnicity, sensitivity to change, and criterion and convergent validity of subscales. RESULTS The fruit and vegetable subscale showed a significant correlation with serum carotenoid values (r =.44, P <.001), indicating acceptable criterion validity. Milk, fat/cholesterol, diet quality, food security, and fruit/vegetable subscales showed significant correlations with dietary variables. Nineteen items have acceptable reliability. Twenty items showed no baseline differences by ethnic group. Eleven of the 15 items expected to show change following the intervention demonstrated sensitivity to change. CONCLUSIONS AND IMPLICATIONS This brief food behavior checklist (16 items) is easy to administer to a client group, has an elementary reading level (fourth grade), and has a low respondent burden in addition to meeting requirements for validity, reliability, and sensitivity to change. This study establishes a process that can be used by other researchers to develop and further refine instruments for use in community health promotion interventions.

Development of a Tool to Assess Psychosocial Indicators of Fruit and Vegetable Intake for 2 Federal Programs

OBJECTIVES To evaluate the validity of food behavior items, using a biological measure (serum carotenoids) as the criterion for validity of fruit and vegetable intake, and the results from multiple 24-hour recalls to test convergent validity with nutrient intake. DESIGN Participants responded to 39 food-behavior questions and later completed three 1-day dietary recalls. Serum carotenoid levels were determined for a 59% randomly selected subsample. SUBJECTS/SETTING A convenience sample of 100 English-speaking, low-income women participating in a Food Stamp Nutrition Education Program in 8 California counties. Statistical analyses Spearman correlation coefficients were calculated between responses to the food behavior items and (a) serum carotenoid levels and (b) mean nutrient intakes from the 24-hour recalls. Cronbachs coefficient alpha was determined for items within broad food behavior topics. RESULTS Responses to 10 food behavior items were significantly correlated with serum carotenoid levels (correlations greater than 0.45 were found for choosing low-fat foods and a self-evaluation of overall dietary quality). An additional 12 items showed hypothesized associations with the 24-hour recall data (with a maximum correlation 0.50 for number of eggs per week and dietary cholesterol). Cronbachs coefficient alpha ranged from 0.28 (for 5 fat and cholesterol items) to 0.79 (for 9 fruit and vegetable items). APPLICATIONS/CONCLUSIONS Nutrition professionals can use these methods to validate items for food behavior checklists for specific populations. The items described here may be useful when designing instruments to administer to low-income women in a community setting.

Where is the science? What will it take to show that nutrient profiling systems work?

Literacy is an issue for many low-income audiences. Using visual information processing theories, the goal was improving readability of a food behavior checklist and ultimately improving its ability to accurately capture existing changes in dietary behaviors. Using group interviews, low-income clients (n = 18) evaluated 4 visual styles. The text plus color photographs style was preferred over the other 3 visual styles: text only, text plus black and white line drawings, and text plus gray-scale photographs. Employing cognitive interviewing in an iterative process, clients (n = 25) recommended simplifying text for 10 items, modifying content for 15 of 16 visuals, and replacing text with visual content for 7 of 16 items. Professional staff (n = 7) and educators (n = 10) verified that visuals and revised text accurately reflected the content of each item. Clients reported that the revised checklist captured their attention, added pleasure to the evaluation process, improved their understanding of the behaviors in question, and facilitated comprehension of text. Readability scores improved by more than 2 grades. This process can be duplicated by others interested in enhancing the quality of existing evaluation tools.

Food Insecurity Among US Children: Implications for Nutrition and Health

OBJECTIVE Development of an evaluation tool of psychosocial constructs for use by participants in 2 federal programs, Food Stamp Nutrition Education and the Expanded Food and Nutrition Education Program. DESIGN Cross-sectional data from a longitudinal study. PARTICIPANTS Limited-resource women (n = 111) living in low-income communities. MEASURES Test-retest reliability, internal consistency, ethnic differences, convergent validity. ANALYSIS Spearman rank order correlation, analysis of variance, principal components analysis. RESULTS Reliability coefficients ranged from a low of r = .18 (not significant) to r = .74 (P < .0001). Two items were deleted for not meeting criteria for reliability and 2 for redundancy. Ethnic differences at baseline were significant for 1 item. Domain constructs loaded on 4 to 5 factors for the biopsychosocial framework. Estimates of convergent validity of 9 constructs led to the deletion of 3 (ie, perceived barriers, social support, and perceived norms), with retention of perceived benefits, perceived control, self-efficacy, readiness to eat more fruit, readiness to eat more vegetables, and perceived diet quality. As an estimate of convergent validity, the final version of the tool with 6 constructs remaining showed significant correlations with indicators of diet quality: serum carotenoid values (r = .38, P < .001); hypothesized nutrients calculated from the mean of 3 24-hour dietary recalls (vitamin C, r = .47, P < .0001; vitamin A, r = .39, P < .0001; folate, r = .37, P < .0001; beta-carotene, r =.31, P < .001; and fiber, r = .46, P < .0001); fruit and vegetable servings (r = 0.55, P < .0001); Healthy Eating Index (r = .27, P < .05); and a fruit and vegetable behavioral scale (r = .60, P < .0001). CONCLUSION AND IMPLICATIONS This systematic process yielded a fruit and vegetable evaluation tool useful for practitioners and researchers. This is the first validation study of this type to estimate convergent validity with 5 indicators of diet quality, including a biomarker.

Using Qualitative Methods to Improve Questionnaires for Spanish Speakers: Assessing Face Validity of a Food Behavior Checklist

Nutrient profiling is defined as the science of ranking or categorizing foods on the basis of their nutritional composition. Validity is a general term meaning accuracy. Nutrient profiling systems in the United States have not undergone any systematic validation effort to assess their accuracy against a comparison measure or group of measures. Different types of validation studies should be conducted: content, face, convergent, criterion, and predictive. This article provides a conceptual framework for establishing the validity of nutrient profiling systems with the desired objective of assisting US consumers with food selection to improve diet quality. For a profiling system to work successfully in the American marketplace, it must function well with consumers from most or all cultural groups, from all racial groups, and with low-literate as well as highly literate people. Emphasis should be placed on conducting different types of validation studies and multiple studies with different subpopulation groups. The use of consistent standards to assess the accuracy and usefulness of multiple profiling systems is imperative to successfully identify a nutrient profiling intervention that will have the potential to lead to improved diet quality and eventually to an improved health status in US consumers.