Michelle A.

McGregor

M.S. Thesis Defense

Department of Food Science & Human
Nutrition
 Research Objective

• To understand why African American

men choose the foods they do, here
fruit and vegetables, and especially
with regards to risk for prostate
cancer.
Rationale for Fruits & Vegetables
1. Fruit & vegetables associated with
reduced risk for prostate cancer, HTN &
CHD.
• 70% of all cancer due to lifestyle, including diet
• Men eating > 2svg/da had 36% risk reduction
J Natl Cancer Inst 1995; 87
• 7th day Adventists had reduced risk of prostate
CA with increased tomato product intake
Cancer 1989;64
2. Micronutrients,esp anti-oxidants, may have
important role in reducing cancer incidence

Good food sources of lycopene

• Tomato products
• Pink grapefruit
• Watermelon
• Apricots
• Guava
• Papaya
 3. Fruit & vegetable intakes are low,
especially in men
4.5
4 4.4
3.5 3.9 African
American
No. svg F/V

3 3.3 3.3 men

2.5 3 3
Caucasian
2 men
1.5
1
0.5
0
BRFSS 5 A Day CSFII
4. Need to know how to increase F/V
intakes
 $1.5 million by NCI for minority focus
groups on increasing fruits & vegetables
• MSU male students in focus groups, “No
one ever died from not eating F/V”
• Head Start mothers reported the men in
households as barriers to serving
vegetables at meals.
5. Personal Interest
• Optimizing health through diet
• Many years working in church
ministries
• Family history of prostate cancer
 Cancer Incidence in Men
by Site & Race
700

600

500
Num ber of Incidence

White
400
Black

300 Asian/Pacific
Islander
American Indian

200 Hispanic2

100

0
All Sites Colon & rectum Lung & bronchus Prostate
 Mortality Rates in Men
by Site & Race
350

300

250 White
Per 100,000, age-adjusted

Black
200
Asian/Pacific
Islander
American Indian
150
Hispanic2

100

50

0
All Sites Colon & rectum Lung & bronchus Prostate
Risks for Prostate Cancer

• Diet • Family History

• Age • Physical
• Race activity
• Vasectomy
 Limited Research on Subject

1. Prostate Cancer in African American

men: increasing knowledge and self-
efficacy. Boehm S, Coleman Burns P, et al J
Community Health Nursing. 1995;12(3):161-9
 Changes in Knowledge & Self-Efficacy for Prostate
Cancer Screening after Intervention, paired t-test

Instrument n Mean SD t-Test

Knowledge Inventory 123

Pretest 8.7 1.7 *-9.73
Posttest 10.1 1.2

*p<0.001
Self-Efficacy Scale 102
Pretest 14.6 4.2 *-6.14
Posttest 17 4.1

Boehm S, Coleman Burns P. Prostate Cancer in African American men: increasing

knowledge and self-efficacy. J Community Health Nursing. 1995;12(3):161-9
2. Prostate Cancer: Perceptions of
African American Males. Price JH,
Colvin TL. J Natl Med Assoc. 1993;85:941-
947
Knowledge & Perceived Susceptibility of
Prostate Cancer, Health Belief Model

Family Hx

SD
Fried Food N
SA

Knowledge

0 20 40 60 80
Prostate Cancer: Perceptions of African American Males. Price JH, Colvin TL. J Natl
Med Assoc. 1993;85:941-947
3. Psychosocial Correlates of
Dietary Intake
Baranowski T Annu Rev. Nutr.1999.19; 17

• Self-efficacy was the strongest

psycho-social predictor for F/V
intake in a variety of populations
• Psycho-social constructs predict
<30% variance in dietary behavior
• The more specific the dietary
outcome, the better the prediction
Ex: -Milk instead of dairy foods
-Salads instead of vegetables
4. Determinants of Intentions to
Adopt a Low-fat Diet,Men 30-60 Yr
Nguyen, MN, Otis J, Potvin L. Am J Health Promot.
1996:10(3);201-207

