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Mixed Method Approaches to Understanding Cancer-Related Dietary Risk Reduction among Public Housing Residents

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Abstract

Improving diet is one important pathway for addressing cancer disparities. We conducted mixed-method analyses of 468 24-h dietary recalls from 156 African–American women residents of Washington DC public housing to better understand dietary patterns. Recalls were rated for five cancer-related preventive characteristics (adequate fruits/vegetables, moderate fat, moderate calories, no alcohol, and adequate Healthy Eating Index score), combined as a scale. Bivariate and multivariate analyses identified psychosocial and dietary characteristics associated with scale scores. Qualitative analyses of dietary records identified contextual aspects of food patterns within and across score groups. Sixty-one percent of respondents met zero or one dietary goal; alcohol abstention was most common (64%). Only 12% achieve either three (6%), four (4%), or all five (<1%) goals; five fruit and vegetable servings were least common (15%). The underlying scalar structure of responses suggests that fruit and vegetable consumption is seldom achieved in this population without other scale components. Poorer scores were associated with younger age, depressive symptoms, stressful life events, smoking, and food-purchasing practices. Qualitative analyses identified eight themes related to differences between dietary patterns. Findings reinforce the value of nonreductionist approaches to cancer-related nutrition intervention.

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References

  1. Brawley OW, Berger MZ. Cancer and disparities in health: perspectives on health statistics and research questions. Cancer. 2008;113(7 Suppl):1744–1754.

    Article  PubMed  Google Scholar 

  2. Jones LA, Chilton JA, Hajek RA, Iammarino NK, Laufman L. Between and within: international perspectives on cancer and health disparities. J Clin Oncol. 2006;24:2204–2208.

    Article  PubMed  Google Scholar 

  3. Doll R. Symposium on diet and cancer: an overview of the epidemiological evidence linking diet and cancer. Proc Nutr Soc. 1990;49:119–131.

    Article  PubMed  CAS  Google Scholar 

  4. Wiseman M. The second world cancer research fund/American institute for cancer research expert report. Food, nutrition, physical activity and the prevention of cancer: a global perspective. Proc Nutr Soc. 2008;67:253–256.

    Article  PubMed  Google Scholar 

  5. Kushi LH, Byers T, Doyle C, et al. American cancer society guidelines on nutrition and physical activity prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2006;56:254–281.

    Article  PubMed  Google Scholar 

  6. Amuna P, Zotor FB. Epidemiological and nutrition transition in developing countries: impact on human health and development. Proc Nutr Soc. 2008;67:82–90.

    Article  PubMed  Google Scholar 

  7. Stuckler D. Population causes and consequences of leading chronic diseases: a comparative analysis of prevailing explanations. Milbank Quarterly. 2008;86:273–326.

    Article  PubMed  Google Scholar 

  8. Casagrande SS, Wang Y, Anderson C, Gary TL. Have Americans increased their fruit and vegetable intake? Am J Prev Med. 2007;32(4):257–263.

    Article  PubMed  Google Scholar 

  9. Havas S, Heimendinger J, Reynolds K, et al. 5 a day for better health: a new research initiative. J Am Diet Assoc. 1994;94:32–36.

    Article  PubMed  CAS  Google Scholar 

  10. Bisogni CA, Falk LW, Madore E, et al. Dimensions of everyday eating and drinking episodes. Appetite. 2007;48:218–231.

    Article  PubMed  Google Scholar 

  11. Messina M, Lampe JW, Birt DF, et al. Reductionism and the narrowing nutrition perspective: time for reevaluation and emphasis on food synergy. JADA. 2001;101:1416–1419.

    CAS  Google Scholar 

  12. Subar AF, Heimendinger J, Patterson BH, Krebs-Smith SM, Pivonka E, Kessler R. Fruit and vegetable intake in the United States: the baseline survey of the five a day for better health program. Am J Health Promot. 1995;9:352–360.

    PubMed  CAS  Google Scholar 

  13. Li R, Serdula M, Bland S, Mokdad A, Bowman B, Nelson D. Trends in fruit and vegetable consumption among adults in 16 US states: behavioral risk factor surveillance system, 1990–1996. Am J Public Health. 2000;90:777–781.

    Article  PubMed  CAS  Google Scholar 

  14. Diaz VA, Mainous AG, Koopman RJ, Carek PJ, Geesey ME. Race and diet in the overweight: association with cardiovascular risk in a nationally representative sample. Nutrition. 2005;21:718–725.

    Article  PubMed  Google Scholar 

  15. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–1555.

