Tailoring a fruit and vegetable intervention on ethnic identity: results of a randomized study.

OBJECTIVE Many targeted interventions have been developed and tested with African Americans (AA); however, AAs are a highly heterogeneous group. One characteristic that varies across AAs is Ethnic Identity (EI). Little research has been conducted on how to incorporate EI into the design of health messages and programs. DESIGN We tested whether tailoring a print-based fruit and vegetable (F & V) intervention on EI would enhance program impact. AA adults were recruited from two integrated healthcare delivery systems and then randomized to receive three newsletters focused on F & V behavior change over three months. One set of newsletters was tailored only on demographic and social cognitive variables (control condition), whereas the other (experimental condition) was additionally tailored on EI. MAIN OUTCOME MEASURES The primary outcome for the study was F & V intake, assessed at baseline and three months later using the composite of two brief self-report frequency measures. RESULTS A total of 560 eligible participants were enrolled, of which 468 provided complete 3-month follow-up data. The experimental group increased their daily mean F & V intake by 1.1 servings compared to .8 servings in the control group (p = .13). Afrocentric experimental group participants showed a 1.4 increase in F & V servings per day compared to a .43 servings per day increase among Afrocentric controls (p < .05). CONCLUSIONS Although the overall between-group effects were not significant, tailoring dietary messages on ethnic identity may improve intervention impact for some AA subgroups.

[1]  D. Midthune,et al.  Correspondence of the NCI Fruit and Vegetable Screener to repeat 24-H recalls and serum carotenoids in behavioral intervention trials. , 2008, The Journal of nutrition.

[2]  W. Kroeze,et al.  A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors , 2006, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[3]  B. Graubard,et al.  Trends in black-white differentials in dietary intakes of U.S. adults, 1971-2002. , 2007, American journal of preventive medicine.

[4]  K. Resnicow,et al.  Conducting health interventions in black churches: a model for building effective partnerships. , 2001, Ethnicity & disease.

[5]  A Davis,et al.  Go Girls!: Results from a Nutrition and Physical Activity Program for Low-Income, Overweight African American Adolescent Females , 2000, Health education & behavior : the official publication of the Society for Public Health Education.

[6]  C. Denny,et al.  Trends in fruit and vegetable consumption among adults in the United States: behavioral risk factor surveillance system, 1994-2000. , 2004, American journal of public health.

[7]  Carol Carr,et al.  Improving multiple behaviors for colorectal cancer prevention among african american church members. , 2004, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[8]  Matthew W. Kreuter,et al.  Achieving Cultural Appropriateness in Health Promotion Programs: Targeted and Tailored Approaches , 2003, Health education & behavior : the official publication of the Society for Public Health Education.

[9]  T. Baranowski,et al.  A motivational interviewing intervention to increase fruit and vegetable intake through Black churches: results of the Eat for Life trial. , 2001, American journal of public health.

[10]  T. Baranowski,et al.  Cultural sensitivity in public health: defined and demystified. , 1999, Ethnicity & disease.

[11]  S. Terrell,et al.  An Inventory to Measure Cultural Mistrust among Blacks. , 1981 .

[12]  D. Makuc,et al.  Health, United States, 2003; with chartbook on trends in the health of Americans , 2003 .

[13]  R. Sellers.  A Call to Arms for Researchers Studying Racial Identity , 1993 .

[14]  Tabbye M. Chavous,et al.  Racial Ideology and Racial Centrality as Predictors of African American College Students' Academic Performance , 1998 .

[15]  Robin E. Soler,et al.  Development of a Racial and Ethnic Identity Scale for African American Adolescents: The Survey of Black Life , 1999 .

[16]  W. Pequegnat,et al.  Working with families in the era of HIV/AIDS , 2000 .

[17]  T. Baranowski,et al.  Validation of three food frequency questionnaires and 24-hour recalls with serum carotenoid levels in a sample of African-American adults. , 2000, American journal of epidemiology.

[18]  K. Resnicow,et al.  Healthy Body/Healthy Spirit: a church-based nutrition and physical activity intervention. , 2002, Health education research.

[19]  K. Resnicow,et al.  Results of the healthy body healthy spirit trial. , 2005, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[20]  S. Noar,et al.  Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. , 2007, Psychological bulletin.

[21]  Dawn C. Bucholtz,et al.  Cultural tailoring for mammography and fruit and vegetable intake among low-income African-American women in urban public health centers. , 2005, Preventive medicine.

[22]  V. Strecher.  Computer-tailored smoking cessation materials: a review and discussion. , 1999, Patient education and counseling.

[23]  J. Brug,et al.  Computer-tailored interventions motivating people to adopt health promoting behaviours: introduction to a new approach. , 1999, Patient education and counseling.

[24]  Cross,et al.  Shades of Black: Diversity in African American Identity , 1991 .

[25]  J. Brug,et al.  The impact of a computer-tailored nutrition intervention. , 1996, Preventive medicine.

[26]  F. Worrell,et al.  Validating the Cross Racial Identity Scale , 2002 .

[27]  D. Williams,et al.  Ethnicity and Disease , 1996 .

[28]  S. Noar.  A Health Educator's Guide to Theories of Health Behavior , 2004, International quarterly of community health education.

[29]  K. Resnicow,et al.  Development of a Racial Identity Scale for Low-Income African Americans , 1997 .

[30]  K. Resnicow,et al.  Body and soul. A dietary intervention conducted through African-American churches. , 2004, American journal of preventive medicine.

[31]  Johannes Brug,et al.  Past, present, and future of computer-tailored nutrition education. , 2003, The American journal of clinical nutrition.

[32]  R. Braithwaite,et al.  Health Issues in the Black Community , 1992 .

[33]  J. Hardin,et al.  Accuracy and precision of two short screeners to assess change in fruit and vegetable consumption among diverse populations participating in health promotion intervention trials. , 2008, The Journal of nutrition.

[34]  Tabbye M. Chavous,et al.  Multidimensional Inventory of Black Identity: A Preliminary Investigation of Reliability and Construct Validity , 1997 .

[35]  The relationship between racial identity and self-esteem in African American college and high school students. , 1998 .

[36]  J. Helms,et al.  Relation of Racial Identity Attitudes to Self-Actualization and Affective States of Black Students. , 1985 .

[37]  V. Strecher,et al.  One size does not fit all: The case for tailoring print materials , 1999, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[38]  M. Symons,et al.  Fruit and vegetable consumption and prevention of cancer: the Black Churches United for Better Health project. , 1999, American journal of public health.