Michelle L. Granner

Factors of Fruit and Vegetable Intake by Race, Gender, and Age among Young Adolescents

OBJECTIVE To explore demographic differences in individual, social, and environmental factors potentially related to fruit and vegetable intake. DESIGN Self-report questionnaires administered to a convenience sample of middle school students during regular classes. PARTICIPANTS Black and white adolescents, 11 to 15 years of age (N = 736). VARIABLES MEASURED Measures included self-efficacy, family dinner frequency, normative beliefs, outcome expectations, modeling, availability, preferences, snack choice, and demographics. ANALYSIS Chi-square, general linear models, and Poisson and linear regressions as appropriate. RESULTS Black participants reported greater social influences than did white participants, whereas white adolescents reported greater family environmental influences on fruit and vegetable intake. The oldest adolescents reported lower self-efficacy, peer modeling, family dinner frequency, and fruit and vegetable preferences compared with younger adolescents. White participants and females reported a higher preference for vegetables than did black participants and males. Regression models for self-efficacy and snack choice explained 41% and 34% of the variance, respectively. Preferences for vegetables and parental modeling were the strongest correlates of self-efficacy. Self-efficacy was the strongest correlate of snack choice. CONCLUSIONS AND IMPLICATIONS Decreases in several factors with age highlight the importance of intervention for this age group. Future research is needed for a better understanding of the formation and modification of self-efficacy and snack choice.

Association of Environmental Factors to Meeting Physical Activity Recommendations in Two South Carolina Counties

Purpose. The purpose of the study was to examine associations between environment and policy factors and physical activity. Design. A random-digit-dialed, cross-sectional telephone survey was administered. Setting. The setting was a two-county area of eastern South Carolina. Subjects. Before weighting, the sample included 1936 adults; 36.9% African-American, 63.1% white, and 60.1% women. The age group distribution was 28.8% 55+ years, 39.3% 35–54 years, and 31.9% 18–34 years of age. The response rate was 62.9%. Measures. Six physical activity questions (2001 Behavioral Risk Factor Surveillance Survey [BRFSS]) were used to create a dichotomous variable, “meets/does not meet recommendation for moderate or vigorous physical activity.” Self-report items assessed knowledge, presence, and use of recreational facilities; presence of environmental and worksite supports; perceived safety; condition of sidewalks; and quality of street lighting Results. Linear and logistic regression were used to analyze the data. Unadjusted odds for meeting the recommendation were significantly greater for well-maintained sidewalks (OR = 1.90); safe areas for walking/jogging (OR = 1.39); knowledge of routes for bicycling (OR = 1.38) and walking/jogging (OR = 1.32); and worksites with sports teams (OR = 1.53), exercise facilities (OR = 1.33), flexible time for exercise (OR = 1.33), and preventive checkups (OR = 1.26). Among persons who met the recommendation, means were greater for number of known walking/jogging routes (p = .04); number of known bicycling routes (p < .01); number of days per month uses tracks, trails, routes, pathways (p < .01); and number of days per month uses outdoor recreation areas (p < .01). Conclusion. The results support an association between level of physical activity and environmental and policy factors in two southeastern counties in South Carolina. Limitations of the study include self-reported data and cross-sectional design.

Levels of cigarette and alcohol use related to eating-disorder attitudes.

OBJECTIVE To examine levels of cigarette and alcohol use relative to body dissatisfaction and drive for thinness in 206 black and white college women. METHOD Anonymous, paper-and-pencil, self-report questionnaires were administered. RESULTS Frequency of both cigarette and alcohol use were significantly and linearly related to body dissatisfaction and drive for thinness. Regression analyses indicated that negative-affect reduction motivations for use of these substances were more strongly related to eating-disorder attitudes than were levels of use. CONCLUSIONS Cigarette and alcohol use, independent of race and other demographic variables, increased along a continuum with eating-disorder attitudes.

A randomized trial of a diet and exercise intervention for overweight and obese women from economically disadvantaged neighborhoods: Sisters Taking Action for Real Success (STARS)☆

BACKGROUND Lower socioeconomic status at both the individual and neighborhood level is associated with increased health risks. Weight loss can reduce this risk, but few high quality weight-loss studies target this population. OBJECTIVES STARS tests a culturally appropriate, group-based behavioral and social support intervention on body weight and waist circumference in women from financially disadvantaged neighborhoods. DESIGN A stratified (by BMI) randomized trial. Randomization to group was generated by a random numbers table with allocation concealment by opaque envelopes. METHODS Participants 25-50 years who had a BMI ≥ 25 kg/m(2) and a waist circumference ≥ 88 cm were recruited from 18 census tracts in Columbia, SC with high rates of poverty between November 2008 and November 2010. All participants received a dietary and exercise counseling session. Intervention participants then receive 16 theoretically-based and tailored weekly group sessions followed by 8 weeks of telephone maintenance counseling. Control participants receive 16 weekly health education mailings. Measurements correspond to baseline, post-group intervention, and post-telephone counseling, and for intervention participants, after a 12-week no-contact period. Measurement staff was blinded to group assignment. RESULTS Participants (N=155; n=80 intervention, n=75 minimal intervention control) were primarily African American (86.5%) and averaged 38.9 years with a mean BMI of 40.1 kg/m(2) and waist circumference of 115.4 cm. Food insecurity was reported by 43% of participants. SUMMARY STARS targets an underserved population with an innovative, tailored, and theoretically-grounded, group-based intervention followed by telephone maintenance. If effective, the approach has the potential to be feasible and cost-effective for community delivery.

