Journal of Nutrition Education and Behavior
Research ArticleUnderstanding African American Women's Decisions to Buy and Eat Dark Green Leafy Vegetables: An Application of the Reasoned Action Approach
Introduction
Increased consumption of fruits and vegetables (FV) may help decrease disparities in diet-related health outcomes.1 However, vegetable consumption in the US is low, and only 26% of adults meet national recommendations.2, 3 Vegetable consumption is even lower among minority populations (ie, Mexican Americans and African Americans [AA] relative to Whites).4 Vegetables in the “dark green” group, as identified by the US Department of Agriculture, are both cruciferous and leafy (eg, spinach, broccoli, romaine lettuce, watercress, Swiss chard, kale, collard, and mustard greens). Although they are the most nutritious group, dark green vegetables are also the least consumed.5, 6, 7 They are rich sources of vitamins A and C, folate, and β-carotene, and they provide numerous health benefits (eg, reduced risk of cardiovascular diseases).7, 8, 9, 10 The importance of consuming dark green leafy vegetables (DGLV) is highlighted in the US Department of Health and Human Services National Healthy People 2020 policy statement (ie, increase the proportion of dark green vegetables consumed by Americans) and the Dietary Guidelines for Americans (ie, women should consume 1.5 cups of DGLV per week, and men should consume 1.5–2 cups per week).5, 8, 11
The diets of AA have been of particular interest to researchers; Kirkpatrick, Dodd, Reedy, and Krebs-Smith posited that such racial minority populations could potentially benefit from eating more DGLV.4, 12, 13, 14, 15 There is no single “typical” eating pattern to which all AA ascribe,13 and studies indicate that DGLV are common in the AA culture and have been since the Atlantic slave trade. Specifically, during this time, dark green vegetables (eg, spinach and various types of greens) and other vegetables (eg, sweet potatoes, okra, squash) were brought from Africa to America.16, 17, 18, 19 Although DGLV remain an important and cultural component of some AA diets, determinants of their consumption have yet to be fully understood.20, 21, 22 To identify these determinants, it has been recommended that DGLV be studied separately from fruit and other types of vegetables (eg, red, orange), a practice not often reported in the literature.23
Although an examination of DGLV eating behaviors is important, there is an expressed need to examine behavioral domains beyond eating,14 given that eating is the most distal behavior relative to buying and preparing food.24 African American women have been described as being household “gatekeepers” who are primarily responsible for buying and preparing food.25 They often take pride in this role and have intentions to share food among family, friends, and those who are in need.26 These notions support findings that characterize AA women as dietary change agents who influence familial consumption of healthful food such as FV.12, 13, 27, 28 Therefore, the current study sought to expand the DGLV evidence base by using behavior change theory to explore intrapersonal factors associated with intentions to buy and eat more DGLV among a sample of midwestern AA women who buy and prepare household food.
The Reasoned Action Approach (RAA) is a theoretical model of behavior change that has been used to identify beliefs underlying people's behavioral decisions. The theory is the latest formulation of the Theory of Planned Behavior, and it assumes that one's intention is the most immediate predictor of behavior.29 According to the RAA, there are 3 global constructs that determine one's intention to perform a behavior: (1) attitude toward a behavior; (2) perceived norms about performing a behavior; and (3) self-efficacy about performing a behavior.29, 30 The RAA and its constructs have been used to understand behaviors associated with obesity and chronic disease prevention,31, 32 as well as determinants of AA fruit and vegetable consumption.14, 33, 34 Such studies have supported the use of RAA constructs in explaining general variations in FV consumption among AA, but few studies have focused specifically on DGLV in this population.
