Journal of Community Health

, Volume 35, Issue 1, pp 10–17 | Cite as

Addressing Health Disparities Among African Americans: Using the Stages of Change Model to Document Attitudes and Decisions About Nutrition and Physical Activity

  • Angelia M. Paschal
  • Rhonda K. Lewis-Moss
  • Jamilia Sly
  • Beverly J. White
Original Paper
First Online:

Abstract

Physical activity (PA) and poor fruit/vegetable intake are contributors of health disparities among African Americans (AA). In order to design effective interventions to address these behaviors, it is essential to assess where individuals are in terms of their attitudes and decisions. The aim of this study was to use the Stages of Change Model to assess AA’s attitudes and decisions regarding pertinent health behaviors and provide suggestions about how to address them. A survey was administered to 242 low-income, medically underserved adults (47% AA, 27% White, and 26% “Others”). The majority was in the SOC’s: “contemplation” stage for PA (they were considering PA); “maintenance” stage for vegetable intake (they had consumed ≥3 vegetable servings daily for ≥6 months); and in the “contemplation” stage for fruit intake (those grouped as “Others” were significantly more likely to be in the “maintenance” stage). Although education and awareness are important, this study has implications for interventions with greater emphasis on creating environments or providing resources to promote or support behavioral change.

Keywords

African American Black Health behaviors Attitudes Stages of change 
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References