• 5 variables: Outcome evaluation, subjective

norms, perceived behavioral control,
perceived power of the control factor and
attitude, explained 51 % of total variance in
intentions to eat a low fat diet.
• Family members had most influence on
changing men’s diets.
 Theory Rationale
 Understanding food
intakes requires
exploration of attitudes,
self-efficacy & social
support for desired
behaviors
 Figure. Theory of Planned
Behavioral Behavior Model
Beliefs
Attitude
toward
Valuation of behavior
behavioral (Att)
outcomes

External
Variables:

Age Normative
Sex Beliefs
Occupation Subjective
SES Norms (SN) Intention Behavior
Education

Motivation
to Comply

Self-Efficacy
(SE)
 Research Questions
… for African American men
1. How much fruit and vegetables are
consumed?
2. Do attitudes & self efficacy relate to
eating fruit and vegetables?
3. Does social support relate to eating
fruits and vegetables?
 Subjects
• N= 96 men
• African American men >25 yr
(25-76 yr)
• Diversity of education, income &
occupation
• Recruited at churches & Black
fraternity groups in Detroit &
Lansing, MI
 Crosstabulation of Affiliations by
Intention to Eat Fruit

90%

80%

70%

60%
% age of men

50% unlikely
neutral
40% likely

30%

20%

10%

0%
church fraternity football
(n=64) (n=23) (n=9)
 Prostate Cancer Hx by Age
45%

40%

35%

30%

25% yes
%ages

no
20% don't know

15%

10%

5%

0%
under 35 35-44 45-64 65 and older
 Cross-tabulation of Affiliation
by F & V Intake (>5 svg)

80%

70%

60%

50%
%ages

less than 5 servings

40%
5 or more servings

30%

20%

10%

0%
church fraternity football
 Methods
1. Data collection at group meetings
 Consent forms
 Incentive: Drawing for fruit basket
 Instrument completed
 35 items for Att, SN, SE
 Demographics
 NCI Fruit & Vegetable Screener

2. Prostate Cancer Seminar

 Nutrition & prostate cancer information
presented by a prostate cancer survivor
 NCI Fruit & Vegetable Screener
• Add info to discuss here ie,
– Describe items and number
– How validated
– How fruit & veg svg tabulated
 Attitude constructs,
Cronbach α’s & Loadings
Att1 “Fruit and Vegetable Good for Health” Att 2 “Fat & Alcohol Not Good for Health”
α=0.90 α= 0.84
Eating fruit can reduce my risk for prostate Eating fried foods increases my risk for
cancer 0.67 prostate cancer 0.87
Eating vegetables can reduce my risk for Drinking alcohol increases my risk for
prostate cancer 0.62 prostate cancer 0.86
Eating fruit will help me maintain my weight
0.78
Eating vegetables will help me maintain my
Att 3 “Fruit and Vegetables Tastes Good”
weight 0.83
α= 0.95
Eating fruit will help keep me healthy 0.86
In eating only fruit that tastes good to me
Eating vegetables will help keep me healthy
0.97
0.87
In eating only vegetables that tastes good to me
0.97
 Self-Efficacy constructs,
Cronbach α’s & Loadings
Self-Efficacy for Fruits α= 0.88 Self-Efficacy for Vegetables α= 0.90
I can keep fruit at hand/readily available I can keep vegetable at hand/readily
0.78 available 0.78
I can eat the recommended number of I can eat the recommended number of
servings of fruit when I eat on servings of vegetables when I eat
my own 0.81 on my own 0.77
I can choose a variety of fruit 0.73 I can choose a variety of vegetables 0.76
I can make time to eat fruit 0.74 I can make time to eat vegetables 0.86
When I eat at home, I can eat more fruit When I eat at home, I can eat more
0.78 vegetables 0.81
I can eat more fruit to reduce risk for I can eat more vegetables to reduce risk
prostate cancer 0.75 for prostate cancer 0.73
I can eat fruit to benefit my health 0.77 I can eat vegetables to benefit my health
0.79
 Subjective Norms constructs,
Cronbach α’s & Loadings
SN2 “Family & Physician Encourage F/V”
α= 0.88
SN1 “Associates Encourage F/V” α= 0.89 My family encourages me to eat
My friends encourage me to eat enough fruit 0.74
enough fruit 0.65 My family encourages me to eat enough
My friends encourage me to eat vegetables 0.75
enough vegetables 0.78 My doctor encourages me to eat enough
My co-workers encourage me to eat fruit 0.86
enough fruit 0.83 My doctor encourages me to eat enough
My co-workers encourage me to eat vegetables 0.85
enough vegetables 0.76
Other people in my life think I should eat SN3 “Family & Friends Influence F/V”
enough fruit 0.77 α= 0.87
Other people in my life think I should eat I would eat more fruit if my family
enough vegetables 0.77 thinks I should 0.75
I would eat more vegetables if my family
thinks I should 0.75
I would eat more fruit if my friends thinks I
should 0.79
I would eat more vegetables if my friends
thinks I should 0.77
 Methods
3. Statistical Analysis (SPSS version 10.0)
a. Item analysis by Confirmatory Factor
Analysis of 35 items for 8 constructs
b. Total reported fruit & vegetable intakes
c. Stepwise Regression to predict intention
to eat & reported intake of fruit &
vegetables
 Hypothesis 1
Fruit & vegetable intake among African American
men will be low compared to the 5 A Day
dietary recommendations of two fruits and three
vegetables.
 Fruit & Vegetable Intakes from NCI Screener:
svg & % eating recommended svg (n=96)

