Randi L. Wolf

Food Label Use and Its Relation to Dietary Intake among US Adults

Rates of diet-related chronic disease combined with the lack of current data on patterns of food label use by the US population warrant re-examination of the use and potential influence of this public health tool. The purpose of this study was to describe the prevalence of food label use and the association between food label use and nutrient intake in a nationally representative sample of US adults who participated in the 2005-2006 National Health and Nutrition Examination Survey. Data on food label use were collected during the interview portion of the survey, and nutrient intake was estimated using the average of two 24-hour dietary recalls. In this sample, 61.6% of participants reported using the Nutrition Facts panel, 51.6% looked at the list of ingredients, 47.2% looked at serving size, and 43.8% reviewed health claims at least sometimes when deciding to purchase a food product. There were significant differences (P<0.05) in food label use across all demographic characteristics examined. Significant differences (P<0.05) in mean nutrient intake of total energy, total fat, saturated fat, cholesterol, sodium, dietary fiber, and sugars were observed between food label users and non-users with label users reporting healthier nutrient consumption. The greatest differences observed were for total energy and fat and for use of specific nutrient information on the food label. Despite food label use being associated with improved dietary factors, label use alone is not expected to be sufficient in modifying behavior ultimately leading to improved health outcomes.

Telephone Outreach to Increase Colorectal Cancer Screening in an Urban Minority Population

OBJECTIVES We compared the effectiveness of a telephone outreach approach versus a direct mail approach in improving rates of colorectal cancer (CRC) screening in a predominantly Black population. METHODS A randomized trial was conducted between 2000 and 2003 that followed 456 participants in the New York metropolitan area who had not had recent CRC screening. The intervention group received tailored telephone outreach, and the control group received mailed printed materials. The primary outcome was medically documented CRC screening 6 months or less after randomization. RESULTS CRC screening was documented in 61 of 226 (27.0%) intervention participants and in 14 of 230 (6.1%) controls (prevalence rate difference=20.9%; 95% CI = 14.34, 27.46). Compared with the control group, the intervention group was 4.4 times more likely to receive CRC screening within 6 months of randomization. CONCLUSIONS Tailored telephone outreach can increase CRC screening in an urban minority population.

Knowledge, Barriers, and Stage of Change as Correlates of Fruit and Vegetable Consumption among Urban and Mostly Immigrant Black Men

BACKGROUND Daily fruit and vegetable consumption in black men is low and has remained relatively unchanged during the past 20 years. OBJECTIVE To examine awareness of fruit and vegetable recommendations promoted by federal agencies and correlates of fruit and vegetable consumption among an urban and mostly immigrant population of adult black men. DESIGN A cross-sectional study analyzing baseline data (n=490) from a randomized controlled trial. SETTING A large health care workers union. MAIN OUTCOME MEASURES Knowledge, perceived benefits, stage of readiness, perceived barriers, and daily servings of fruit and vegetable intake. STATISTICAL ANALYSES PERFORMED One-way analysis of variance and t tests were used to compare fruit and vegetable intake across main study variables. Regression analysis was used to identify independent predictors of fruit and vegetable intake. RESULTS Fruit and vegetable intake was low (mean was three servings/day). Ninety-four percent were not aware that men should consume at least nine servings of fruits and vegetables daily and 59.8% were not aware that eating a colorful variety is important. In contrast, over half (54.7%) were aware that a single serving is equal to about a handful; 94.1% correctly reported fruit and vegetables as an important source of fiber; 79.6% correctly reported vitamin pills were not a substitute for eating fruits and vegetables; and 94.5% recognized that there are health benefits to eating fruits and vegetables, although identification of specific benefits was minimal. In regression analysis, a greater level of fruit and vegetable consumption was significantly associated with greater knowledge of fruit and vegetable recommendations, lower perceived barriers, and a more advanced stage of change (action vs contemplation/preparation). Perceived health benefits were not associated with fruit and vegetable consumption. CONCLUSIONS There is a lack of awareness of the current fruit and vegetable recommendations. In addition, men reported fruit and vegetable intakes that were far below national recommendations. Greater efforts are needed to help urban and primarily immigrant black men realize the importance of and recommendations for fruit and vegetable consumption.

