Journal of the American College of Nutrition
ISSN: 0731-5724 (Print) 1541-1087 (Online) Journal homepage: http://www.tandfonline.com/loi/uacn20
Dietary and Behavioral Factors Associated with Diet Quality among Low-income Overweight and Obese African American Women Terryl J. Hartman PhD, MPH, RD, Regine Haardörfer PhD, MEd, Laura L. Whitaker MPH, Ann Addison PhD, MSN, FNP-C, Maria Zlotorzynska PhD, MPH, Julie A. Gazmararian PhD, MPH & Michelle C. Kegler DrPH, MPH To cite this article: Terryl J. Hartman PhD, MPH, RD, Regine Haardörfer PhD, MEd, Laura L. Whitaker MPH, Ann Addison PhD, MSN, FNP-C, Maria Zlotorzynska PhD, MPH, Julie A. Gazmararian PhD, MPH & Michelle C. Kegler DrPH, MPH (2015) Dietary and Behavioral Factors Associated with Diet Quality among Low-income Overweight and Obese African American Women, Journal of the American College of Nutrition, 34:5, 416-424, DOI: 10.1080/07315724.2014.982305 To link to this article: http://dx.doi.org/10.1080/07315724.2014.982305
Published online: 24 Apr 2015.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=uacn20 Download by: [Chinese University of Hong Kong]
Date: 06 November 2015, At: 06:33
Original Research
Dietary and Behavioral Factors Associated with Diet Quality among Low-income Overweight and Obese African American Women
Downloaded by [Chinese University of Hong Kong] at 06:33 06 November 2015
Terryl J. Hartman, PhD, MPH, RD, Regine Haard€ orfer, PhD, MEd, Laura L. Whitaker, MPH, Ann Addison, PhD, MSN, FNP-C, Maria Zlotorzynska, PhD, MPH, Julie A. Gazmararian, PhD, MPH, and Michelle C. Kegler, DrPH, MPH Department of Epidemiology (T.J.H., M.Z., J.A.G.), Department of Behavioral Sciences and Health Education & Emory Prevention Research Center (R.H., M.C.K.), HERCULES–Emory’s Environmental Health Center, Emory Prevention Research Center (L.L.W.), Rollins School of Public Health and Winship Cancer Institute (TJH), Emory University, Atlanta, Georgia; Primary Care of Southwest GA, Inc., Blakely, Georgia (A.A.) Key words: diet quality, Healthy Eating Index, overweight, obesity Objectives: The goal of this research was to assess the roles of demographic and home food environment characteristics on diet quality measured with the U.S. Department of Agriculture’s Healthy Eating Index (HEI) in a population of low-income overweight and obese African American women. Design: Cross-sectional analysis of baseline data. Setting: A community-based study of low-income overweight and obese African American women. Subjects: Participants enrolled in the Healthy Homes/Healthy Families study including a home environment survey (e.g., food availability, food practices and social support) and 24-hour recall dietary data collected on one weekday and one weekend day (n D 198). Results: In multivariate regression analyses, demographic characteristics were not significantly associated with diet quality; however, several home food environment characteristics were significantly associated with higher quality diets, including healthy shopping (e.g., regularly purchasing fresh fruits and vegetables), selecting healthy beverages (e.g., without added sugar), healthy food preparation, and serving behaviors. Eating while watching television was associated with lower quality diets. Nearly 33% (p < 0.001) of the variance in HEI total score was explained by the home food environment factors, far surpassing that explained by demographic characteristics (3.5%, p D 0.21). Conclusions: Interventions targeting the home food environment may improve overall diet quality in low-income overweight African American populations.