In this study, the RAA was used to understand a sample of AA women's intentions to perform 2 behaviors: (1) eat more cups of DGLV each week over the next 3 months; and (2) buy more DGLV each week over the next 3 months. When using the RAA, behaviors are defined in terms of the target, action, context, and time.35 Intention to eat and intention to buy are the chosen action elements. “More” (vs a specific number of cups) was selected as the target to reflect Healthy People 2020's recommendation to eat a higher proportion of DGLV.11 Given that DGLV recommendations are based on weekly consumption, “each week” is the context.5 “Three months,” which has been used in previous RAA research, was chosen as an appropriate time interval to initiate behavior change.20, 22
Section snippets
Methods
Participants were recruited from 8 local community and professional organizations, health clinics, and faith-based institutions. Recruitment methods varied by site and included personal contact and flyers at sites and announcements at meetings and services. Inclusion criteria were: AA; female; 18 years of age or older; resident of Marion County, Indiana; and primarily responsible for buying and preparing household food. Eligible women read and signed the study consent form. Participants were
Participants
A convenience sample of 410 women with a mean age of 43 years (SD = 15.7) consented to be in the study. Additional participant and household data are in Table 1.
Purchasing and Consumption
Seventy-six percent of women in the study reported that they had bought DGLV within the past 7 days. On average, participants ate 1.5 cups of DGLV in the past 33 days, and 80% ate at least 1 type of DGLV in the past 7 days. Two thirds of participants indicated that members of their household eat their primary meal of the day together.
Discussion
In this sample of low- to moderate-income AA women residing in Marion County, Indiana (located in the midwestern region of the US), results indicated that most participants (80%) ate DGLV in the past 7 days and, on average, reported adequate intakes (ie, 1.5 cups in the past 3 days). Female sex and higher education level (ie, 57% completed at least 1 year of college) have been associated with general FV consumption in other samples.38, 39 As previously noted, studies have identified DGLV to be
Uncited table
Table 2.
Acknowledgments
The authors would like to acknowledge Millicent Fleming-Moran, PhD, and staff at the Marion County Health Department; Ruth Lambert, PhD; LaWanda Lambert Girton; Terry Curtis; Dr. Linda Johnson; Brittany Baird; and Darleesa Gates-Doss, PhD, MPH for assistance in accessing the target population, the provision of resources, and/or technical assistance. Dr. Sheats is supported by US Public Health Service grant T32 HL007034 from the National Heart, Lung, and Blood Institute and Stanford University.
References (55)
- et al.
Most Americans eat much less tan recommended amounts of fruits and vegetables
J Am Diet Assoc
(2006) - et al.
Sources of food group intakes among the US population, 2001-2002
J Am Diet Assoc
(2008) - et al.
More Americans are eating “5 A Day” but intakes of dark green and cruciferous vegetables remain low
J Nutr
(2000) - et al.
Overview of the health benefits of fruit and vegetable consumption for the dietetics professional: selected literature
J Am Diet Assoc
(2000) Cluster analysis defines distinct dietary patterns for African American men and women
J Am Diet Assoc
(2009)- et al.
Built environment and health behaviors among African Americans: a systematic review
Am J Prev Med
(2009) - et al.
Phenolic compound profile of selected vegetables frequently consumed by African Americans in the southeast United States
Food Chem
(2007) - et al.
Availability of commonly consumed and culturally specific fruits and vegetables in African American and Latino neighborhoods
J Am Diet Assoc
(2010) - et al.
Salient beliefs about eating and buying dark green vegetables as told by Mid-western African American women
Appetite
(2013) - et al.