Patient Preferences and Adherence to Colorectal Cancer Screening in an Urban Population

We measured patient preferences for colorectal cancer (CRC) screening strategies and actual receipt of alternative CRC screening tests among an urban minority sample participating in an intervention study. The fecal occult blood test was the most preferred test, reportedly owing to its convenience and the noninvasive nature. For individuals who obtained a test that was other than their stated preference (41.1%), reasons for this discordance may be due to physician preferences that override patient preferences.

Barriers to Colorectal Cancer Screening With Fecal Occult Blood Testing in a Predominantly Minority Urban Population: A Qualitative Study

Colorectal cancer is the second leading cause of cancer death in the United States.1 Appropriate screening can reduce incidence of and mortality from colorectal cancer.2–5 The US Preventive Services Task Force recommends that all average-risk individuals aged 50 years and older receive colorectal cancer screening.6 The American Cancer Society recommends several acceptable approaches to screening, including an annual 3-card home fecal occult blood test.7 The Healthy People 2010 objective is to increase the proportion of people aged 50 and older who have received a fecal occult blood test within the preceding 2 years to at least 50%.8 Lack of knowledge, confidence, and skills; negative attitudes toward the tests themselves; fear of the consequences of screening; and inadequate social support all have been suggested as possible barriers to colorectal cancer screening,9 whereas positive attitudes toward colorectal cancer screening and physician encouragement have been associated with receipt of a fecal occult blood test with a home stool kit.10 Despite these studies, gaps remain in what is known about barriers to successful interventions to increase colorectal cancer screening, particularly in minority populations.11,12 This study is based on the assumption that identification and definition of barriers to colorectal cancer screening in low-income, underserved minority populations can help guide the development of effective interventions.

Informed decision making about prostate cancer testing in predominantly immigrant black men: A randomized controlled trial

BackgroundDecision support interventions have been developed to help men clarify their values and make informed decisions about prostate cancer testing, but they seldom target high-risk black and immigrant men.PurposeThis study evaluated the efficacy of a decision support intervention focused on prostate cancer testing in a sample of predominantly immigrant black men.MethodsBlack men (N = 490) were randomized to tailored telephone education about prostate cancer testing or a control condition.ResultsPost-intervention, the intervention group had significantly greater knowledge, lower decision conflict, and greater likelihood of talking with their physician about prostate cancer testing than the control group. There were no significant intervention effects on prostate specific antigen testing, congruence between testing intention and behavior, or anxiety.ConclusionsA tailored telephone decision support intervention can promote informed decision making about prostate cancer testing in black and predominantly immigrant men without increasing testing or anxiety.

Food choice and diet variety in weight-restored patients with anorexia nervosa.

Anorexia nervosa is a serious psychiatric illness associated with substantial morbidity and mortality. Weight-restored females with anorexia nervosa with limited diet variety, assessed by a diet variety score, have been reported to have poor outcomes. Using the same patient cohort, the objective of the current study was to provide a detailed description of the types of foods from which patients restrict variety in their diets. Forty-one weight-restored patients, hospitalized between June 2000 and July 2005, who completed a 4-day food record before discharge were followed for up to 1 year. Patient outcomes were categorized as a success (n=29) or failure (n=12) using Morgan-Russell criteria. Although the total number of foods selected did not differ between the success and failure groups (73±14 vs 74±13, respectively; P=0.741), a significant difference in the total number of different foods was observed: the failure group selected fewer and the success group selected more (43±9 vs 51±7; P=0.005). Outcomes groups also differed significantly in the variety of foods selected from 5 of 17 food groups. Results suggest that a diet limited in total variety and specifically limited in variety from five food groups may be associated with relapse in patients with anorexia nervosa.