Mean + Mode Skew Fruit Vegetable

Intakes
SD
>2 svg >3 svg > 3svg >5svg
Reported Fruit 2.4 + 3.1 1.5 2.1 36% 24%
Fruit w/out Juice 0.89 + 1.5 0.5 2.9 10% 9%
Reported Vegetables 4.6 + 5.1 0.1 3.2 49% 25%
Vegetables w/out
2.6 + 3.2 0.45 3.4 23% 7%
potatoes
 Hypothesis 2
Attitudes towards eating fruits and vegetables,
self-efficacy and subjective norms will be
associated with both the intentions to eat and
the reported intakes of fruits and vegetables,
according to the TPB constructs.
 Table 2.5. Correlation matrix of intentions to eat and
reported intakes of fruit & vegetables and attitudes,
subjective norms and self-efficacy (n=96)
Attitude Subjective Norm Self-Efficacy
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1. IntFruit 1.00
2. IntVeg .656** 1.00
3. Log Reported Fruit .426** .268* 1.00
4. Log Fruit, no Juice .521** .384** .762** 1.00
5. Log Reported Veg .324** .346** 0.163 .326** 1.00
6. Log Veg, no Pot .495** .565** .250* .411** .740** 1.00
7. Attitude 1 .202* 0.117 0.195 .242* 0.026 0.121 1.00
8. Attitude 2 0.038 0.140 0.123 0.208 0.116 0.057 .315** 1.00
9. Attitude 3 0.017 0.022 -0.161 -0.136 -0.040 -0.021 0.15 0.01 1.00
10. Sub Norm 1 0.202 0.171 -0.054 0.022 0.13 0.085 .268** 0.103 0.062 1.00
11. Sub Norm 2 .360** .323** 0.182 .269* .290** .359** .338** 0.202 0.016 .505** 1.00
12. Sub Norm 3 .323** .212* 0.085 .214* .218* .319** .285** 0.113 0.121 .532** .486** 1.00
13. SE Fruit .391** .414** .334** .507** 0.002 0.192 .438** .327** -0.047 0.047 .350** .237* 1.00
14. SE Veg .315** .484** .269* .453** 0.043 .317** .398** 0.134 -0.072 0.024 .300** .227* .710** 1.00

**Significant p<0.01 (2-tailed)

*Significant p<0.05 (2-tailed)
1. IntFruit-Intention to eat fruit
2. IntVeg-Intention to eat vegetable
3. Logrepfr-Log Reported fruit
4. Logfrju-Log Fruit no Juice
5. LogRpvg-Log Reported Vegetable
6. Logvgpot-Log veg no potatoes
7. Attitude 1-Fruit and Vegetables Good for Health
8. Attitude 2-Fat & Alcohol Not Good for Health
9. Attitude 3-Fruits and Vegetables Taste Good
10. Sub Norm 1-Associates Encourage F/V
11. Sub Norm 2- Family & Physician Encourage F/V
12. Sub Norm 3-Family & Friends Influence F/V
13. SE Fruit-Self-efficacy for Fruits
14. SE Veg-Self-efficacy for Vegetables
 Table 2.6. Correlation matrix of intentions to eat and reported
intakes of fruit & vegetables and subjective norms (n=96)

