DIETARY PRACTICES OF AFRICAN-AMERICANS IN MACON...

DIETARY PRACTICES OF DIETARY PRACTICES OF AFRICANAFRICAN--AMERICANS AMERICANS

IN MACON COUNTY, ALABAMA IN MACON COUNTY, ALABAMA

BovellBovell--Benjamin, ACBenjamin, AC11, Dawkins, N, Dawkins, N11, , Pace, RDPace, RD11,, ShikanyShikany, JM, JM2 2

Department of Food and Nutritional Sciences, Tuskegee Department of Food and Nutritional Sciences, Tuskegee University, Tuskegee, AL University, Tuskegee, AL

Division of Preventive Medicine, University of Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL Alabama at Birmingham, Birmingham, AL

BACKGROUNDBACKGROUND

BACKGROUNDBACKGROUND•• In the U.S., AfricanIn the U.S., African--American males have American males have

higher cancer incidence and higher cancer incidence and mortality rates mortality rates than white malesthan white males

•• AfricanAfrican--American women have lower American women have lower incidence but higher mortality rates than incidence but higher mortality rates than white womenwhite women

•• Poor nutrition and adverse dietary practices Poor nutrition and adverse dietary practices contribute to these disparitiescontribute to these disparities

BACKGROUNDBACKGROUND•• Diet is a significant, modifiable risk factor Diet is a significant, modifiable risk factor

associated with cancer associated with cancer

•• Considerable gap in the knowledge base Considerable gap in the knowledge base regarding:regarding:

•• cancercancer--related dietary habits related dietary habits •• food preferences and food preferences and •• food preparation practices among Africanfood preparation practices among African--

Americans in the rural South Americans in the rural South


•• SemiSemi--quantitative food frequency quantitative food frequency questionnaire (FFQ)questionnaire (FFQ)

•• most commonly used dietary assessment most commonly used dietary assessment instrument for epidemiologic researchinstrument for epidemiologic research

•• recalls the frequency and portion sizes of all recalls the frequency and portion sizes of all foods consumed over a specific time period foods consumed over a specific time period

BACKGROUNDBACKGROUND•• Commonly used FFQ Commonly used FFQ -- NCI dietary health NCI dietary health

questionnaire (DHQ)questionnaire (DHQ)•• extensively studied and validated in the extensively studied and validated in the

American populationAmerican population

•• little information re: its sensitivity and validity little information re: its sensitivity and validity in Africanin African--Americans in the rural SouthAmericans in the rural South

•• FFQsFFQs will effectively measure habitual dietary will effectively measure habitual dietary intake, only if they are intake, only if they are specifically tailored to specifically tailored to encompass the diets of the target populationencompass the diets of the target population


•• Limited attempts have been made to develop Limited attempts have been made to develop culturally sensitiveculturally sensitive FFQsFFQs for use in the for use in the southeastern U.S.southeastern U.S.

•• Tucker et al. (2005) developed a regional FFQ Tucker et al. (2005) developed a regional FFQ for use in the Lower Mississippi Delta (LMD)for use in the Lower Mississippi Delta (LMD)

BACKGROUNDBACKGROUND•• Tucker et al. (2005) found that:Tucker et al. (2005) found that:

•• regional food use patterns differed from national, regional food use patterns differed from national, and between Africanand between African--Americans and Caucasians Americans and Caucasians in the LMDin the LMD

»» Ex. Ex. -- in the rural South, Africanin the rural South, African--Americans Americans commonly consume foods such as cured pork commonly consume foods such as cured pork products products -- the crawfish and jambalaya consumed the crawfish and jambalaya consumed in the LMD are not generally consumed in the LMD are not generally consumed

•• modified FFQ should contribute to improved modified FFQ should contribute to improved assessment of usual dietary intake in the LMDassessment of usual dietary intake in the LMD

BACKGROUNDBACKGROUND•• Focus groups Focus groups

•• generally underutilized in diet and nutrition generally underutilized in diet and nutrition researchresearch

•• especially suited to exploring, describing, and especially suited to exploring, describing, and understanding the dietary habits of Africanunderstanding the dietary habits of African--Americans because of the historical Americans because of the historical importance of oral communication patterns in importance of oral communication patterns in their culture their culture

