Demographic and psychosocial predictors of fruit and vegetable intakes differ: implications for dietary interventions

OBJECTIVE: The National Cancer Institute (Rockville, Md) has launched a nationwide initiative--5 A Day for Better Health--to encourage consumption of fruits and vegetables. Because the tastes and culinary uses of fruits and vegetables differ, however, it is not known whether a general 5-A-Day message is an effective intervention strategy. This study examined whether there are differences between the demographic and psychosocial correlates of fruit and vegetable intakes. DESIGN: Data are from the Washington State Cancer Risk Behavior Survey (1995-1996), a cross-sectional, random-digit-dial telephone survey representative of the adult population of Washington State. SUBJECTS/SETTING: Interviews were completed with 1,450 adults. Data were collected about demographic characteristics, health status, health-related behavior, fruit and vegetable intakes, and the following diet-related psychosocial factors: beliefs, motives, barriers, attitudes, and stages of dietary change. STATISTICAL ANALYSES: Multivariate linear regression analysis was used to test whether the associations of demographic characteristics and psychosocial factors with fruit intake differed from associations with vegetable intake. RESULTS: In general, health status, health-related behavior, and psychosocial factors were more strongly associated with fruit intakes than vegetable intakes. For example, regular exercisers consumed 0.44 more daily servings of fruits and 0.36 more servings of vegetables than nonexercisers. Compared with those in the preaction stage of dietary change, adults in the maintenance stage consumed 0.99 more daily servings of fruits and 0.68 more servings of vegetables. Intrinsic motivations for eating a healthful diet (eg, to feel better) were strongly associated with both fruit and vegetable intakes, and these associations were stronger for fruit. Extrinsic motivations were not associated with either fruit or vegetable intakes. APPLICATIONS: Dietary interventions based on a general 5-A-Day message may be more effective in increasing fruit intakes than vegetable intakes. Targeted interventions that focus specifically on vegetables are probably necessary. Intrinsic motives for eating a healthful diet should be key components of interventions to increase fruit and vegetable intakes.     

Dispositional Motivations and Message Framing: A Test of the Congruency Hypothesis in College Students.

The authors examined the congruency hypothesis that health messages framed to be concordant with dispositional motivations will be most effective in promoting health behaviors. Undergraduate students (N=63) completed a measure of approach/avoidance orientation (behavioral activation/inhibition system) and read a gain- or loss-framed message promoting flossing. Results support the congruency hypothesis: When given a loss-framed message, avoidance-oriented people reported flossing more than approach-oriented people, and when given a gain-framed message, approach-oriented people reported flossing more than avoidance-oriented people. Discussion centers on implications for health interventions and the route by which dispositional motivations affect health behaviors through message framing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using message framing to motivate HIV testing among low-income, ethnic minority women.

This study compared the effectiveness of 4 videotaped educational programs designed to motivate HIV testing among low-income, ethnic minority women. 480 women were assigned randomly to watch one of 2 gain-framed or 2 loss-framed videos. Consistent with prospect theory, participants' perceptions of the certainty of the outcome of an HIV test moderated the effects of framing on self-reported testing behavior 6 months after video exposure. Among participants who reported being certain of the test's outcome, those who saw a gain-framed video reported a higher rate of testing than those who saw a loss-framed message. Among women who perceived the outcome of HIV testing as relatively uncertain, gain- and loss-framed videos led to similar rates of self-reported testing, with some advantage for the loss-framed message. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using message framing to promote acceptance of the human papillomavirus vaccine.

Objective: Use of message framing for encouraging vaccination, an increasingly common preventive health behavior, has received little empirical investigation. The authors examined the relative effectiveness of gain-versus loss-framed messages in promoting acceptance of a vaccine against human papillomavirus (HPV)-a virus responsible for virtually all cases of cervical cancer. Design: Undergraduate women (N = 121) were randomly assigned to read a booklet describing the benefits of receiving (gain-framed message) or the costs of not receiving (loss-framed message) a prophylactic HPV vaccine. After reading the booklet, participants indicated their intent to obtain the HPV vaccine. Main Outcome Measure: A 5-item composite representing intentions to obtain the HPV vaccine. Results: The effect of message framing on HPV vaccine acceptance was moderated by risky sexual behavior and approach avoidance motivation. A loss-framed message led to greater HPV vaccination intentions than a gain framed message but only among participants who had multiple sexual partners and participants who infrequently used condoms. The loss-frame advantage was also observed among participants high in avoidance motivation. Conclusion: Findings highlight characteristics of the message recipient that may affect the success of framed messages promoting vaccine acceptance. This study has practical implications for the development of health communications promoting vaccination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived susceptibility to breast cancer moderates the effect of gain- and loss-framed messages on use of screening mammography.