Associations between neighborhood availability and individual consumption of dark-green and orange vegetables among ethnically diverse adults in Detroit
J Am Diet Assoc
(2011)
Explaining fruit and vegetable consumption: the theory of planned behaviour and misconception of personal intake levels
Appetite
Predicting fruit consumption: cognitions, intention, and habits
J Nutr Educ Behav
Psychosocial factors and dietary habits associated with vegetable consumption
Nutrition
Barriers and facilitating factors affecting fruit and vegetable consumption
Intra-family role expectations and reluctance to change identified as key barriers to expanding vegetable consumption patterns during interactive family-based program for Appalachian low-income food preparers
J Acad Nutr Diet
Concepts of healthful food among low-income African American women
J Nutr Educ Behav
Use of the think aloud method to examine fruit and vegetable purchasing behaviors among low-income African American women
J Nutr Educ Behav
Determinants of low-fat eating behaviors among midlife African American women
J Nutr Educ Behav
Increased fruit and vegetable intake may reduce the nutrition-related health disparities in African Americans
Nutr Rev
State specific trends in fruit and vegetable consumption, 2000-2009
MMWR Morb Mortal Wkly Rep
Income and race/ethnicity are associated with adherence to food-based dietary guidance among US adults and children
J Acad Nutr Diet
Dietary Guidelines for Americans, 2010
Nutritional profile of vegetables and its significance to human health
Factors influencing food choices, dietary intake, and nutrition-related attitudes among African Americans: application of a culturally sensitive model
Ethn Health
Eating behaviors of older African Americans: an application of the Theory of Planned Behavior
The Gerontologist
Cited by (15)
Pregnant Smokers’ Intention to Switch From Cigarettes to E-Cigarettes: A Reasoned Action Approach
2021, Women's Health IssuesCitation Excerpt :Value increases indicated an expectation to resume smoking after pregnancy more quickly. The RAA items were adapted from other RAA studies that measured a myriad of health behaviors (Dobbs et al., 2019; 2020; Geshnizjani, Jozkowski, & Middlestadt, 2013; Hinsz & Nickell, 2015; Sable, Schwartz, Eleanor, & Lisbon, 2006; Sheats, Middlestadt, Ona, Juarez, & Kolbe, 2013). All items were measured using the timeframe “throughout the remainder of my pregnancy.”
Effectiveness of persuasive frames in advocacy videos
2021, Public Relations ReviewCitation Excerpt :In response to these criticisms, contemporary TPB work includes an assumption of theoretical sufficiency, which argues that the influence of all forms of behavioral interventions (communication or otherwise) are mediated by attitudes, subjective norms, and perceived behavioral control (Hennessy et al., 2010; Fishbein & Ajzen, 2011). While this extension has been tested in communication contexts related to health behaviors (e.g., McKeever & McKeever, 2017; Sheats, Middlestadt, Ona, Juarez, & Kolbe, 2013), exploration into the role of message framing of advocacy videos remains untested. By employing both a negatively charged emotional frame (fear) and non-emotional pleasant frame (humor) in a study employing experimental design, this study seeks to both test the sufficiency assumption and address gaps in the literature.
Impact of online reviews on hotel booking intention: The moderating role of brand image, star category, and price
2020, Tourism Management PerspectivesCitation Excerpt :With better understanding of the impact of OCR and the unique factors that will affect hotel bookings, hotel properties will have the ability to better position themselves in the market, leverage OCR and customer comments to their advantage, and exploit unknown existing qualities. It is clear that much of the research concentrating on the subjects of online commerce (Hansen, Jensen, & Solgaard, 2004), consumer behavior (Bagozzi, Wong, Abe, & Bergami, 2000; Kim, Kim, & Goh, 2011; Lo & Qu, 2015; Sheats, Middlestadt, Ona, Juarez, & Kolbe, 2013; Tajuddin, Zainol, & Sahil, 2014), and online content sharing (Branley & Covey, 2018), make use of the theory of reasoned action. Likewise, the use of this model has been identified as suitable for the current study.
Understanding international tourists' attitudes towards street food in Phuket, Thailand
2017, Tourism Management PerspectivesCitation Excerpt :The service quality dimensions included the speed and efficiency of the service staff, their friendliness and disposition to help (Ryu et al., 2012) and the respondent's perception of the hygiene of the physical environment including the cleanliness of the establishment and the staff (Juric & Worsley, 1998; Sulaiman & Haron, 2013). The second part of the questionnaire was designed to obtain information about past travel behavior and experience, future behavioral intentions, subjective norms and perceived behavioral control (Yazdanpanah & Forouzani, 2015; Sheats et al., 2013; Bhuyan, 2010), The last part covered the respondent's socio-demographic characteristics (S. Seo, Kim, Oh, & Yun, 2013; Zoltan & Masiero, 2012; Chen & Tsai, 2007). This study was implemented on Phuket Island, one of the most important tourist destinations of Thailand, from December 2015 until January 2016.
An application of the reasoned action approach to clinical students' intention toward a career in geriatrics
2024, Nursing and Health SciencesI’m Lovin’ It: How Fast Food Advertising Influences Meat-Eating Preferences
2022, Journal of Health Communication