  1. 1.
    Dunn, A. L., Trivedi, M. H., & O’Neal, H. A. (2001). Physical activity dose–response effects on outcomes of depression and anxiety. Medicine and Science in Sports and Exercise, 33(6), S587–S597.CrossRefPubMedGoogle Scholar
  2. 2.
    Feldblum, I., German, L., Castel, H., Harman-Boehm, I., Bilenko, N., Eisinger, M., et al. (2007). Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status. Nutrition Journal, 2(6), 37.CrossRefGoogle Scholar
  3. 3.
    Martinsen, E. W. (2008). Physical activity in the prevention and treatment of anxiety and depression. Nordic Journal of Psychiatry, 62(247), 25–29.CrossRefPubMedGoogle Scholar
  4. 4.
    Samieri, C., Jutand, M. A., Féart, C., Capuron, L., Letenneur, L., & Barberger-Gateau, P. (2008). Dietary patterns derived by hybrid clustering method in older people: Association with cognition, mood, and self-rated health. Journal of the American Dietetic Association, 108(9), 1461–1471.CrossRefPubMedGoogle Scholar
  5. 5.
    Unusan, N. (2006). Linkage between stress and fruit and vegetable intake among university students: An empirical analysis on Turkish students. Nutrition Research, 26(8), 385–390.CrossRefGoogle Scholar
  6. 6.
    Bazzano, L. A., He, J., Ogden, L. G., Loria, C. M., Vupputuri, S., Myers, L., et al. (2002). Fruit and vegetable intake and risk of cardiovascular disease in U.S. adults the first National Health and Nutrition Examination Survey Epidemiologic follow-up study. American Journal of Clinical Nutrition, 76, 93–99.PubMedGoogle Scholar
  7. 7.
    Hung, H., Joshipura, K. J., Jiang, R., Hu, F. B., Hunter, D., Smith-Warner, S. A., et al. (2004). Fruit and vegetable intake and risk of major chronic disease. Journal of the National Cancer Institute, 96(21), 1577–1584.PubMedCrossRefGoogle Scholar
  8. 8.
    Joshipura, K. J., Hu, F. B., Manson, J. E., Stampfer, M. J., Rimm, E. B., Speizer, F. E., et al. (2001). The effect of fruit and vegetable intake on risk for coronary heart disease. Annals of Internal Medicine, 134, 1106–1114.PubMedGoogle Scholar
  9. 9.
    Kirsh, V. A., Peters, U., Mayne, S. T., Subar, A. F., Chatterjee, N., Johnson, C. C., et al. (2007). Prospective study of fruit and vegetable intake and risk of prostate cancer. Journal of the National Cancer Institute, 99(15), 1200–1209.CrossRefPubMedGoogle Scholar
  10. 10.
    National Center for Health Statistics. Centers for Disease Control, Prevention. (2007). Health, United States, 2007. Hyattsville, MD: National Center for Health Statistics. Centers for Disease Control, Prevention.Google Scholar
  11. 11.
    Schoenborn, C. A., Adams, P. F., Barnes, P. M., Vickerie, J. L., & Schiller, J. S. (2004). Health behaviors of adults: United States, 1999–2001, National Center for Health Statistics. Vital Health Statistics, 10(219), 1–79.Google Scholar
  12. 12.
    Kansas Department of Health & Environment. (2007). Kansas BRFSS. Behavioral risk factor surveillance system (BRFSS). Accessed October 2008. Retrieved Sep 5, 2008 from http://www.kdheks.gov/brfss/.
  13. 13.
    Centers for Disease Control, Prevention. (2007). Fruit and vegetable consumption among adults—United States, 2005. Morbidity and Mortality Weekly Report, 56, 213–217.Google Scholar
  14. 14.
    Prochaska, J. O., & Diclemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390–395.CrossRefPubMedGoogle Scholar
  15. 15.
    Prochaska, J. O., Diclemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to the addictive behaviors. American Psychologist, 13, 47–51.Google Scholar
  16. 16.
    Prochaska, J. O., Redding, C. A., & Evers, K. E. (2002). The transtheoretical model and stages of change. In K. Glanz, B. K. Rimer, & F. M. Lewis (Eds.), Health behavior and health education (3rd ed., pp. 99–120). San Francisco: Jossey-Bass.Google Scholar
  17. 17.
    Fahrenwald, N. L., & Walker, S. N. (2003). Application of the transtheoretical model of behavior change to the physical activity behavior of WIC mothers. Public Health Nursing, 20(4), 307–317.CrossRefPubMedGoogle Scholar
  18. 18.
    Hawkins, D. S., Hornsby, P. P., & Schorling, J. B. (2001). Stages of change and weight loss among rural African American women. Obesity Research, 9, 59–67.CrossRefPubMedGoogle Scholar
  19. 19.
    Walcott-McQuigg, J. A., & Prohaska, T. R. (2001). Factors influencing participation of African American elders in exercise behavior. Public Health Nursing, 18(3), 194–203.CrossRefPubMedGoogle Scholar
  20. 20.
    Dijkstra, A., DeVries, H., & Roijackers, J. (1999). Targeting smokers with low readiness to change with tailored and non-tailored self-help materials. Preventive Medicine, 28, 203–211.CrossRefPubMedGoogle Scholar
  21. 21.
    Rakowski, W. R., Ehrich, B., Goldstein, M. G., Rimer, B. K., Pearlman, D. N., Clark, M. A., et al. (1998). Increasing mammography among women aged 40–74 by use of a stage-matched, tailored intervention. Preventive Medicine, 27, 748–756.CrossRefPubMedGoogle Scholar
