Dietary Risk Assessment in the WIC Program (2002) / Chapter Skim
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7 Behavioral Indicators of Diet and Physical Activity
7 Behavioral Indicators of Diet and Physical Activity
Pages 93-114
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From page 93... ...
One such method would be the use of behavioral indicators. This chapter explores the concept of behavioral indicators and their possible role in the assessment of an individual's dietary and physical activity patterns for the purposes of determiningfailure to meet Dietary Guidelines and therefore WIC eligibility.
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From page 94... ...
Similarly, activity levels can also be affected by contextual factors like the weather, the availability of safe outdoor areas, the support or interest of family and peers, and the presence of competing sedentary activities such as television viewing. Interest in using these behavioral indicators in WIC may also be increased by the untested assumption that, in comparison to conventional tools for assessing diet and activity, these indicators may be easier to recall, less susceptible to various types of reporting bias, and therefore most appropriate targets for behavioral counseling.
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From page 95... ...
Target indicators are those that identify precursors of diet or activity, which, if changed, result in improved dietary intake or levels of physical activity (Nicklas et al., in press, Siega-Riz et al., 2000~ If behavioral indicators are causative of the diet or activity patterns, the behaviors are modifiable, and if the changes result in improved diet or activity practices, then they could be targets for WIC-related nutrition education efforts (see Box 7-2~. To continue with the prior example, if families could be easily encouraged to more frequently eat meals together, and increased family dinners resulted in improved dietary intake, then frequency of eating a meal as a family is a likely target indicator for change.
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From page 96... ...
Possible surrogate or target behavioral practices were each placed within one of the following categories: indicator foods, food, eating, or dietary patterns, meal patterns, health-related behaviors, psychosocial characteristics, parent food practices, ecological factors, or alternative technology. Most of the research on behaviors as possible surrogates for measures of dietary intake was not conducted with the intent of validating surrogates.
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From page 97... ...
Likewise, aggregates or clusters of these psychosocial characteristics have also been shown to correlate with dietary intake in marketing studies. Although the causal status of these psychosocial characteristics has not been clearly demonstrated, if established, they could become target indicators.
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From page 98... ...
98 DIETARYRISKASSESSMENTIN THE WIC PROGRAM TABLE 7-2 References for Data Bearing on Behavioral Nutrition Indicators by WIC Target Group and Category of Indicator Practices 25~8 months Children/Adolescents Indicator foods Eating eggs for breakfast Eating ready-to-eat cereal for breakfast Eating coffee, soft drink, or dessert alone for breakfast Added sugar Milk consumption Juice consumption Soft drink consumption Food, eating, or dietary patterns Many factors Prudent diet factor Western diet factor Fat practices Many clusters Dietary adequacy Vegetarian Meal patterns Meal consistency Regularly eat breakfast Snacking Eating out of home frequently Eating fast food frequently Eating span Longest fast > 13 hours Related behaviors (self) Smoking Physical activity Eating while watching television Nicklas et al., in press Forshee and Storey, 2001 Ballew et al., 2000 Ballew et al., 2000 Ballew et al., 2000 Jacobs and Dwyer, 1988 Siega-Riz et al., 1998 Sampson et al., 1995 Berenson et al., 1980 Rosmond et al., 2000 Coon et al., 2001
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From page 99... ...
BEHA VIORAL INDICATORS 99 Pregnant Lactating Postpartum Adults Siega-Riz et al., 2000 Siega-Riz et al., 2000 Siega-Riz et al., 2000 Randall et al., 1990, l991b; Wolff and Wolff, 1995 Fung et al., 2001 Fung et al., 2001 Kristal et al., 1990 Huijbregts et al., 1995; Millen et al., 2001; Slattery et al., 1998; Wirfalt and Jeffery, 1997 Knol and Haughton, 1998 Donovan and Gibson, 1996; Janelle and Barr, 1995 Nicklas et al., 1998; Siega-Riz et al., 2000 Zizza et al., 2001 Clemens et al., 1999; McCrory et al., 1999 French et al., 2000 Haste et al., 1990 Huijbregts et al., 1995; Ma et al., 2000; Randall et al., 1991 a; Tucker et al., 1992 Matthews et al., 1997; Rogers et al., 1995; Slattery et al., 1998 continued
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From page 100... ...