and 17.8% with BMI 40, respectively. Although obesity showed no significant increase among women overall from 1999 to 2010, non-Hispanic black women saw a significant increase in those years [1]. Obesity is positively associated with the development of type 2 diabetes [2], coronary heart disease [3,4], some types of cancer [5], and other chronic conditions [6–9] and inversely associated with longevity [10]. Recent research suggests that previous studies have likely underestimated the association between obesity and mortality among African American
INTRODUCTION High prevalence of overweight and obesity is a major public health concern in the United States. Over two thirds (69.2%) of U.S. adults are overweight (body mass index [BMI] 25) and more than one third (35.9%) are obese (BMI 30) [1]. African American women have a higher prevalence of obesity (58.5%) compared to all women (35.8% obese) and non-Hispanic white women (32.2% obese). In addition, African American women have higher prevalence of grade 2 and grade 3 obesity, with 30.7% having a BMI 35
Address correspondence to: Terryl J. Hartman, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322. E-mail: [email protected]
Journal of the American College of Nutrition, Vol. 34, No. 5, 416–424 (2015) Ó American College of Nutrition Published by Taylor & Francis Group, LLC 416
Downloaded by [Chinese University of Hong Kong] at 06:33 06 November 2015
Diet Quality among African American Women women. Nearly one third (26.8%) of deaths in African American women are associated with these conditions [10]. Significant adult mortality is attributed to dietary risk factors for chronic disease, including high dietary trans-fatty acids, low omega-3 fatty acids, high dietary salt, and low intake of fruits and vegetables [11]. Many eating behaviors have been linked to overweight and obesity, including eating frequency, eating out [12], and eating while watching television [13]. Eating behaviors influence diet quality multifactorially, including through individual and social, physical, and macrolevel environmental contexts [14]. The U.S. Department of Agriculture’s Healthy Eating Index 2005 (HEI) measures compliance with key diet-related recommendations of the 2005 Dietary Guidelines for Americans and represents all major food groups found in My Pyramid [15]. According to the HEI, the mean diet quality of all U.S. Americans above age 2 is 58.2 on a scale of 0–100, with 100 as the maximum (and most favorable) score [16]. Previous research has shown diet quality to be associated with psychosocial constructs such as knowledge, self-efficacy, and social support [17]. African Americans are less likely than other racial groups to adhere to dietary standards and are also underrepresented in diet-related healthy behavior research [18]. Though some studies have examined the diet quality of African American women in relation to demographics and psychosocial characteristics [19–21], no known studies have examined the effect of the home food environments of African American women on diet quality as measured by the HEI. Reviews examining psychosocial predictors of fruit and vegetable intake suggest emphasizing environmental and behavioral factors for diet quality interventions [22], as well as adapting the socioecological model for interventions targeted at African Americans [18]. The objective of the current study is to assess the roles of demographic and home food environment physical (e.g., food inventory and placement, food shopping and preparation methods) and social (e.g., support from family for healthy eating) characteristics on diet quality in a population of low-income overweight and obese African American women by means of the HEI. The results of this research will advise whether future intervention to change the home food environment can affect diet quality. In turn, this will add to the growing literature that suggests that intervention strategies aimed at social determinants may have the ability to affect overall diet quality.
MATERIALS AND METHODS Population and Data Collection The Healthy Homes/Healthy Families study is a randomized controlled intervention trial designed to test the effectiveness of home-based coaching to promote healthier home food
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION
and physical activity environments for weight gain prevention. Details of the study and data collection procedures have been reported previously [23]. Briefly, the trial was developed by the Emory Prevention Research Center using a communitybased participatory research approach in partnership with the Cancer Coalition of South Georgia and the Emory Prevention Research Center Community Advisory Board. The Community Advisory Board is composed of 18–22 residents of southwest Georgia, representing local organizations such as churches, businesses, health departments, and civic organizations. All data collection procedures were approved by the Institutional Review Board at Emory University and verbal informed consent was obtained by telephone. Overweight and obese (body mass index > 25) female participants ages 35–65 were recruited from February 2011 to December 2012 from 9 southern Georgia clinic sites affiliated with 3 federally qualified health centers. Individuals had to speak English, live with at least one other person, and reside within 30 miles of a participating community health center. Providers were asked to exclude those with contraindications for physical activity or for participation in a medically unsupervised study on healthy eating and physical activity/weight gain prevention. Pregnant women were also excluded from the study. Trained interview staff collected data by telephone at baseline and 6 and 12 months. Participants provided demographic (e.g., age; educational status; income, measured categorically according to the Behavioral Risk Factor Surveillance System cut points [24]; residence; number of children living in the household, defined as sleeping in that home at least 3 nights per week) and healthrelated information (height in feet and inches and weight in pounds used to calculate BMI [kg/m2]), completed a series of home food environment questions, and completed two 24-hour dietary recalls (one weekday and one weekend day) at each time point. The data included in the present article are from baseline, prior to any intervention, and include only lowincome (defined as 35–50 (N D 98) >50 (N D 100) Education
ISSN: 0731-5724 (Print) 1541-1087 (Online) Journal homepage: http://www.tandfonline.com/loi/uacn20
Dietary and Behavioral Factors Associated with Diet Quality among Low-income Overweight and Obese African American Women Terryl J. Hartman PhD, MPH, RD, Regine Haardörfer PhD, MEd, Laura L. Whitaker MPH, Ann Addison PhD, MSN, FNP-C, Maria Zlotorzynska PhD, MPH, Julie A. Gazmararian PhD, MPH & Michelle C. Kegler DrPH, MPH To cite this article: Terryl J. Hartman PhD, MPH, RD, Regine Haardörfer PhD, MEd, Laura L. Whitaker MPH, Ann Addison PhD, MSN, FNP-C, Maria Zlotorzynska PhD, MPH, Julie A. Gazmararian PhD, MPH & Michelle C. Kegler DrPH, MPH (2015) Dietary and Behavioral Factors Associated with Diet Quality among Low-income Overweight and Obese African American Women, Journal of the American College of Nutrition, 34:5, 416-424, DOI: 10.1080/07315724.2014.982305 To link to this article: http://dx.doi.org/10.1080/07315724.2014.982305
Published online: 24 Apr 2015.