OBJECTIVEOBJECTIVE

•• To To generate information about dietary generate information about dietary practices, food preferences and food practices, food preferences and food preparation methods in Africanpreparation methods in African--Americans Americans in Macon County, Alabama, as a precursor in Macon County, Alabama, as a precursor to an intervention designed to modify an to an intervention designed to modify an existing food frequency questionnaire (FFQ)existing food frequency questionnaire (FFQ)

METHODOLOGYMETHODOLOGYQuestion Development Question Development •• A combination of complementary strategies A combination of complementary strategies

including: including: •• review of the literaturereview of the literature

•• brainstorming sessions with Africanbrainstorming sessions with African--American American faculty, staff, and students at Tuskegee faculty, staff, and students at Tuskegee University, community members of Tuskegee University, community members of Tuskegee and pilot focus groups and pilot focus groups

METHODOLOGYMETHODOLOGY


A qualitative research design using focus A qualitative research design using focus group methodology and a structured focus group methodology and a structured focus group interview guidegroup interview guide


Tightly structured designTightly structured designPPredetermined interview redetermined interview

guideguide

Exploratory designExploratory designUse of probes to elicit Use of probes to elicit

informationinformation

Phenomenological processPhenomenological processEliciting the participantsEliciting the participants’’experiences related to food experiences related to food preparation methods and preparation methods and

other concernsother concerns

Focus Group DesignFocus Group Design


ParticipantsParticipants•• African American males and females from African American males and females from

Shorter, Franklin and Tuskegee in Macon Shorter, Franklin and Tuskegee in Macon County, AlabamaCounty, Alabama

•• Participants received reminder phone calls Participants received reminder phone calls the day prior to their scheduled focus group the day prior to their scheduled focus group meetingmeeting

METHODOLOGYMETHODOLOGYParticipantsParticipantsApproval for the studyApproval for the study

•• Human Participants Review Committee at Human Participants Review Committee at Tuskegee Tuskegee

•• Institutional Review Board for Human Use at Institutional Review Board for Human Use at the UABthe UAB

METHODOLOGYMETHODOLOGYParticipantsParticipants•• At At each focus groupeach focus group::

•• purpose of study explainedpurpose of study explained

•• participants consented and assured about the participants consented and assured about the confidentiality of the informationconfidentiality of the information

•• a brief demographic questionnaire was filleda brief demographic questionnaire was filled

METHODOLOGYMETHODOLOGYFocus Group ProcedureFocus Group Procedure•• 2 pilot focus groups (N = 19) 2 pilot focus groups (N = 19)

•• 8 formal groups (N = 61)8 formal groups (N = 61)

•• Each group meeting ~ 100 minutesEach group meeting ~ 100 minutes

•• Trained AfricanTrained African--American facilitator not American facilitator not

associated with the studyassociated with the study

METHODOLOGYMETHODOLOGYFocus Group ProcedureFocus Group Procedure

•• 66--10 persons participated in each focus 10 persons participated in each focus

group, and at the end of each sessiongroup, and at the end of each session

•• Participants received a modest Participants received a modest

remuneration for his/her time and remuneration for his/her time and

participationparticipation


•• Focus groups were audio taped and Focus groups were audio taped and transcribed verbatimtranscribed verbatim

•• Responses were also recorded on flip Responses were also recorded on flip charts, and the transcripts compared to charts, and the transcripts compared to these written notes to minimize these written notes to minimize misinterpretation of the data misinterpretation of the data

METHODOLOGYMETHODOLOGYData AnalysisData Analysis•• QRS NUD*IST 6QRS NUD*IST 6

•• Transcripts read independently for initial Transcripts read independently for initial coding of themescoding of themes

•• Themes were identified using a consensus Themes were identified using a consensus approachapproach

•• Overall summary report of major findings Overall summary report of major findings reviewed by research team as a validity check reviewed by research team as a validity check

RESULTS RESULTS AND DISCUSSION AND DISCUSSION

RESULTS RESULTS AND DISCUSSION AND DISCUSSION Pilot focus groupsPilot focus groups•• Participants in the pilot focus groups were Participants in the pilot focus groups were

excluded from the formal groupsexcluded from the formal groups

• Served primarily to:•• confirm the content and cultural sensitivity of confirm the content and cultural sensitivity of

the foods identified in the structured interviewthe foods identified in the structured interview