Objective: This study examined the role of three distinct beliefs about risk (risks associated with screening, construal of the function of screening as health-affirming or illness-detecting, and perceived susceptibility to breast cancer) in moderating women's responses to framed messages that promote mammography. Design: Three hundred fifty-five women recruited from an inner city hospital, nonadherent to guidelines for receiving annual screening mammograms,were randomly assigned to view a gain- or loss-framed video message about the importance of mammography. Main Outcome Measure: Mammography screening was self-reported at a 3-month follow-up. Results: Only perceived susceptibility to breast cancer significantly moderated the effect of message framing on screening. Women with average and higher levels of perceived susceptibility for breast cancer were significantly more likely to report screening after viewing a loss-framed message compared to a gain-framed message. No effects of framing on reported screening were observed for women with lower levels of perceived susceptibility. Conclusion: The study identifies a key role for perceived susceptibility in shaping responses to framed messages that promote cancer screenings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Comparison of 4 questionnaires for assessment of fruit and vegetable intake

OBJECTIVE: This study compared fruit and vegetable assessments derived from 4 self-administered questionnaires. METHODS: Among 102 adolescents, servings of fruits and vegetables assessed by 4 questionnaires were compared with estimates from 24-hour recalls. RESULTS: The prevalence of consuming 5 or more servings of fruits and vegetables a day was underestimated by the questionnaires. Questionnaires asking subjects to recall their diet over the previous year were more effective in ranking subjects (r's > or = .42) than those assessing previous-day diet (r's > or = .30). CONCLUSIONS: Brief assessments of fruit and vegetable intake are more useful for ranking subjects than for estimating prevalence of consumption of 5 or more servings per day.     

Effective communication of risks to young adults: Using message framing and visual aids to increase condom use and STD screening.

Sexually Transmitted Diseases (STDs)—including HIV/AIDS—are among the most common infectious diseases in young adults. How can we effectively promote prevention and detection of STDs in this high risk population? In a two-phase longitudinal experiment we examined the effects of a brief risk awareness intervention (i.e., a sexual health information brochure) in a large sample of sexually active young adults (n = 744). We assessed the influence of gain- and loss-framed messages, and visual aids, on affective reactions, risk perceptions, attitudes, behavioral intentions, and reported behaviors relating to the prevention and detection of STDs. Results indicate that gain-framed messages induced greater adherence for prevention behaviors (e.g., condom use), whereas loss-framed messages were more effective in promoting illness-detecting behaviors (e.g., making an appointment with a doctor to discuss about STD screening). The influence of the framed messages on prevention and detection of STDs was mediated by changes in participants' attitudes toward the health behaviors along with changes in their behavioral intentions. Moreover, when visual aids were added to the health information, both the gain- and loss-framed messages became equally and highly effective in promoting health behaviors. These results converge with other data indicating that well-constructed visual aids are often among the most highly effective, transparent, fast, memorable, and ethically desirable means of risk communication. Theoretical, economic, and public policy implications of these results are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Comparing gain- and loss-framed messages for smoking cessation with sustained-release bupropion: A randomized controlled trial.

Prospect theory suggests that because smoking cessation is a prevention behavior with a fairly certain outcome, gain-framed messages will be more persuasive than loss-framed messages when attempting to encourage smoking cessation. To test this hypothesis, the authors randomly assigned participants (N=258) in a clinical trial to either a gain- or loss-framed condition, in which they received factually equivalent video and printed messages encouraging smoking cessation that emphasized either the benefits of quitting (gains) or the costs of continuing to smoke (losses), respectively. All participants received open label sustained-release bupropion (300 mg/day) for 7 weeks. In the intent-to-treat analysis, the difference between the experimental groups by either point prevalence or continuous abstinence was not statistically significant. Among 170 treatment completers, however, a significantly higher proportion of participants were continuously abstinent in the gain-framed condition as compared with the loss-framed condition. These data suggest that gain-framed messages may be more persuasive than loss-framed messages in promoting early success in smoking cessation for participants who are engaged in treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of message framing on mammography utilization.