Submit your article to this journal
Article views: 135
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=uacn20 Download by: [Chinese University of Hong Kong]
Date: 06 November 2015, At: 06:33
Original Research
Dietary and Behavioral Factors Associated with Diet Quality among Low-income Overweight and Obese African American Women
Downloaded by [Chinese University of Hong Kong] at 06:33 06 November 2015
Terryl J. Hartman, PhD, MPH, RD, Regine Haard€ orfer, PhD, MEd, Laura L. Whitaker, MPH, Ann Addison, PhD, MSN, FNP-C, Maria Zlotorzynska, PhD, MPH, Julie A. Gazmararian, PhD, MPH, and Michelle C. Kegler, DrPH, MPH Department of Epidemiology (T.J.H., M.Z., J.A.G.), Department of Behavioral Sciences and Health Education & Emory Prevention Research Center (R.H., M.C.K.), HERCULES–Emory’s Environmental Health Center, Emory Prevention Research Center (L.L.W.), Rollins School of Public Health and Winship Cancer Institute (TJH), Emory University, Atlanta, Georgia; Primary Care of Southwest GA, Inc., Blakely, Georgia (A.A.) Key words: diet quality, Healthy Eating Index, overweight, obesity Objectives: The goal of this research was to assess the roles of demographic and home food environment characteristics on diet quality measured with the U.S. Department of Agriculture’s Healthy Eating Index (HEI) in a population of low-income overweight and obese African American women. Design: Cross-sectional analysis of baseline data. Setting: A community-based study of low-income overweight and obese African American women. Subjects: Participants enrolled in the Healthy Homes/Healthy Families study including a home environment survey (e.g., food availability, food practices and social support) and 24-hour recall dietary data collected on one weekday and one weekend day (n D 198). Results: In multivariate regression analyses, demographic characteristics were not significantly associated with diet quality; however, several home food environment characteristics were significantly associated with higher quality diets, including healthy shopping (e.g., regularly purchasing fresh fruits and vegetables), selecting healthy beverages (e.g., without added sugar), healthy food preparation, and serving behaviors. Eating while watching television was associated with lower quality diets. Nearly 33% (p < 0.001) of the variance in HEI total score was explained by the home food environment factors, far surpassing that explained by demographic characteristics (3.5%, p D 0.21). Conclusions: Interventions targeting the home food environment may improve overall diet quality in low-income overweight African American populations.