•• to elicit traditional, culturally important foods, to elicit traditional, culturally important foods, which may have been overlookedwhich may have been overlooked

RESULTS RESULTS AND DISCUSSION AND DISCUSSION Pilot focus groupsPilot focus groups•• Main findings:Main findings:

•• indicated that most participants routinely indicated that most participants routinely consumed fast foods, and a variety of consumed fast foods, and a variety of different beansdifferent beans

•• the structured interview was modified to the structured interview was modified to reflect questions about fast food and bean reflect questions about fast food and bean consumption practices consumption practices

RESULTS RESULTS AND DISCUSSION AND DISCUSSION Formal focus groupsFormal focus groups

Table 1. Selected Characteristics of ParticipantsTable 1. Selected Characteristics of Participants

GenderGenderMale FemaleMale Female

9 109 10

9 69 6

6 86 8

6 76 7

Age Group Age Group YearsYears

1818--3535

3636--5050

5151--6565

6666--7575

(N = 61)(N = 61)

RESULTS RESULTS AND DISCUSSION AND DISCUSSION Formal focus groupsFormal focus groups•• Themes identified:Themes identified:

•• Dietary practicesDietary practices

•• Food preferencesFood preferences

•• Food preparation methodsFood preparation methods

•• Fast food practicesFast food practices

•• Seasonal/specialty foodsSeasonal/specialty foods


•• Turnip, collard and Turnip, collard and mustard greens mustard greens

•• Okra, fried green Okra, fried green tomatoestomatoes

•• Potato salad, macaroni Potato salad, macaroni and cheeseand cheese

•• Corn on cob Corn on cob

ChitlinsChitlins, fried chicken, fried chicken

Pork chops (anything withPork chops (anything withfried pork)fried pork)

Pig ears, feet, chicken feetPig ears, feet, chicken feet

HogheadHoghead cheese cheese

Fat back, ham hocks, neck Fat back, ham hocks, neck bones bones

Fried catfish and whitingFried catfish and whiting

Definitions of Definitions of ““Soul FoodSoul Food””


•• Field and blackField and black--eyed peaseyed peas

•• BlackBlack--eyed peas and riceeyed peas and rice

•• Baked, snap, string, butter Baked, snap, string, butter and pinto beansand pinto beans

•• SweetpotatoSweetpotato piepie

•• Peach cobblerPeach cobbler

CornbreadCornbread

Buttermilk cornbreadButtermilk cornbread

Crackling cornbreadCrackling cornbread

Fried cornbreadFried cornbread

GritsGrits

Definitions of Definitions of ““Soul FoodSoul Food””


•• The usual The usual breakfast foods such as eggs, breakfast foods such as eggs, bacon, ham, cheese, hash brown, grits, bacon, ham, cheese, hash brown, grits, cereals and orange juice were reportedcereals and orange juice were reported

•• The breakfast cereals reported by The breakfast cereals reported by individuals and across groups and gender individuals and across groups and gender were the readywere the ready--toto--eat types such as eat types such as cornflakes and bran flakescornflakes and bran flakes

RESULTS RESULTS AND DISCUSSION AND DISCUSSION Lunch Lunch –– females 20females 20--35y35y

•• 60% 60% -- fast foods 2fast foods 2--3 3 times/weektimes/week

•• 10% 10% -- vegetables dailyvegetables daily

•• 20% 20% -- salads 2salads 2--5 times 5 times per week per week

Lunch Lunch –– males 20males 20--35y35y

•• Consumed mostly Consumed mostly pizzapizza

•• WingsWings

•• French friesFrench fries

•• Other fast foodsOther fast foods

RESULTS RESULTS AND DISCUSSION AND DISCUSSION Lunch Lunch –– females 36females 36--50y50y•• A variety of A variety of

sandwiches including sandwiches including hogshead cheese hogshead cheese

•• 67% consumed fast 67% consumed fast foods 2 times/weekfoods 2 times/week

Lunch Lunch –– males 36males 36--50y50y•• Less fast food Less fast food

consumptionconsumption

•• Sandwiches such as Sandwiches such as bologna, banana and bologna, banana and peanut butter/jellypeanut butter/jelly