This experiment compared the effectiveness of gain- versus loss-framed messages to persuade women to obtain mammography screening. One hundred and thirty-three women 40 years and older and not adhering to current guidelines for obtaining mammography screening were assigned randomly to view either gain-framed (emphasizing the benefits of obtaining mammography) or loss-framed (emphasizing the risks of not obtaining mammography) persuasive videos that were factually equivalent. Attitudes and beliefs were measured before and immediately following the intervention. Mammography utilization was assessed 6 and 12 months later. Consistent with predictions based on prospect theory, women who viewed the loss-framed message were more likely to have obtained a mammogram within 12 months of the intervention. These findings suggest that loss-framed messages may have an advantage in the promotion of detection behaviors such as mammography. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shaping perceptions to motivate healthy behavior: The role of message framing.

Health-relevant communications can be framed in terms of the benefits (gains) or costs (losses) associated with a particular behavior, and the framing of such persuasive messages influences health decision making. Although to ask people to consider a health issue in terms of associated costs is considered an effective way to motivate behavior, empirical findings are inconsistent. In evaluating the effectiveness of framed health messages, investigators must appreciate the context in which health-related decisions are made. The influence of framed information on decision making is contingent on people, first, internalizing the advocated frame and, then, on the degree to which performing a health behavior is perceived as risky. The relative effectiveness of gain-framed or loss-framed appeals depends, in part, on whether a behavior serves as an illness-detecting or a health-affirming function. Finally the authors discuss the cognitive and affective processes that may mediate the influence of framed information on judgment and behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Consumption of fruits and vegetables in Missouri

High consumption of fruits and vegetables has been linked with a reduced risk of several important chronic diseases. The authors utilized telephone survey techniques to assess the level of fruit and vegetable consumption among adult Missouri residents. Only 28% of respondents reported consumption of five servings of fruits and vegetables per day. Older females had the highest rate of consuming five servings per day, while young males had the lowest rate. These findings, in conjunction with national data, show the need for increasing emphasis on the "5 A Day" campaign.     

Self-affirmation promotes health behavior change.

Objective: Evidence shows that self-affirmation has a positive effect on message acceptance and other variables that motivate health behavior change; however, this has not been translated into actual behavioral change. We propose that particular features of the previous studies may account for this failure; the current study addresses this. It is designed to test whether a self-affirmation manipulation can increase a health-promoting behavior (fruit and vegetable consumption). It also explores the extent to which efficacy variables mediate the self-affirmation and behavior relationship. Design: Women (N = 93) were randomly allocated to a self-affirmation or control task prior to reading a message regarding the health-promoting effects of fruit and vegetables. Main Outcome-Measures: Response-efficacy, self-efficacy, and intention measures were taken immediately after exposure to the message, followed by a 7-day diary record of fruit and vegetable consumption. Results: Self-affirmed participants ate significantly more portions of fruit and vegetables, an increase of approximately 5.5 portions across the week, in comparison to the control group. This effect was mediated by response-efficacy. Conclusion: Self-affirmation interventions can successfully influence health-promoting behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why Are You Bringing Up Condoms Now? The Effect of Message Content on Framing Effects of Condom Use Messages.

According to prospect theory (A. Tversky & D. Kahneman, 1981), messages advocating a low-risk (i.e., easy, low-cost) behavior are most effective if they stress the benefits of adherence (gain framed), whereas messages advocating a risky behavior are most effective if they stress the costs of nonadherence (loss framed). Although condom use is viewed as a low-risk behavior, it may entail risky interpersonal negotiations. Study 1 (N = 167) compared ratings of condom use messages advocating relational behaviors (e.g., discussing condoms) or health behaviors (e.g., carrying condoms). As predicted, loss-framed relational messages and gain-framed health messages received higher evaluations. Study 2 (N = 225) offers a replication and evidence of issue involvement and gender as moderators. Results are discussed with reference to the design of condom use messages. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intervention effects of information and self-regulation on eating fruits and vegetables over two years.

Objective: This study tested whether an intervention that combined information with self-regulation strategies had a better effect on eating fruits and vegetables than an information-only intervention. Design: Women between age 30 and 50 (N = 255) participated in a 24-month randomized controlled trial comparing two brief interventions: All participants received the same information intervention; participants in the information plus self-regulation group additionally learned a self-regulation technique that integrates mental contrasting with implementation intentions. Main outcome measures: Participants reported in daily diaries how many servings of fruits and vegetables they ate per day during 1 week at baseline, and in the first week, 1, 2, 4, and 24 months after intervention. Results: Participants in both groups ate more fruits and vegetables (0.47 to 1.00 daily servings) than at baseline during the first 4 months after intervention. Two years later, participants in the information plus self-regulation group maintained the higher intake, whereas participants in the information group returned to baseline levels. Conclusion: Adding self-regulation training to an information intervention increased its effectiveness for long-term behavior change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing fruit and vegetable consumption among children: the 5-a-Day Power Plus program in St. Paul, Minnesota

