Michelle A. McGregor

1. Michelle A. McGregor M.S. Thesis Defense Department of Food Science & Human Nutrition

2. 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.

3. Rationale for Fruits & Vegetables • 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

4. 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

5. 3. Fruit & vegetable intakes are low, especially in men

6. 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.

7. 5. Personal Interest • Optimizing health through diet • Many years working in church ministries • Family history of prostate cancer

9. Cancer Incidence in Men by Site & Race

10. Mortality Rates in Men by Site & Race

11. Risks for Prostate Cancer • Diet • Age • Race • Family History • Physical activity • Vasectomy

12. Limited Research on Subject • 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

13. Changes in Knowledge & Self-Efficacy for Prostate Cancer Screening after Intervention, paired t-test 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

14. 2.Prostate Cancer: Perceptions of African American Males. Price JH, Colvin TL. J Natl Med Assoc. 1993;85:941-947

15. Knowledge & Perceived Susceptibility of Prostate Cancer, Health Belief Model Prostate Cancer: Perceptions of African American Males. Price JH, Colvin TL. J Natl Med Assoc. 1993;85:941-947

16. 3. Psychosocial Correlates of Dietary Intake Baranowski TAnnu 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

17. 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.

18. My Research

19. Theory Rationale • Understanding food intakes requires exploration of attitudes, self-efficacy & social support for desired behaviors

20. Behavioral Beliefs Attitude toward behavior (Att) Valuation of behavioral outcomes External Variables: Age Sex Occupation SES Education Normative Beliefs Behavior Subjective Norms (SN) Intention Motivation to Comply Self-Efficacy (SE) Figure. Theory of Planned Behavior Model

21. Research Questions • … for African American men • How much fruit and vegetables are consumed? • Do attitudes & self efficacy relate to eating fruit and vegetables? • Does social support relate to eating fruits and vegetables?

22. 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

24. Prostate Cancer Hx by Age

25. Cross-tabulation of Affiliation by F & V Intake (>5 svg)

26. Methods • 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 • Prostate Cancer Seminar • Nutrition & prostate cancer information presented by a prostate cancer survivor

27. NCI Fruit & Vegetable Screener • Add info to discuss here ie, • Describe items and number • How validated • How fruit & veg svg tabulated

28. Attitude constructs, Cronbach α’s & Loadings Att1 “Fruit and Vegetable Good for Health” α=0.90 Eating fruit can reduce my risk for prostate cancer 0.67 Eating vegetables can reduce my risk for prostate cancer 0.62 Eating fruit will help me maintain my weight 0.78 Eating vegetables will help me maintain my weight 0.83 Eating fruit will help keep me healthy 0.86 Eating vegetables will help keep me healthy 0.87 Att 3 “Fruit and Vegetables Tastes Good” α= 0.95 In eating only fruit that tastes good to me 0.97 In eating only vegetables that tastes good to me 0.97 Att 2 “Fat & Alcohol Not Good for Health” α= 0.84 Eating fried foods increases my risk for prostate cancer 0.87 Drinking alcohol increases my risk for prostate cancer 0.86

29. Self-Efficacy for Fruits α= 0.88 I can keep fruit at hand/readily available 0.78 I can eat the recommended number of servings of fruit when I eat on my own 0.81 I can choose a variety of fruit 0.73 I can make time to eat fruit 0.74 When I eat at home, I can eat more fruit 0.78 I can eat more fruit to reduce risk for prostate cancer 0.75 I can eat fruit to benefit my health 0.77 Self-Efficacy for Vegetables α= 0.90 I can keep vegetable at hand/readily available 0.78 I can eat the recommended number of servings of vegetables when I eat on my own 0.77 I can choose a variety of vegetables 0.76 I can make time to eat vegetables 0.86 When I eat at home, I can eat more vegetables 0.81 I can eat more vegetables to reduce risk for prostate cancer 0.73 I can eat vegetables to benefit my health 0.79 Self-Efficacyconstructs, Cronbach α’s & Loadings

30. Subjective Normsconstructs, Cronbach α’s & Loadings SN3 “Family & Friends Influence F/V” α= 0.87 I would eat more fruit if my family 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 SN1 “Associates Encourage F/V” α= 0.89 My friends encourage me to eat enough fruit 0.65 My friends encourage me to eat enough vegetables 0.78 My co-workers encourage me to eat enough fruit 0.83 My co-workers encourage me to eat enough vegetables 0.76 Other people in my life think I should eat enough fruit 0.77 Other people in my life think I should eat enough vegetables 0.77 SN2 “Family & Physician Encourage F/V” α= 0.88 My family encourages me to eat enough fruit 0.74 My family encourages me to eat enough vegetables 0.75 My doctor encourages me to eat enough fruit 0.86 My doctor encourages me to eat enough vegetables 0.85

31. Methods • Statistical Analysis(SPSS version 10.0) • Item analysis by Confirmatory Factor Analysis of 35 items for 8 constructs • Total reported fruit & vegetable intakes • Stepwise Regression to predict intention to eat & reported intake of fruit & vegetables

32. 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.

33. Fruit & Vegetable Intakes from NCI Screener: svg & % eating recommended svg (n=96)

34. 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.

35. Table 2.5.Correlation matrix of intentions to eat and reported intakes of fruit & vegetables and attitudes, subjective norms and self-efficacy (n=96)

36. Table 2.6.Correlation matrix of intentions to eat and reported intakes of fruit & vegetables and subjective norms (n=96)

37. Table 2.7.Correlation matrix of intentions to eat and reported intakes of fruit & vegetables and self-efficacy (n=96)

38. 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.

39. Three Regression Models for Fruits 1SE= Self-Efficacy, 2SN=Subjective Norms

40. Two Regression Models for Vegetables 1SE= Self-Efficacy, 2SN=Subjective Norms

41. Availability Taste Family & physician Friends Availability Cost Busy lifestyle Laziness Fruit and Vegetable Promoters vs. Hindrances

42. Conclusions • 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 • Both SE & SN variously predict F/V intakes & intentions, but only 10-27% of variance • Attitudes did not predict F/V intakes or intentions.

43. 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

44. 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.

45. Implications Health professionals can… Influence fruit & vegetable intakes in African American men by targeting physicians, family and friends. Establish rapport with churches and professional groups to educate African American men & their families on health issues. Design educational activities to increase self efficacy of men to eat fruits and vegetables.

46. Acknowledgements Supported in part by a grant from MSU’s College of Human Ecology and the Michigan Agricultural Experiment Station