•• 44% 44% -- consumed consumed chicken 4 times/weekchicken 4 times/week

RESULTS RESULTS AND DISCUSSION AND DISCUSSION Lunch Lunch –– females 66females 66--75y75y•• FruitsFruits

•• FishFish

•• VegetablesVegetables

•• Salads Salads

•• Sandwiches Sandwiches

Lunch Lunch –– males 66males 66--75y75y•• HamburgersHamburgers

•• Turkey sandwichesTurkey sandwiches

•• SaladsSalads

•• Baked chickenBaked chicken

•• Pork chopsPork chops

RESULTSRESULTS AND DISCUSSIONAND DISCUSSIONSome commonly eaten vegetablesSome commonly eaten vegetables

•• Beets Bell peppers Cucumbers Beets Bell peppers Cucumbers

•• Carrots Broccoli ZucchiniCarrots Broccoli Zucchini

•• Corn Brussels sprouts Cabbage Corn Brussels sprouts Cabbage

•• Rutabagas Cauliflower SpinachRutabagas Cauliflower Spinach

•• Squash TomatoesSquash Tomatoes

RESULTS RESULTS AND DISCUSSION AND DISCUSSION Some commonly eaten dinner foods Some commonly eaten dinner foods –– Meats & ProductsMeats & Products

•• Barbecue ribs Barbecue ribs BeefBeef•• Stew with potatoes Stew with potatoes GumboGumbo•• Camp stew Camp stew ChickenChicken•• Fish Fish Ham hocksHam hocks•• Hamburger Hamburger LambLamb•• Liver and gravy Liver and gravy MeatloafMeatloaf•• Neck bones Neck bones Oxtail Oxtail •• Pork Sausage Pork Sausage Pig Pig -- tail, feet, earstail, feet, ears•• Shrimp Shrimp Turkey Turkey


Most commonly used cooking methodsMost commonly used cooking methods•• Frying (stir and panFrying (stir and pan--fry) fry) •• BakingBaking•• Grilling Grilling •• Boiling Boiling •• Steaming or microwavingSteaming or microwaving


LowLow--fat behaviorsfat behaviors

•• 36% removed skin when cooking 36% removed skin when cooking chicken; 44% did not; others removed it chicken; 44% did not; others removed it sometimes or after cookingsometimes or after cooking

•• Roughly 50% trimmed fats when they Roughly 50% trimmed fats when they cooked meats and 23% did not cooked meats and 23% did not

RESULTS RESULTS AND DISCUSSION AND DISCUSSION Food Items Usually added to VegetablesFood Items Usually added to Vegetables

Cheese Cheese Oil Oil Bacon Bacon Butter Butter ShorteningShortening

Spices Spices –– cinnamon cinnamon Peppers Peppers –– black, bellblack, bellHerbs, celery, thymeHerbs, celery, thymeSeasonings Seasonings –– smoked smoked Seasoning saltSeasoning saltSalt Salt –– sea, Kosher light, sea, Kosher light, low sodiumlow sodiumOnions Onions Garlic Garlic

Salt pork Salt pork PigPig’’s feet s feet Ham hocks Ham hocks Meat Meat Fatback Fatback Neck bones Neck bones Turkey Turkey –– smoked, smoked, parts, neckparts, neck

Fats, Oils, Fats, Oils, OilOil--RelatedRelated

Spices and SeasoningsSpices and SeasoningsMeat, Poultry, Meat, Poultry, MeatMeat--RelatedRelated

RESULTS AND DISCUSSIONRESULTS AND DISCUSSION

•• Assessment of dietary practices to reduce Assessment of dietary practices to reduce cancer risk among Africancancer risk among African--Americans Americans requires culturallyrequires culturally--specific information, specific information, which is not typically found in existing which is not typically found in existing standard standard FFQs FFQs

RESULTS AND DISCUSSIONRESULTS AND DISCUSSION•• Pertinent findings revealedPertinent findings revealed

•• AfricanAfrican--AmericansAmericans’’ preference for traditional preference for traditional foods, which represents a large part of their foods, which represents a large part of their cultural heritagecultural heritage

•• ““Soul FoodSoul Food”” -- perceived as healthy and perceived as healthy and inexpensive, preference, obvious pride and inexpensive, preference, obvious pride and ownership for it ownership for it