OBJECTIVES: A randomized school based trial sought to increase fruit and vegetable consumption among children using a multicomponent approach. METHODS: The intervention, conducted in 20 elementary schools in St. Paul, targeted a multiethnic group of children who were in the fourth grade in spring 1995 and the fifth grade in fall 1995. The intervention consisted of behavioral curricula in classrooms, parental involvement, school food service changes, and industry support and involvement. Lunchroom observations and 24-hour food recalls measured food consumption. Parent telephone surveys and a health behavior questionnaire measured psychosocial factors. RESULTS: The intervention increased lunchtime fruit consumption and combined fruit and vegetable consumption, lunchtime vegetable consumption among girls, and daily fruit consumption as well as the proportion of total daily calories attributable to fruits and vegetables. CONCLUSIONS: Multicomponent school-based programs can increase fruit and vegetable consumption among children. Greater involvement of parents and more attention to increasing vegetable consumption, especially among boys, remain challenges in future intervention research.     

Fruit and vegetable consumption, nutritional knowledge and beliefs in mothers and children

Increasing fruit and vegetable consumption is an important health behaviour. Parental and other psychosocial influences on children's fruit and vegetable consumption are poorly understood. The contribution of a variety of psychosocial and environmental factors to consumption of fruit and vegetables by children aged 9-11 years was explored. Ninety-two mothers and children (48 girls and 44 boys) were recruited via urban primary health-care practices. Socio-economic and educational level, nutritional knowledge and health- and diet-related beliefs and attitudes were assessed in mothers and children by questionnaires and semistructured interviews. Mothers> diets were measured by a food frequency questionnaire, while children's diets were assessed by 3-day diaries (N=80). The pattern of influence of the various measures on fruit and vegetable consumption was compared with that on children's confectionery intake. The children's intakes of macronutrients were typical for the U.K. (37% fat, 50% carbohydrate and 13% protein by energy; 12 g/day fibre), while median fruit, fruit juice and vegetable intake amounted to about 2.5 servings/day. Univariate correlations and subsequent multiple regression analyses revealed quite different influences on the three food types. Independent predictors of children's fruit intake included mothers> nutritional knowledge (beta=0.37), mothers> frequency of fruit consumption (beta=0.30) and mothers> attitudinal conviction that increasing fruit and vegetable consumption by their children could reduce their risk of developing cancer (beta=0.27; multiple r2=0.37,p<0.0001). Children's vegetable consumption was independently explained by the child's liking for commonly eaten vegetables (beta=0.36) and the mother's belief in the importance of disease prevention when choosing her child's food (beta=-0.27 r2=0.20,p<0.001). Children's confectionery consumption was predicted by the mother's liking for confectionery (beta=0.32) and the children's concern for health in choosing what to eat (beta=-0.26 r2=0.16, p<0.005). Children's consumption of fruit and vegetables are related to different psychosocial and environmental factors. Promotion of this behaviour may require attention to nutritional education and child feeding strategies of parents.     

Increases in human plasma antioxidant capacity after consumption of controlled diets high in fruit and vegetables

BACKGROUND: The putative beneficial effects of an increased consumption of fruit and vegetables have been associated with antioxidant nutrients. However, the effect of fruit and vegetable consumption on the overall antioxidant status in humans is unclear. OBJECTIVE: The objective of this study was to investigate whether a diet rich in fruit and vegetables would affect the antioxidant capacity of human plasma. DESIGN: Thirty-six healthy nonsmokers resided in a metabolic research unit and consumed 2 sets of controlled diets. Diet A contained 10 servings of fruit and vegetables each day for 15 d. Diet B was the same as diet A, except diet B also provided 2 servings of broccoli each day on days 6-10. There was a free-living period of a minimum of 6 wk between the 2 experiments using either diet A or diet B. Fasting plasma antioxidant capacity, measured as oxygen radical absorbance capacity (ORAC), and alpha-tocopherol concentrations were determined on days 1, 6, 11, and 16. RESULTS: The fasting baseline plasma ORAC of these subjects was significantly correlated with their estimated daily intake of total antioxidants from fruit and vegetables during the previous year. Plasma ORAC of these subjects was significantly increased by both diets A and B. This increase in ORAC could not be explained by the increase in the plasma alpha-tocopherol concentration. CONCLUSION: Increased consumption of fruit and vegetables can increase the plasma antioxidant capacity in humans.     