ResearchResearch and Professional BriefFood Label Use and Its Relation to Dietary Intake among US Adults

Rates of diet-related chronic disease combined with the lack of current data on patterns of food label use by the US population warrant re-examination of the use and potential influence of this public health tool. The purpose of this study was to describe the prevalence of food label use and the association between food label use and nutrient intake in a nationally representative sample of US adults who participated in the 2005-2006 National Health and Nutrition Examination Survey. Data on food label use were collected during the interview portion of the survey, and nutrient intake was estimated using the average of two 24-hour dietary recalls. In this sample, 61.6% of participants reported using the Nutrition Facts panel, 51.6% looked at the list of ingredients, 47.2% looked at serving size, and 43.8% reviewed health claims at least sometimes when deciding to purchase a food product. There were significant differences (P<0.05) in food label use across all demographic characteristics examined. Significant differences (P<0.05) in mean nutrient intake of total energy, total fat, saturated fat, cholesterol, sodium, dietary fiber, and sugars were observed between food label users and non-users with label users reporting healthier nutrient consumption. The greatest differences observed were for total energy and fat and for use of specific nutrient information on the food label. Despite food label use being associated with improved dietary factors, label use alone is not expected to be sufficient in modifying behavior ultimately leading to improved health outcomes.

Tailored telephone education to promote awareness and adoption of fruit and vegetable recommendations among urban and mostly immigrant black men: a randomized controlled trial.

BACKGROUND Fruit and vegetable (FV) intake in black men are far below national recommendations. METHODS Urban, primarily immigrant, black men (n=490) from the New York City metropolitan area participating in the Cancer Awareness and Prevention (CAP) Trial (2005-2007) were randomly assigned to one of two intervention groups: 1) FV Education (FVE) or 2) Prostate Education (PE). Both interventions entailed a mailed brochure plus two tailored telephone education (TTE) calls. Outcomes, measured at baseline and at eight months, included knowledge of FV recommendations, perceived benefits, stage of readiness to adopt recommendations and self-reported FV consumption. RESULTS At follow-up, the FVE group consumed an average of 1.2 more FV servings per day than the PE group (P<0.001; adjusted for baseline). The FVE group also demonstrated increases in knowledge about recommended FV amounts (P<0.01) and appropriate serving sizes (P<0.05), and in the percent of participants moving from a lower to a higher stage of readiness to adopt FV recommendations (P<0.05). The FVE group did not demonstrate increases in knowledge related to the importance of eating a colorful variety or in the ability to name potential health benefits. CONCLUSIONS TTE can be a practical and moderately effective intervention for raising awareness of FV recommendations and for promoting FV consumption in urban and primarily immigrant black men.

MySmileBuddy: An iPad-Based Interactive Program to Assess Dietary Risk for Early Childhood Caries

E ARLY CHILDHOOD CARIES (ECC), DEFINED AS THE occurrence of tooth decay in children younger than age 6 years, is a chronic, highly prevalent, and consequential disease of US children that is overwhelmingly diet-dependent. Although ECC is a multifactorial disease that is only partially explained by sugar intake, the importance of diet has long been established through laboratory, clinical, and epidemiologic studies. This knowledge has been translated into dietary recommendations for the prevention or suppression of caries activity in young children, often with only limited success. In an effort to reduce ECC prevalence and its consequences in a high-risk, economically stressed Latino population in Northern Manhattan, NY, a multidisciplinary team of Columbia University researchers—including experts from behavioral nutrition, pediatric medicine and dentistry, community health, social work, and information technology—has developed MySmileBuddy, a prototype Internet-based application for the iPad (Apple, Inc) that facilitates community health workers’ (CHWs) engagement of parents in dental caries prevention, with funding support from the National Institute on Minority Health and Health Disparities. The prototype was designed for the iPad but can be used by CHWs with parents on any laptop, desktop, tablet, or Internet-enabled telephone because this program operates in common Internet browsers. Central to its utility is its diet recall function (Figure 1), a subprogram designed to engage families in a modified 24-hour recall that contributes to a risk score for individual children. Here we describe the challenges confronted and approaches adopted in designing this diet recall function for initial dietary screening by nonprofessional peer counselors.