Impact of a Community-Based Prevention Marketing Intervention to Promote Physical Activity Among Middle-Aged Women

A physical activity intervention applied principles of community-based participatory research, the community-based prevention marketing framework, and social cognitive theory. A nonrandomized design included women ages 35 to 54 in the southeastern United States. Women (n = 430 preprogram, n = 217 postprogram) enrolled in a 24-week behavioral intervention and were exposed to a media campaign. They were compared to cross-sectional survey samples at pre- (n = 245) and postprogram (n = 820) from the media exposed county and a no-intervention county (n = 234 pre, n = 822 post). Women in the behavioral intervention had statistically significant positive changes on physical activity minutes, walking, park and trail use, knowledge of mapped routes and exercise partner, and negative change on exercise self-efficacy. Media exposed women had statistically significant pre- to postprogram differences on knowledge of mapped routes. No-intervention women had significant pre- to postprogram differences on physical activity minutes, walking, and knowledge of mapped routes.

Association of body mass index to meeting physical activity recommendations

OBJECTIVE To investigate the association between BMI and physical activity based on the CDC-ACSM recommendation and a more demanding standard consistent with the IOM recommendation. METHODS A random-digit-dialed survey (n=1810) used 2001 BRFSS questions to measure physical activity. RESULTS Data revealed a monotonic association between BMI and physical activity level. Lower odds of meeting both recommendations were associated with higher BMI. The proportion meeting the CDC-ACSM recommendation was at least 3 times that of persons meeting the IOM-based recommendation. CONCLUSIONS Meeting either recommendation was associated with BMI; however, a larger proportion of persons were meeting the less demanding CDC-ACSM recommendation.

Correlates of Television Viewing Among African American and Caucasian Women

This study explores the associations between time spent watching television and physical activity, selected eating behaviors, and quality of life variables among 189 African American and Caucasian women aged 18–60 years. Data were collected via a cross-sectional, random-digit-dialed telephone survey. Seventy-two percent and 46% of women reported to “always, often, or sometimes” eating or overeating while watching television, respectively. Significant associations with television time per week included: eating meals or snacks while watching television, number of days per month feeling depressed, number of days per month feeling anxious, self-rated health, and BMI. Results contribute to recent studies finding associations between television viewing, body mass index, and health; and suggest potential points for intervention.

Frequency of consumption at fast-food restaurants is associated with dietary intake in overweight and obese women recruited from financially disadvantaged neighborhoods

Fast-food restaurants are more prevalent in lower-income and predominately African American neighborhoods, where consumption of fast food is also higher. In general populations, fast-food consumption is related to less healthy dietary intake. This cross-sectional study examined the hypotheses that greater fast-food consumption is associated with less healthy dietary intake and poorer diet quality in overweight and obese women (n = 196, 25-51 years, 87% African American) recruited from financially disadvantaged Census tracts. Dietary intake and diet quality (Alternate Healthy Eating Index) were assessed via three 24-hour dietary recalls. Linear regression models tested the association between fast-food consumption and each outcome (model 1). Model 2 added sociodemographics and physical activity. Model 3 added total caloric intake. Fast-food consumption was significantly associated with total caloric intake; total intake of meat, grains, sweetened beverages, dairy, fiber, cholesterol, sodium, and added sugar; and percent of calories from total fat, saturated fat, and trans-fatty acids. Statistically significant associations remained in model 2, but most were not significant in model 3. Fast-food consumption was not associated with diet quality (Alternate Healthy Eating Index) in any model. In this at-risk sample, fast-food consumption was associated with more negative dietary practices. Significant associations generally disappeared when controlling for total caloric intake, suggesting that women who eat more fast food have higher total caloric intakes as a result of increased consumption of unhealthy rather than healthy foods.

Correlates of physical activity among African American and white women.

OBJECTIVE To compare potential correlates of physical activity between African American and white women. METHODS A random-digit-dialed telephone survey was conducted in central South Carolina. Bivariate and multivariate analyses focused on women aged 18+ (N = 1176). RESULTS African American women reported greater maintenance of sidewalks and public parks than did white women, who reported higher physical activity, exercise self-efficacy, access to indoor walking facilities, and knowledge of mapped-out walking routes. Exercise self-efficacy was the only significant correlate of physical activity among both African American and white women. CONCLUSIONS Self-efficacy was a robust cross-sectional correlate of physical activity in women.

Measurement properties of psychosocial and environmental measures associated with fruit and vegetable intake among middle school adolescents.

OBJECTIVE To assess the measurement properties of several scales modified or created to assess factors related to fruit and vegetable intake within a young adolescent population. DESIGN Cross-sectional with data collected via self-report. SETTING Data were collected in regularly scheduled classes in the school setting. PARTICIPANTS African American and Caucasian middle school students (ages 11-15 years). VARIABLES MEASURED Self-efficacy, modeling, outcome expectations, normative beliefs, parental food management practices, and influences on food choice. ANALYSIS Pearson correlations, factor analysis, and Cronbach α. RESULTS Subscales with adequate to good internal consistencies (0.65-0.88) were established. Fruit and vegetable intake was significantly correlated with self-efficacy, parent and peer modeling, family and peer normative beliefs, and social and health outcome expectations. Fruit and vegetable intake was not significantly correlated with permissive eating, food self-preparation, or the 3 subscales measuring influences on food choice (social influence, avoiding weight-gain food, and appeal and access). CONCLUSIONS AND IMPLICATIONS These measures, most originally developed for children and adults and modified for this study, demonstrated adequate measurement properties for an adolescent sample.