•• ““Soul Food to me is not so much the food, but Soul Food to me is not so much the food, but how we prepare it, we Southern people prepare how we prepare it, we Southern people prepare our food with a lot of fatour food with a lot of fat””


•• Processed, salted foodsProcessed, salted foods•• risk factors for cancer risk factors for cancer

•• High fat dietsHigh fat diets•• increased cancer risk in humansincreased cancer risk in humans•• overweight and obesity overweight and obesity •• body fatness is a cause of endometrial, body fatness is a cause of endometrial,

postmenopausal breast, and colorectal cancerspostmenopausal breast, and colorectal cancers


•• Fast foodFast food--eating preferenceseating preferences•• Fast foods, if not used sparingly, are causes of Fast foods, if not used sparingly, are causes of

weight gain, overweight and obesity, which weight gain, overweight and obesity, which have been associated with some cancershave been associated with some cancers

RESULTS AND DISCUSSIONRESULTS AND DISCUSSION•• Pertinent findingsPertinent findings

•• provided relevant information for the provided relevant information for the modification of the FFQ (DHQ) for use in modification of the FFQ (DHQ) for use in AfricanAfrican--Americans in the rural southAmericans in the rural south

•• several traditional, cultural foods such as fried several traditional, cultural foods such as fried green tomatoes were added; others, which green tomatoes were added; others, which were not commonly consumed were deleted were not commonly consumed were deleted from the DHQ from the DHQ

RESULTS AND DISCUSSIONRESULTS AND DISCUSSIONNATIONAL INSTITUTES OF HEALTHNATIONAL INSTITUTES OF HEALTH

Diet History QuestionnaireDiet History Questionnaire

GENERAL INSTRUCTIONS

•Answer each question as best you can. Estimate if you are not sure. A guess is better than leaving a blank.

•Use only a black ball-point pen. Do not use a pencil or felt-tip pen. Do not fold, staple, or tear the pages.

•Put an X in the box next to your answer.

•If you make any changes, cross out the incorrect answer and put an X in the box next to the correct answer. Also draw a circle around the correct answer.

•If you mark NEVER, NO, or DON’T KNOW for a question, please follow any arrows or instructions that direct you to the next question.

BEFORE TURNING THE PAGE, PLEASE COMPLETE THE FOLLOWING QUESTIONS.

Department of Food and Nutritional Sciences, Department of Food and Nutritional Sciences, Tuskegee UniversityTuskegee University

Division of Preventive Medicine, University of Alabama Division of Preventive Medicine, University of Alabama at Birminghamat Birmingham

Diet History Questionnaire* Diet History Questionnaire* –– ModifiedModified

Diet History QuestionnaireDiet History Questionnaire

GENERAL INSTRUCTIONS

•Answer each question as best you can. Estimate if you are not sure. A guess is better than leaving a blank.

•Use only a black ball-point pen. Do not use a pencil or felt-tip pen. Do not fold, staple, or tear the pages.

•Put an X in the box next to your answer.

•If you make any changes, cross out the incorrect answer and put an X in the box next to the correct answer. Also draw a circle around the correct answer.

•If you mark NEVER, NO, or DON’T KNOW for a question, please follow any arrows or instructions that direct you to the next question.

BEFORE TURNING THE PAGE, PLEASE COMPLETE THE FOLLOWING QUESTIONS.

IMPLICATIONS AND NEXT STEPSIMPLICATIONS AND NEXT STEPS•• AfricanAfrican--Americans have unique dietary Americans have unique dietary

practices with strong cultural and historical practices with strong cultural and historical rootsroots

•• this should be taken into consideration when this should be taken into consideration when planning to modify or create nutritional planning to modify or create nutritional assessment tools for use in this populationassessment tools for use in this population

•• The findings also led to the development of a The findings also led to the development of a modified FFQ, which is being validated in modified FFQ, which is being validated in AfricanAfrican--Americans in the rural SouthAmericans in the rural South

ACKNOWLEDGEMENTSACKNOWLEDGEMENTS

•• NIH grant #U54 CA118948NIH grant #U54 CA118948

•• MSM/Tuskegee/UAB partnershipMSM/Tuskegee/UAB partnership

•• Dr. Tim Turner, TU Cancer CenterDr. Tim Turner, TU Cancer Center

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