African-American Womens’ Eating Habits and Intention to Change: a Pilot Study

J. Racial and Ethnic Health Disparities (2014) 1:199–206 DOI 10.1007/s40615-014-0026-2 African-American Womens’ Eating Habits and Intention to Change: a Pilot Study Fern J. Webb & Jagdish Khubchandani & Michelle Doldren & Joyce Balls-Berry & Shirley Blanchard & Liane Hannah & Jevetta Stanford & Selena Webster-Bass Received: 19 February 2014 / Revised: 1 May 2014 / Accepted: 11 June 2014 / Published online: 27 June 2014 # W. Montague Cobb-NMA Health Institute 2014 Abstract Unhealthy diet is one of the leading contributors for chronic disease related morbidity and mortality in AfricanAmerican (AA) women living in the USA. The purpose of this study was to describe eating habits and intention to change using the stages of change (SOC) model in a sample of AA women. A cross-sectional population-based study was conducted in Florida with AA women. A total of 292 AA women participated. Outcome variables were eating breakfast, foods having low to no fat, fruits and vegetables, whole grain products, foods with low to no salt, and few to no snacks. SOC was the main independent variable. Almost half (48 %) seldom added salt to meals, 45 % consumed low-fat foods, F. J. Webb : L. Hannah Department of Community Health and Family Medicine, University of Florida, Jacksonville, FL 32208, USA J. Khubchandani (*) Department of Physiology and Health Science, Ball State University, Muncie, IN 47306, USA e-mail: M. Doldren Institute for Child Health Policy, Nova Southeastern University, Fort Lauderdale, FL 33328, USA J. Balls-Berry Section of Clinical Epidemiology, Mayo Clinic, Rochester, MN 55905, USA S. Blanchard School of Pharmacy and Health Professions, Creighton University, Omaha, NE 68178, USA J. Stanford Clinical and Translational Science Institute, University of Florida, Jacksonville, FL 32208, USA S. Webster-Bass Webster-Bass Health Resources, Jacksonville, FL 32208, USA 32 % consumed breakfast every day, and 32 % consumed primarily whole grain products. Women in action and maintenance SOC were significantly more likely to eat breakfast (odds ratio (OR)=1.50, 95 % confidence interval (CI): 1.10– 2.03), mostly or only low-fat foods (OR=4.11, 95 % CI: 2.59– 6.51), ≥4 servings of fruits and vegetables (OR=1.75, 95 % CI: 1.09–2.83), and whole grain products (OR=2.05, 95 % CI: 1.42–2.97). AA women want to eat healthier but do not always practice healthy diets. Understanding SOC can be essential to develop interventions for improving AA women’s eating habits. Keywords Diet . African-American . Women . Stages of change . Health behavior Introduction It is well documented that an unhealthy diet is a significant contributor to the leading causes of death in the USA. Eating habits are a function of age, gender, race/ethnicity, culture, socioeconomic status, and food availability [1–3].Unhealthy dietary patterns and the associated burden of chronic diseases, morbidity, and mortality are more frequent in those who are disadvantaged based on a variety of factors like income, education, race, and ethnicity [1–6]. For example, AfricanAmerican (AA) women in the USA earn significantly less than men and women of other races and ethnicities, even when they have similar qualifications and occupational statuses. This disparity in income of AA women inherently influences food choices and increases the subsequent risk of chronic disease morbidity and mortality. In addition, eating habits of AA women in the USA are significantly influenced by cultural celebrations and rituals that often include eating foods prepared by frying, seasoning with animal fat, or adding refined sugar [2, 3, 6–8]. 200 Stages of change (SOC), a construct of the transtheoretical model (TTM), was developed using psychotherapy and behavioral change theories to characterize one’s readiness to change a particular behavior (e.g., diet) [9, 10]. SOC represents a temporal dimension of change that occurs over time and consists of (1) precontemplation stage where one is not considering a behavior change, (2) contemplation stage where one is aware that a behavior change needs to occur, (3) preparation stage where one begins to make specific plans to change behavior, (4) action stage where one is actually beginning to practice the new behavior for no more than 6 months, and (5) maintenance stage where one has changed and is practicing the new behavior for at least 6 months. The TTM postulates that in order to practice a healthy behavior and to acquire a new lifestyle, individuals will pass through these stages and gradually acquire a new health behavior and this movement from one stage to another can be manipulated by using specific processes of change [10–12]. Empirical research suggests that the SOC model can be used to explain fat intake among AA women who have been assessed for their intentions to eat healthy. For example, Hargreaves and colleagues found that AA women who reported being in the action stage reported less fat intake compared to women who were in the precontemplation or contemplation stages [13]. Moreover, a study of rural AA women in the USA found that education, friends’ thoughts on weight, body mass index (BMI), and positive attitudes about weight loss were significant predictors of SOC as it relates to practicing a healthy diet [14]. Sbrocco and colleagues examined SOC and behavioral outcomes among AA women entering obesity treatment programs. Sbrocco found that SOC may be a useful construct for understanding behavioral change among AA women pursuing weight management and that SOC for eating habits among African-Americans should be further investigated [15]. Examining SOC is complex in its relation to dietary change and eating habits for individuals. For example, a single person can be found currently maintaining a particular eating habit (i.e., eating at ≥3 fruits and vegetables per day), but contemplating a change of another eating habit or behavior (i.e., eating more whole grain products). This is consistent with several published studies confirming that people are at different stages for individual fat-reducing behaviors [8, 16, 17]. A 2010 American Heart Association scientific statement suggested that more evidence regarding the usefulness of the SOC construct, aimed at intervening with dietary changes for African-Americans, is needed [18]. Moreover, little is known about eating habits among African-American women and the association of their eating habits with intentions to change. Thus, the purpose of this study was to examine the association between SOC and eating habits in a sample of AfricanAmerican women. J. Racial and Ethnic Health Disparities (2014) 1:199–206 Methods Participants and Study Design This cross-sectional population-based study was approved by the University of Florida Institutional Review Board-03. African-American research assistants recruited women living in four urban environments throughout Florida, to ensure recruitment of socially and culturally diverse groups with varied health (...truncated)