and 17.8% with BMI 40, respectively. Although obesity showed no significant increase among women overall from 1999 to 2010, non-Hispanic black women saw a significant increase in those years [1]. Obesity is positively associated with the development of type 2 diabetes [2], coronary heart disease [3,4], some types of cancer [5], and other chronic conditions [6–9] and inversely associated with longevity [10]. Recent research suggests that previous studies have likely underestimated the association between obesity and mortality among African American
INTRODUCTION High prevalence of overweight and obesity is a major public health concern in the United States. Over two thirds (69.2%) of U.S. adults are overweight (body mass index [BMI] 25) and more than one third (35.9%) are obese (BMI 30) [1]. African American women have a higher prevalence of obesity (58.5%) compared to all women (35.8% obese) and non-Hispanic white women (32.2% obese). In addition, African American women have higher prevalence of grade 2 and grade 3 obesity, with 30.7% having a BMI 35
Address correspondence to: Terryl J. Hartman, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322. E-mail: [email protected]
Journal of the American College of Nutrition, Vol. 34, No. 5, 416–424 (2015) Ó American College of Nutrition Published by Taylor & Francis Group, LLC 416
Downloaded by [Chinese University of Hong Kong] at 06:33 06 November 2015
Diet Quality among African American Women women. Nearly one third (26.8%) of deaths in African American women are associated with these conditions [10]. Significant adult mortality is attributed to dietary risk factors for chronic disease, including high dietary trans-fatty acids, low omega-3 fatty acids, high dietary salt, and low intake of fruits and vegetables [11]. Many eating behaviors have been linked to overweight and obesity, including eating frequency, eating out [12], and eating while watching television [13]. Eating behaviors influence diet quality multifactorially, including through individual and social, physical, and macrolevel environmental contexts [14]. The U.S. Department of Agriculture’s Healthy Eating Index 2005 (HEI) measures compliance with key diet-related recommendations of the 2005 Dietary Guidelines for Americans and represents all major food groups found in My Pyramid [15]. According to the HEI, the mean diet quality of all U.S. Americans above age 2 is 58.2 on a scale of 0–100, with 100 as the maximum (and most favorable) score [16]. Previous research has shown diet quality to be associated with psychosocial constructs such as knowledge, self-efficacy, and social support [17]. African Americans are less likely than other racial groups to adhere to dietary standards and are also underrepresented in diet-related healthy behavior research [18]. Though some studies have examined the diet quality of African American women in relation to demographics and psychosocial characteristics [19–21], no known studies have examined the effect of the home food environments of African American women on diet quality as measured by the HEI. Reviews examining psychosocial predictors of fruit and vegetable intake suggest emphasizing environmental and behavioral factors for diet quality interventions [22], as well as adapting the socioecological model for interventions targeted at African Americans [18]. The objective of the current study is to assess the roles of demographic and home food environment physical (e.g., food inventory and placement, food shopping and preparation methods) and social (e.g., support from family for healthy eating) characteristics on diet quality in a population of low-income overweight and obese African American women by means of the HEI. The results of this research will advise whether future intervention to change the home food environment can affect diet quality. In turn, this will add to the growing literature that suggests that intervention strategies aimed at social determinants may have the ability to affect overall diet quality.
MATERIALS AND METHODS Population and Data Collection The Healthy Homes/Healthy Families study is a randomized controlled intervention trial designed to test the effectiveness of home-based coaching to promote healthier home food
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION
and physical activity environments for weight gain prevention. Details of the study and data collection procedures have been reported previously [23]. Briefly, the trial was developed by the Emory Prevention Research Center using a communitybased participatory research approach in partnership with the Cancer Coalition of South Georgia and the Emory Prevention Research Center Community Advisory Board. The Community Advisory Board is composed of 18–22 residents of southwest Georgia, representing local organizations such as churches, businesses, health departments, and civic organizations. All data collection procedures were approved by the Institutional Review Board at Emory University and verbal informed consent was obtained by telephone. Overweight and obese (body mass index > 25) female participants ages 35–65 were recruited from February 2011 to December 2012 from 9 southern Georgia clinic sites affiliated with 3 federally qualified health centers. Individuals had to speak English, live with at least one other person, and reside within 30 miles of a participating community health center. Providers were asked to exclude those with contraindications for physical activity or for participation in a medically unsupervised study on healthy eating and physical activity/weight gain prevention. Pregnant women were also excluded from the study. Trained interview staff collected data by telephone at baseline and 6 and 12 months. Participants provided demographic (e.g., age; educational status; income, measured categorically according to the Behavioral Risk Factor Surveillance System cut points [24]; residence; number of children living in the household, defined as sleeping in that home at least 3 nights per week) and healthrelated information (height in feet and inches and weight in pounds used to calculate BMI [kg/m2]), completed a series of home food environment questions, and completed two 24-hour dietary recalls (one weekday and one weekend day) at each time point. The data included in the present article are from baseline, prior to any intervention, and include only lowincome (defined as 35–50 (N D 98) >50 (N D 100) Education