1 2 3 4 5 6
1. IntFruit 1
2. IntVeg .656** 1
3. Log Reported Fruit .426** .268* 1
4. Log Fruit, no Juice .521** .384** .762** 1
5. Log Reported Veg .324** .346** 0.163 .326** 1
6. Log Veg, no Pot .495** .565** .250* .411** .740** 1
7. Sub Norm 1 0.202 0.171 -0.054 0.022 0.13 0.085
8. Sub Norm 2 .360** .323** 0.182 .269* .290** .359**
9. Sub Norm 3 .323** .212* 0.085 .214* .218* .319**
 Table 2.7. Correlation matrix of intentions to eat and reported
intakes of fruit & vegetables and self-efficacy (n=96)

1 2 3 4 5 6
1. IntFruit 1
2. IntVeg .656** 1
3. Log Reported Fruit .426** .268* 1
4. Log Fruit, no Juice .521** .384** .762** 1
5. Log Reported Veg .324** .346** 0.163 .326** 1
6. Log Veg, no Pot .495** .565** .250* .411** .740** 1
7. SE Fruit .391** .414** .334** .507** 0.002 0.192
8. SE Veg .315** .484** .269* .453** 0.043 .317**
 Hypothesis 3

Attitudes towards fruit & vegetables, self-efficacy

and subjective norms will predict both the
intentions to eat and the reported intakes of fruits
and vegetables in African American men.
 Three Regression
Models for Fruits
Variables (N=96) r R2 Sign.

1. Intention Eat Fruit

1SE for Fruit

2SN2- “Family & Physician”

0.44 0.19 <0.001

2. Reported Fruit Intake

SE for Fruit 0.43 0.19 <0.001
3. Reported Fruit Intake w/o
Juice 0.41 0.16 <0.001
SE for Fruit
1SE= Self-Efficacy, 2SN=Subjective Norms
Two Regression Models
for Vegetables

Variables (N=96) r R2 Sign.

1. Intention Eat Veg

1SE for Veg

2SN2- “Family & Physician” 0.52 0.27 <0.001

2. Vegetable Intake w/o

Potatoes 0.33 0.11 0.001
SN2- “Family & Physician”

1SE= Self-Efficacy, 2SN=Subjective Norms

 Fruit and Vegetable
Promoters vs. Hindrances

• Availability • Availability
• Taste • Cost
• Family & physician • Busy lifestyle
• Friends • Laziness
 Conclusions
1. Mean F/V intakes were high compared to
5 A Day, but only 36% getting 2 svg
fruits & 49% getting 3 svg vegetables
• These %’s dropped by over half when
juice & potatoes were excluded
2. Both SE & SN variously predict F/V
intakes & intentions, but only 10-27% of
variance
3. Attitudes did not predict F/V intakes or
intentions.
 Strengths
– Factor analysis on constructs for validity
and reliability
– Pilot tested on Afr-Am men
– Sample size
– Theoretically based—Theory of Planned
Behavior
– NCI Fruit & Vegetable Screener
– SE separate for fruit and for vegetables
 Limitations
– Small percentage of variance explained
– Constructs for attitudes and subj norms
were combined for fruit and vegetables
– NCI Screener tends to report high intakes.
 Implications
Health professionals can…
1. Influence fruit & vegetable intakes in African
American men by targeting physicians, family
and friends.
2. Establish rapport with churches and professional
groups to educate African American men & their
families on health issues.
3. Design educational activities to increase self
efficacy of men to eat fruits and vegetables.
 Acknowledgements
Supported in part by a grant from
MSU’s College of Human
Ecology and the Michigan
Agricultural Experiment Station