Since many of these behavioral indicators of diet have been abstracted from other assessment instruments (e.g., 24-hour dietary recalls, food frequency questionnaires) , few indicators of reliability have been reported in the literature.
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From page 101... ...
Those consuming coffee, soft drink, and/or dessert consumed the fewest breakfast calories, lower daily intakes of protein, fiber, and folate, and the highest intake of saturated fat (Siega-Riz et al., 2000~. The consumption of ready-to-eat cereal for breakfast was associated with consumption of lower total fat, and more folio acid, iron, niacin, vitamin A,
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From page 102... ...
Food, Eating, or Dietary Patterns Food, eating, or dietary patterns are consistent groupings of foods, usually determined by statistical techniques. Using food frequency data from 2,255 adults in the Western New York Diet Study (1975-1986)
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From page 103... ...
Based on the anthropological theory of core foods, an 18-item questionnaire was developed to assess aspects of reduced dietary fat practices (Kristal et al., 1990~. A confirmatory factor analysis of these items revealed five factors: (1)
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From page 104... ...
Because they would be dependent on tools similar to FFQs, it appears unlikely that food patterns could be valid or reliable enough to be used for eligibility determination. Meal Patterns Meal patterns characterize aspects of meals such as whether specific meals or snacks were consumed, where the meals were consumed, or over what time
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From page 105... ...
, using 24-hour diet recalls, 37 percent skipped breakfast the previous day (Nicklas et al., 1998~. Those not eating breakfast consumed 568 fewer calories per day, less protein, less saturated fat, but 121 mg more cholesterol.
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From page 106... ...
consumed significantly more total calories, fat as a percentage of calories, hamburgers, French fries, and soft drinks. Additionally they consumed less dietary fiber, vegetables, and fruit (French et al., 2000~.
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From page 107... ...
Since regular smoking can be relatively easily assessed, it is possible that this could provide important surrogate or target behavioral indicators. Among the previously described dietary pattern studies using FFQs, smoking was negatively correlated with the salad, fruit, healthful, and whole grain factors, and positively correlated with the high-fat factor among men, and with similar patterns among women (Randall et al., 1991a)
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From page 108... ...
Thus, better understanding of these relationships may lead to more effective dietary change interventions, which suggests they could be target indicators. A particularly promising avenue of research comes from the realm of social marketing.
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From page 109... ...
(Baranowski et al., 2000~. Ecological or Environmental Correlates Other possible sources of behavioral indicators of diet are ecological or environmental variables.
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From page 110... ...
. A limitation of this research for purposes of behavioral indicators has been the weak relationships obtained (0.1 < r < 0.25~.
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From page 111... ...
for all behavioral indicators where individual assessment is concerned. Indeed, the categories of indicator foods, dietary patterns, and meal patterns are derived from traditional, food-based assessment techniques such as 24-hour dietary recall and FFQs.
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From page 112... ...
to be target behavioral indicators for physical activity in WICenrolled preschool children. Television Viewing as a Behavioral Indicator of Physical Activity Television viewing has also been considered a potential behavioral indicator of physical activity and, for several reasons, the committee felt that this indicator
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From page 113... ...
This makes television viewing a particular concern for the WIC population. Several large studies, based on nationally representative samples, show a direct association between television viewing and obesity in children and adolescents (Andersen et al., 1998, Dietz and Gortmaker, 1985, Gordon-Larsen et al., 1999, Gortmaker et al., 1996, Pate and Ross, 1987~.
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From page 114... ...
While television viewing may be a plausible target behavior for physical activity, more needs to be known about whether altering television viewing levels in the populations served by WIC would have a demonstrable impact on activity or fatness. CONCLUSIONS REGARDING THE USE OF BEHAVIORAL INDICATORS FOR ELIGIBILITY DETERMINATION Behavioral indicators of food intake or physical activity hold no promise of distinguishing individuals who are ineligible from those eligible for WIC based on the criterionfailure to meet Dietary Guidelines, or on nutrient intake or level of physical activity.
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