    Article  PubMed  CAS  Google Scholar 

  16. Shankar S, Klassen AC. Influences on fruit and vegetable procurement and consumption among urban African–American public housing residents, and potential strategies for intervention. Fam Econ Nutr Rev. 2001;13:33–45.

    Google Scholar 

  17. Shankar S, Klassen AC, Garrett-Mayer E, et al. Evaluation of a nutrition education intervention for women residents of Washington, DC, public housing communities. Health Educ Res. 2007;22(3):425–437.

    Article  PubMed  Google Scholar 

  18. Piano Clark VL, Creswell JW. The Mixed Methods Reader. Thousand Oaks: Sage; 2008.

    Google Scholar 

  19. Klassen AC, Garrett-Mayer E, Houts PS, Shankar S, Torio CM. The relationship of body size to participation and success in a fruits and vegetables intervention among low-income women. J Community Health. 2008;33(2):78–89.

    Article  PubMed  Google Scholar 

  20. Sullivan HW, Klassen AC. Nutrition-related cancer prevention attitudes in low-income women. Prev Med. 2007;45(2-3):139–145.

    Article  PubMed  Google Scholar 

  21. Houts PS, Shankar S, Klassen AC, Robinson EB. Use of pictures to facilitate nutrition education for low-income African American women. J Nutr Educ Behav. 2006;38(5):317–318.

    Article  PubMed  Google Scholar 

  22. Houts PS, Shankar S, Klassen AC, Robinson EB, McCarthy M. A problem solving approach to nutrition education and counseling. J Nutr Educ Behav. 2006;38(4):254–258.

    Article  Google Scholar 

  23. US Department of Agriculture, Center for Nutrition Policy and Promotion. The Healthy Eating Index. CNPP-1. Washington, DC: US Department of Agriculture; 1995.

    Google Scholar 

  24. Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.

    Article  Google Scholar 

  25. Guttman L. A basis for scaling qualitative data. Am Soc Rev. 1944;9:139–150.

    Article  Google Scholar 

  26. Snijders T, Bosker R. Multilevel Analysis. Thousand Oaks: Sage; 1999.

    Google Scholar 

  27. Rabe-Hesketh S, Skrondal A. Multilevel and Longitudinal Modeling Using Stata. College Station: Stata; 2005.

    Google Scholar 

  28. Alteide DL. Ethnographic content analysis. Qual Sociol. 1987;10(1):65–77.

    Article  Google Scholar 

  29. Glaser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. Hawthorne: Aldine de Gruyter; 1977.

    Google Scholar 

  30. IOM (Institute of Medicine). State of the USA Health Indicators: Letter Report. Washington, DC: The National Academies Press; 2009.

    Google Scholar 

  31. US Substance Abuse and Mental Health Services Administration, Office of Applied Studies. 2007 National Survey on Drug Use & Health. Accessed on: October 28, 2008. Available at: www.oas.samhsa.gov/NSDUHlatest.htm.

  32. Graves K, Kaskutas LA. Beverage choice among native American and African American urban women. Alcohol Clin Exp Res. 2002;26:218–222.

    PubMed  Google Scholar 

  33. Bluthenthal RN, Taylor DB, Guzman-Becerra N, Robinson PL. Characteristics of malt liquor beer drinkers in a low-income, racial minority community sample. Alcohol Clin Exp Res. 2005;29:402–409.

    Article  PubMed  Google Scholar 

  34. Prochaska JO, Velicer WF, DiClemente CC, Fava J. Measuring processes of change: applications to the cessation of smoking. J Consult Clin Psychol. 1988;56(4):520–528.

    Article  PubMed  CAS  Google Scholar 

  35. Office of Women’s Health, Center for Disease Control and Prevention. Leading causes of death by race/ethnicity, all females, United States, 2004. Accessed on: October 27, 2008. Available at: www.cdc.gov/Women/lcod.htm.

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Acknowledgements

This work was supported by a grant from the American Cancer Society, as well as funding from the Cigarette Restitution Fund of the State of Maryland.

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Authors and Affiliations

  1. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Ann C. Klassen & Katherine Clegg Smith

  2. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA

    Ann C. Klassen & Katherine Clegg Smith

  3. Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Ann C. Klassen, Maureen M. Black & Laura E. Caulfield

  4. Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA

    Maureen M. Black

  5. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Laura E. Caulfield

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  1. Ann C. Klassen
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Correspondence to Ann C. Klassen.

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Klassen, A.C., Smith, K.C., Black, M.M. et al. Mixed Method Approaches to Understanding Cancer-Related Dietary Risk Reduction among Public Housing Residents. J Urban Health 86, 624–640 (2009). https://doi.org/10.1007/s11524-009-9352-9

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  • DOI: https://doi.org/10.1007/s11524-009-9352-9

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