Randomised controlled trial of effect of fruit and vegetable consumption on plasma concentrations of lipids and antioxidants

OBJECTIVES: To determine the extent to which plasma antioxidant concentrations in people with habitual low intake of fruit and vegetables respond to increased intakes of these foods. To examine whether advice to increase fruit and vegetables will result in reduction of concentrations of total and low density lipoprotein cholesterol. DESIGN: Randomised controlled trial in which intervention and control groups were followed up for eight weeks. The intervention group was asked to consume eight servings of fruit and vegetables a day. SETTING: Dunedin, New Zealand. SUBJECTS: Eighty seven subjects with normal lipid concentrations who ate three or fewer servings of fruit and vegetables daily. MAIN OUTCOME MEASURES: Plasma concentrations of vitamin C, retinol, alpha and beta carotene, alpha tocopherol, lipids, and lipoproteins. Dietary intake assessed with diet records over four days. RESULTS: The mean plasma vitamin C, alpha carotene, and beta carotene concentrations increased in parallel with increased dietary intake of fruit and vegetables in the intervention group. Concentrations of retinol, alpha tocopherol, lipids, and lipoproteins remained unchanged despite some increase in dietary vitamin E and a small reduction in saturated fat intake. CONCLUSIONS: Following a recommendation to increase fruit and vegetable consumption produces change in plasma concentrations of vitamin C, alpha carotene, and beta carotene likely to reduce incidence of cancer. More specific dietary advice to modify fat intake may be necessary to reduce the risk of cardiovascular disease mediated by lipoprotein and vitamin E.     

Dietary risk factors for pre-eclampsia among women attending Harare Maternity Hospital, Zimbabwe

OBJECTIVE: To identify specific foods that predispose Zimbabwean women to a higher or lower risk of pre-eclampsia and/or eclampsia. DESIGN: A case control study was implemented. Participants were asked by questionnaire to recall the specific amounts of meats, poultry, fruits, fish, vegetables and dairy products they had consumed in the month prior to giving birth. SETTING: Harare Maternity Hospital, Harare, Zimbabwe between June of 1995 and April of 1996. SUBJECTS: 180 women clinically diagnosed with pre-eclampsia (144) or eclampsia (36), and 194 normotensive women without these conditions. MAIN OUTCOME MEASURES: Pre-eclampsia/eclampsia. RESULTS: There were few associations between consumption of specific food items and the occurrence of pre-eclampsia/eclampsia. Meat and fruit were the only foods found to be significantly associated with pre-eclampsia. Women who consumed 12 or more servings of meat per month were more likely to have pre-eclampsia/eclampsia when compared to women eating 11 servings of meat or less per month. While intake of bananas and mangos was unrelated to risk, women who consumed other fruits (i.e. apples, oranges, grapes, peaches, apricots, paw paw, and plums), were 1.7 (95% CI = 1.0 to 3.1) times more likely to develop pre-eclampsia/eclampsia as women who ate none of these fruits. However, women who consumed relatively large quantities of these fruits were not at a particularly high risk. Increased consumption of kapenta was modestly associated with a decrease in disease risk, but this finding was well within the limits of chance and no association was present with intake of other types of fish. CONCLUSIONS: Our findings suggest that variation in consumption of specific foods do not have a strong effect on the incidence of pre-eclampsia in this population. However, further research involving the use of a more comprehensive dietary measure, biochemical measurements of nutrients, pre-pregnancy assessment and ascertainment of dietary intake prior to the development of pre-eclampsia are needed.     

Discrete Emotions and Persuasion: The Role of Emotion-Induced Expectancies.

The authors argue that specific emotions can alter the persuasive impact of messages as a function of the emotional framing of persuasive appeals. Because specific emotions inflate expectancies for events possessing matching emotional overtones (D. DeSteno, R. E. Petty, D. T. Wegener, & D. D. Rucker, 2000), the authors predicted that attempts at persuasion would be more successful when messages were framed with emotional overtones matching the emotional state of the receiver and that these changes would be mediated by emotion-induced biases involving expectancies attached to arguments contained in the messages. Two studies manipulating discrete negative emotional states and message frames (i.e., sadness and anger) confirmed these predictions. The functioning of this emotion-matching bias in parallel with emotion-induced processing differences and the limitations of a valence-based approach to the study of attitude change are also considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)