  22. 22.
    Henry, H., Reimer, K., Smith, C., & Reicks, M. (2006). Associations of decisional balance, processes of change and self-efficacy with stages of change for increased fruit and vegetable intake among low-income, African American mothers. Journal of the American Dietetic Association, 106, 841–849.CrossRefPubMedGoogle Scholar
  23. 23.
    Prochaska, J. O., Velicer, W. F., Rossi, J. S., Goldstein, M. G., Marcus, B. H., Rakowski, W., et al. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13(1), 39–46.CrossRefPubMedGoogle Scholar
  24. 24.
    Richards, A., Kattelman, K. K., & Ren, C. (2006). Motivating 18- to 24-year olds to increase their fruit and vegetable consumption. Journal of the American Dietetic Association, 106, 1405–1411.CrossRefPubMedGoogle Scholar
  25. 25.
    Vallis, M., Ruggiero, L., Greene, G., Jones, H., Zinman, B., Rossi, S., et al. (2003). Stages of change for healthy eating in diabetes. Diabetes Care, 26(5), 1468–1474.CrossRefPubMedGoogle Scholar
  26. 26.
    Kloek, G. C., van Lenthe, F. J., van Nierop, P. W. M., Schrijvers, C. T. M., & Mackenbach, J. P. (2006). Stages of change for moderate-intensity physical activity in deprived neighborhoods. Preventive Medicine, 43, 325–331.CrossRefPubMedGoogle Scholar
  27. 27.
    Sutton, K., Logue, E., Jarjoura, D., Baughman, K., Smucker, W., & Capers, C. (2003). Assessing dietary and exercise stage of change to optimize weight loss interventions. Obesity Research, 11, 641–652.CrossRefPubMedGoogle Scholar
  28. 28.
    Pinto, B. M., Friedman, R., Marcus, B. H., Kelley, H., Tennstedt, S., & Gillman, M. W. (2002). Effects of a computer-based, telephone-counseling system on physical activity. American Journal of Preventive Medicine, 23(2), 113–120.CrossRefPubMedGoogle Scholar
  29. 29.
    Campbell, M. K., Symons, M., Demark-Wahnefried, W., Polhamus, B., Bernhardt, J. M., McClelland, J. W., et al. (1998). Stages of change and psychosocial correlates of fruit and vegetable consumption among rural African American church members. American Journal of Health Promotion, 12(3), 185–191.CrossRefPubMedGoogle Scholar
  30. 30.
    Di Noia, J., Schnicke, S. P., Prochaska, J. O., & Contento, I. R. (2006). Application of the Transtheoretical model to fruit and vegetable consumption among economically disadvantaged African American adolescents: Preliminary findings. American Journal of Health Promotion, 20(5), 342–348.PubMedGoogle Scholar
  31. 31.
    Frenn, M., Malin, S., Villarruel, A. M., Slaikeu, K., McCarthy, S., Freeman, J., et al. (2005). Determinants of physical activity and low-fat diet among low income African American and Hispanic middle school students. Public Health Nursing, 22(2), 89–97.CrossRefPubMedGoogle Scholar
  32. 32.
    Reimer, K., Smith, C., Reicks, M., Henry, H., Thomas, R., & Atwell, J. (2003). Child-feeding strategies of African American women according to stage of change for fruit and vegetable consumption. Public Health Nutrition, 7(4), 505–512.Google Scholar
  33. 33.
    Health Resources and Services Administration (HRSA). (2008). Shortage designation: HPSAs, MUAs & MUPs. Retrieved Sep 5, 2008 from http://datawarehouse.hrsa.gov/HPSA_MUA_Logic.htm.
  34. 34.
    U.S. Census Bureau, Department of Commerce. (2000). Census of state data center census. Retrieved Sep 5, 2008 from http://www.census.gov.
  35. 35.
    Centers for Disease Control and Prevention. (2006). Tobacco use among adults—United States, 2005. MMWR, 55(42), 1145–1148. Retrieved Sep 5, 2008 from www.cdc.gov/mmwr/preview/mmwrhtml/mm5542a1.htm.
  36. 36.
    Karanja, N., Stevens, V. J., Hollis, J. F., & Kumanyika, S. K. (2002). Steps to soulful living (STEPS): A weight loss program for African-American women. Ethnicity and Disease, 12(3), 363–371.PubMedGoogle Scholar
  37. 37.
    Paschal, A. M., Lewis, R. K., Martin, A., Dennis-Shipp, D., & Simpson, D. S. (2004). Baseline assessment of the health status and health behaviors of African Americans participating in the Activities-for-Live program: A community-based health intervention program. Journal of Community Health, 29(4), 305–318.CrossRefPubMedGoogle Scholar
  38. 38.
    Walcott-McQuigg, J. A., Chen, S., Davis, K., Stevenson, E., Choi, A., & Wangsrikhun, S. (2002). Weight loss and weight loss maintenance in African-American women. Journal of the National Medical Association, 94(8), 686–694.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Angelia M. Paschal
    • 1
  • Rhonda K. Lewis-Moss
    • 2
  • Jamilia Sly
    • 2
  • Beverly J. White
    • 3
  1. 1.Department of Preventive Medicine and Public HealthUniversity of Kansas School of Medicine, WichitaWichitaUSA
  2. 2.Department of PsychologyWichita State UniversityWichitaUSA
  3. 3.Center for Health & Wellness, Inc.WichitaUSA

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